Tearing down the barriers to daily home hemodialysis and achieving the highest value renal therapy through holistic product design.

Renal therapy value can be defined as the ratio of outcomes achieved by a dialytic therapy to the total cost of providing that therapy. One desirable goal of any dialysis modality would be the achievement of maximum value. Unfortunately, with conventional hemodialysis and peritoneal dialysis modalities, improving outcomes has always been linked to a simultaneous increase in costs, thereby leaving value relatively unchanged. However, a new modality, daily home hemodialysis, finally may allow this linkage to be broken. The outcomes are dramatically improved as a result of a higher quantity and quality of dialysis dose resulting from the greater frequency of treatments. The costs can be reduced by minimizing the consumed items, avoiding the labor and overhead of dialysis clinics, and reducing the costs associated with morbidity. Provision of this therapy is, however, predicated on the availability of instrumentation designed specifically for it because conventional equipment designed for in-center use is not suitable. By starting with a clean sheet of paper and incorporating such features as insitu reuse of the entire extracorporeal circuit, remote telemonitoring, automated system disinfection, and integrated water purification, most of the impediments to performing this modality can be overcome.