Home dialysis-leveraging the past to define the future of sustainable renal care: A narrative review

Background and Objectives: Home dialysis has re-emerged as a key modality in the management of end-stage kidney disease (ESKD), offering improved patient autonomy, quality of life, and potential system-level sustainability. Yet, its roots extend deep into the early history of renal replacement therapy (RRT), when home-based care was the norm rather than the exception. By leveraging the lessons of the past patient empowerment, training models, and community-based care we may define a sustainable and person-centered future for kidney replacement therapy. To review historical evolution of home dialysis, assess current innovations and barriers, and propose a structured framework for its future implementation. Methods: Narrative review of literature (1960-2025) including registry data, policy reports, and studies on technological innovation and implementation. Results: Home dialysis was widely used in early renal replacement therapy but declined due to structural and policy-related factors. Current uptake remains low in many regions, particularly in Europe, despite evidence of cost-effectiveness and improved outcomes. Technological advances and telehealth have enhanced feasibility, but barriers persist. Conclusion: A four-pillar framework - education, policy alignment, technological innovation, and integrated support systems - provides a practical pathway to expand home dialysis and support sustainable, patient-centered renal care.