Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes

End-stage renal disease (ESRD) is a common and costly health care problem affecting all age groups.

Although the absolute number of patients treated with dialysis in The Netherlands is low (6500 dialysis patients in 2016), it is by far the largest cost-consumer of all treatment modalities in general.

Most dialysis patients are treated 3 times a week during 4 hours with haemodialysis at a dialysis centre (conventional in-centre HD). However, dialysis can also be performed at home, in the form of peritoneal dialysis (PD) or home HD. Dialysis treatment at home is considered to be at least equally effective regarding survival. However, the percentage of patients treated with a form of home dialysis (either PD or home HD) has steadily decreased over the past 15 years in The Netherlands, from 33% in 2002 to 18% in 2016 (www.nefrodata.nl). This decline is mainly attributable to a reduction in the number of PD patients, due to pre-emptive transplantation.



Starting dialysis has major impact on QoL of patients. However, recent available evidence regarding the effects of home dialysis on QoL compared with in-centre HD is limited and outdated. The studies are small and all have a cross-sectional design. Furthermore, patients starting with a form of home dialysis have changed remarkably over the past years: home dialysis patients used to be young, employed and with little comorbidities, whereas during the last years the general home dialysis population is older and suffers from cardiovascular disease. Therefore, an update of older data on clinical outcomes of home dialysis in relation to in-centre HD is necessary.

Home dialysis results in improvement of quality of life, at least comparable clinical outcomes and lower costs, compared to
in-centre HD.

baseline, 3 months, 6 months, and every 6 months thereafter until end of follow-up or end of study.

Home dialysis, both peritoneal dialysis and home haemodialysis