Factors influencing home dialysis choice in Scandinavia: a cross-sectional study.

BACKGROUND

Home dialysis provides several advantages over in-center hemodialysis, yet its uptake remains limited. Understanding how patients and kidney professionals perceive home dialysis is key to improving access and support. The aim of this study was to identify factors influencing the choice of home dialysis and to examine potential differences in perceptions between patients with kidney failure and kidney professionals across countries.

METHODS

A cross-sectional study using mixed-methods explanatory sequential design was conducted. A digital survey, developed through eight workshops (2021–2023) with patients and kidney professionals, included both closed- and open-ended questions. The survey was distributed to patients with kidney failure and kidney professionals in Scandinavia. Quantitative data were analyzed using logistic regression adjusted for gender, age, and country, while qualitative responses underwent content analysis.

RESULTS

The survey received responses from 269 patients and 185 professionals. Patients were predominantly male (57.3%, mean age 61.3), while professionals were mainly female (85.6%, mean age 49.4). Prior patient experience included PD in 179 (35.8%) and HHD in 66 (13.2%). Independence was identified as the top reason for choosing home dialysis, though many found the decision challenging. Patients cited barriers such as unclear reimbursement (OR = 0.29), limited technology (OR = 0.44), and poor communication tools (OR = 0.18). Professionals highlighted patient reluctance (OR = 7.29), relative involvement (OR = 7.54), social isolation (OR = 7.18), and unsuitable home environments (OR = 3.64). Qualitative responses highlighted the complexity of modality choice and illustrated differing perspectives between patients and professionals.

CONCLUSIONS

Patients and professionals perceive distinct barriers to home dialysis. Tailored interventions addressing these differences are essential to improve the uptake of home dialysis in Scandinavia. TRIAL REGISTRATION: NA.