Entering A New Era of Flexible Dialysis Care, With Christopher Chan, MD

The delivery of dialysis care is undergoing a meaningful shift, driven by evolving patient expectations and a growing emphasis on quality of life.

In the United States, an estimated 35.5 million people have kidney disease, approximately 555,000 of whom are on dialysis. For decades, in-center hemodialysis has been the dominant model, requiring patients to commit multiple days each week to lengthy treatment sessions. However, attention is increasingly turning back to home-based approaches that offer greater flexibility and the potential for improved clinical outcomes.

According to Christopher Chan, MD, director of the division of nephrology, professor of medicine, and R Fraser Elliott Chair in Nephrology at Toronto General Hospital, University Health Network, this shift reflects a broader rethinking of what dialysis should achieve. Beyond simply sustaining life, patients are seeking the ability to work, travel, maintain relationships, and live as normally as possible.

“A significant amount of what patients want is a normal life,” he explained in an interview with HCPLive. “[We] want the ability to work, the ability to have a family, the ability to travel, the ability to have a normal diet, and I think that really comes down to how we perform dialysis. The more dose that we're able to deliver to our patients, the more autonomy and flexibility that our patients have.”

Greater treatment intensity, he notes, is associated with improved cardiovascular health, better blood pressure control, and reduced reliance on medications.

Home dialysis encompasses 2 primary modalities: peritoneal dialysis and home hemodialysis. Both approaches, Chan says, have been linked to improved quality of life, with home hemodialysis offering additional benefits when delivered more intensively. These include enhanced fluid and phosphate control, fewer dietary restrictions, and a reduced need for medications such as phosphate binders. He also points to trends toward lower hospitalization rates and improved survival, as well as meaningful gains in areas such as reproductive health.

Chan also emphasizes that the profile of patients eligible for home dialysis is expanding. Historically limited to younger, highly independent individuals, he says home-based care is now being offered more broadly, including through assisted dialysis programs. He highlights growing experience with older patients successfully initiating home therapy, reflecting a shift toward a “home-first” mindset.

“The most recent patient that we have now enrolled in our home assisted hemodialysis program in Toronto is 92, so we're challenging that modality in terms of what would be an appropriate inclusion criteria,” Chan explained. “We're flipping that to say we will try you at our home hemodialysis or home peritoneal dialysis training unit… so we're thinking about more of a home-first paradigm.”

Despite this progress, significant barriers remain. Chan underscores the need for alignment among policymakers, healthcare providers, and industry partners to support wider adoption. Policy changes in several countries are already driving momentum, with initiatives aimed at increasing home dialysis utilization through targeted incentives and infrastructure development.

Looking ahead, he envisions a more integrated and individualized approach to dialysis care. Rather than a one-size-fits-all model, patients may move between home-based and in-center therapies depending on their needs over time.

“I think we need to provide all the different forms of modalities, to actually integrate all of it. In fact, I think an integrated home dialysis solution with in center hemodialysis backup is probably a much more preferred option,” he said.

Editors’ note: Chan reports no relevant disclosures.

References

1. American Kidney Fund. Quick kidney disease facts and stats. Accessed April 1, 2026. https://www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats

2. Ferreira AC, Mateus A. Home dialysis: advantages and limitations. Clin Kidney J. July 3, 2024. doi:10.1093/ckj/sfae180