Need for increased home dialysis

Dr Claire Kennedy, Consultant Nephrologist, St James’s Hospital, Dublin, delivered a presentation at the Irish Nephrology Society Winter Meeting 2026 on ‘Home dialysis: From aspirational to operational’.

Dr Kennedy posited that more patients should be receiving home dialysis across Ireland than are at present.

She highlighted the fact that “home dialysis hasn’t really translated into a reality”, despite it being an opportune time to do so, with telemonitoring now in place to monitor patients remotely.

Data from the HSE National Renal Office (NRO), highlighted by Dr Kennedy, showed that while the absolute number of patients on home dialysis has increased in Ireland in recent years, the proportion has decreased and the growth in in-centre dialysis has been “much bigger”.

“We’re now at in or around 13 per cent nationally [2023 figure], which is well below the international target of 20 per cent and our own national target of 20 per cent,” she said. “That has been somewhat disappointing.”

In 2023, 294 patients nationally received home dialysis while 2,191 received in-centre haemodialysis, according to the NRO data. Regionally, there was between 7 and 14 per cent prevalence of patients on home dialysis in 2024.

“Patients we see nowadays are frailer, older, more obese, and… the goalposts keep changing,” Dr Kennedy told delegates.

“Patients with end-stage kidney disease [ESKD] are ever more complex and we’re all resource-constrained and it seems hard to reach our target.” 

But she stressed there are ways to help improve home dialysis rates, including outpatient education programmes, which have been shown to increase uptake.

Dr Kennedy added that an increasing number of people requiring dialysis care are homeless, which is unfortunately resulting in more fragmented care for these patients.

She noted that 17 per cent of patients with ESKD at St James’s Hospital, Dublin, are homeless, and said dedicated renal social workers are needed to manage these complex cases.