Simon Davies, MD, is  a consultant nephrologist at the University Hospital of North Midlands and Professor of Nephrology and Dialysis Medicine, as well as director of the Institute for Applied Clinical Sciences at Keele University.

Simon Davies, MD

Expanding Dialysis Access: Policy, Variation, and the Role of Peritoneal Dialysis

The issue of global access to home dialysis is a multilayered problem requiring a multifaceted solution, including policy changes, reimbursement systems, and technological innovation, according to experts from the International Home Dialysis Consortium (IHDC).

HCPLive sat down with Simon Davies, MD, a consultant nephrologist at the University Hospital of North Midlands and professor of nephrology and dialysis medicine, as well as director of the Institute for Applied Clinical Sciences at Keele University, who presented the discussion at the World Congress of Nephrology (WCN) in Yokohama, Japan.

Significant variation in dialysis modality use persists across regions, despite ongoing efforts to expand home-based care options. As healthcare systems continue to explore ways to expand dialysis access, questions remain about how best to increase uptake of home-based modalities such as peritoneal dialysis (PD) and home hemodialysis (HHD).

On the policy front, Davies discusses the implementation of a PD-first policy, where patients are initiated on peritoneal dialysis before transitioning to other modalities. This approach has been used as a tool for healthcare expansion, and has been particularly successful in Hong Kong, which has the highest rates of home dialysis.

The greatest risk with this approach is public perception, Davies explains, where PD use among previously disadvantaged populations can lead to perceptions that it is a lower-quality therapy, particularly when wealthier patients receive in-center hemodialysis. This is primarily a social conundrum, as outcomes data show similar results between modalities. Still, patients strongly value having choice in dialysis modality.

To mitigate this, a more flexible PD-preferred approach may be used, where the system encourages PD but does not require it as a first option. Davies gives an example of where this has worked in Mexico, which preserves patient choice while supporting, rather than mandating, home dialysis.

“Most countries are reluctant to go down those sorts of routes. They would rather maintain the free choices available for dialysis,” explained Davies. “By and large, that’s what I would say is the best approach that we should be going for, supporting people to do home dialysis when they want to do it.”

Locating The Real Problem In Rural Communities

 where Davies discussed the global gaps in at-home dialysis, including system-level barriers, provider biases, and policy misalignment.

Brown EA, Jha V, Bavanandan S, et al. International Home Dialysis Consortium: Declaration Advocating for the Promotion of Home Dialysis Globally. 

https://doi.org/10.1016/j.ekir.2025.03.012

Hillenbrand A. HCPLive. Published 2026. Accessed April 10, 2026. https://www.hcplive.com/view/gaps-in-home-dialysis-access-persist-globally-with-simon-davies-md

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Davies explains the future of at-home dialysis access, including policy changes and technological innovation. 

Gaps in Home Dialysis Access Persist Globally, With Simon Davies, MD

The global gaps in access and adoption of home dialysis persist despite previously established clinical and quality-of-life benefits. 

The International Home Dialysis Consortium (IHDC) has worked to identify how system-level barriers, provider biases, and policy misalignment continue to limit home dialysis implementation across the world.

At the World Congress of Nephrology (WCN) in Yokohama, Japan, Simon Davies, MD, a consultant nephrologist at the University Hospital of North Midlands and Professor of Nephrology and Dialysis Medicine, as well as director of the Institute for Applied Clinical Sciences at Keele University, presented findings from IHDC and discussed them in an interview with HCPLive.

Home dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), has long been associated with improved quality of life, greater patient autonomy, and lower overall healthcare costs compared with in-center hemodialysis. Despite these advantages, its use remains highly variable across regions and is often limited by disparities in access, education, infrastructure, and policy. In many settings, particularly in low- and middle-income countries, home dialysis remains underutilized or unavailable, while even high-income countries continue to demonstrate inconsistent adoption across centers.

“I often use the analogy of an onion—you peel away layers of barriers, and even as you get deeper, there are still barriers tied to underlying biases and conditions. These can include a lack of education or understanding of how to deliver the therapy, leading to an understandable reluctance to use it,” explained Davies. “Even when those barriers are removed—for example, in the UK, where financial barriers are not a factor, and everyone should be trained in PD—there is still considerable variation between dialysis centers. That variation seems to reflect differences in belief in the therapy and the culture around ensuring patients are informed about and able to engage with all available options.”

Davies emphasized that these gaps are not solely driven by patient-level factors, but are deeply rooted in how health systems are structured. Differences in reimbursement models, provider incentives, and institutional priorities can all influence whether home dialysis is presented as a viable option to patients.

“I think the really big barriers are how health systems are set up. Wherever somebody makes more money from one therapy rather than another, it’s not a level playing field—and that varies quite a lot from country to country,” Davies said. “If it’s not a level playing field financially for providers, then it’s very hard to make the case for home dialysis.”

Beyond financial considerations, he noted that clinician comfort and perception continue to shape modality selection. Persistent biases and limited familiarity with home-based therapies may lead providers to default to in-center options, even when home dialysis could be appropriate.

“There are still biases present which need to be addressed, and people will use any excuse not to do it if they’re not comfortable with the therapy or think it’s not the right thing for their patients,” Davies added.

The IHDC, a relatively new global initiative, aims to address these multifaceted barriers through collaboration across clinicians, policymakers, and industry stakeholders. By creating a shared framework and offering practical resources, the consortium seeks to support regions working to expand access to home dialysis.

“If you can change policy by creating an environment that encourages the use of home dialysis, there are various levers you can bring in—usually financial—that can make that happen,” Davies said. “Having a group with shared experience and expertise makes it much easier to have those conversations with policymakers.”

Through these efforts, IHDC aims to reduce global disparities in dialysis care and promote more equitable access to home-based treatment options.

Palmer SC, Palmer AR, Craig JC, et al. Home versus in-centre haemodialysis for end-stage kidney disease. 

. Published online November 20, 2014. doi:

https://doi.org/10.1002/14651858.cd009535.pub2

Davies breaks down the gaps to at-home dialysis access and the future of global collaboration. 

Simon Davies, MD

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