Table 1.

Logistic considerations regarding home dialysis treatments, and potential interferences in times of crisis

	Advantages	Limits	Potential interference in case of epidemic
Home-based treatment	Makes it possible to limit exposure to the hospital setting	Isolation. Acute intradialytic problems can be challenging	Less exposure to the hospital milieu; links should be reinforced using telemedicine
Remote counseling	A good way to avoid isolation; should integrate direct follow-up	Fragile and elderly patients may not be able to clearly explain their problems	May need to be increased during epidemics to avoid isolation. An “urgent pathway” has to be ensured
Flexibility—empowerment	Patient empowerment is associated with better survival and better quality of life	Patient-designed dialysis may differ from prescriptions. This can be dangerous	Remote counseling should be reinforced, to avoid the introduction of subtle but important changes to prescriptions
Biochemical controls at home	Practical, reduces the need for going to a laboratory or hospital	Standard pre- and post- dialysis controls may be difficult to organize	Care needs to be taken so that the frequency of controls is not reduced (except in acute epidemic phases)
Family involvement	Can provide important psychological support	The burden may be heavy and create tension	Psychological aid could be needed, and would need to be reinforced in moments of crisis
Residual kidney function	May be better preserved in tailored dialysis programs	Monitoring may be difficult to carry out, and slow loss of kidney function could go unnoticed	Particular attention needs to be paid if only remote monitoring is employed
Assisted home dialysis	Allows limiting exposure to the hospital setting and eliminates travel time	May fail to guarantee privacy. The advantage of empowerment is usually lost	Aids are exposed to contagion and become potential carriers
Reduction of travel time—lower carbon footprint	The ecologic advantages are debated, but are likely to be relevant especially if patients live far from the dialysis units	In some settings, the costs for the patients may be high. Waste management needs to be organized in advance	Limiting need to travel is an advantage in case of lockdown
Other	The clinical results of home dialysis are usually at least competitive with hospital-based therapy	Home dialysis may be time consuming for the health care team, in particular if a personalized schedule is chosen	Delivering supplies may prove difficult to organize during lockdown; technical aid may be delayed. Home dialysis has to be a clear priority for technical aid and delivery of disposables