Population-level barriers to home hemodialysis implementation: a public health systems analysis of adoption readiness, health equity, and policy implications in China

A quarter of Chinese dialysis patients are interested in HHD, revealing significant latent demand. Adoption can be boosted by addressing key facilitators such as provider education, patient knowledge, vascular access, and cannulation anxiety. Since HHD-ready patients have better outcomes and lower healthcare costs, targeted expansion offers an evidence-based strategy to improve health equity, reduce the burden on the health system, and strengthen financial protection for vulnerable populations.