Unlike nephrologists in the United States, ANZ nephrology trainees are required to be trained in and aware of home-dialysis practices. “How can you expect to grow a healthy home program when your U.S. nephrologists remain blissfully unaware of its benefits or its possibilities?” Dr. Agar asks.

Medicolegal issues can bias decision-making, Dr. Agar acknowledges. However, “It is our view and experience that no one cares better for the patient than the patient. Things will, from time to time, go wrong at home; the patient understands this by going home at all. But, again, in our experience, a well-trained home patient makes fewer mistakes and has less go wrong, than do their counterparts in centers.

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“So, we do not fear medicolegality. We do not monitor home patients. We train well, we support strongly, we sustain help-lines, and we put trust and faith in our patients. They, in turn, reward us through dialysis well done, with rehabilitation to family and work, with lives better lived than their counterparts in-center.”

Dr. Agar sees signs that the viability of more frequent and longer administration of dialysis is infiltrating the U.S. dialysis psyche. “More hours of dialysis per week just can’t be managed in your centers—at least not as they are currently structured,” he insists. “This will force a slow but steady imperative to rethink and redesign programs. At least, that is my belief. And, for the outcomes for your U.S. dialysis patients … those changes can’t come fast enough.”