Position Statement of the Brazilian Society of Nephrology on Home Hemodialysis

Home hemodialysis (HHD) has been increasingly consolidated worldwide as an effective modality of kidney replacement therapy (KRT), associated with greater autonomy, flexibility, and quality of life for patients, in addition to allowing individualized prescriptions with more frequent and/or longer sessions. Despite evidence demonstrating survival rates equal to or superior to those of in-center hemodialysis, HHD remains underutilized globally, including in Brazil. Limiting factors include structural, logistical, financial, and cultural barriers, as well as the absence of specific national regulations. This document presents the position of the Brazilian Society of Nephrology (SBN) on HHD, establishing recommendations for patient eligibility, home and dialysis center selection criteria, responsibilities, and technical safety requirements. Two HHD models are described: the self-care modality, in which patients perform the treatment on their own after intensive and strict training, and the assisted modality, carried out with the continuous presence of a healthcare professional. The position emphasizes the need for an associated dialysis center, structured training, safety protocols, continuous monitoring, and emergency backup. Key aspects such as water quality, supply chain logistics, waste disposal, and environmental sustainability are considered essential. The SBN advocates that adherence to HHD should result from shared decision-making between patients, families, and the multidisciplinary team, formalized through an informed consent document. This position aims to support policies, adequate funding, and regulatory adjustments to enable the practice of HHD in Brazil, ensuring care quality, equity of access, and the safety of patients and professionals involved.