Abstract
<jats:p>Conventional thrice-weekly hemodialysis, although lifesaving, is associated with high morbidity, mortality, and significant impairment in quality of life. Recent studies have demonstrated that longer and more frequent dialysis sessions improve solute clearance, stabilize volume control and reduce cardiovascular risk; however, evidence for survival benefits is largely derived from observational studies. The most suitable environment for implementing such intensive regimens is home hemodialysis, which offers patients flexibility, autonomy, and improved adherence. Historically, home hemodialysis was widely practiced during the 1960s–1980s, later declined due to technological and policy changes, but has regained attention since the 2010s with portable devices and evidence of clinical benefits. Current prevalence of home hemodialysis varies across countries, with the highest rates reported in Australia and New Zealand. In addition, new programs have recently been initiated in developing countries, reflecting a growing global interest in this modality. There are no randomized controlled trials specifically designed to evaluate mortality outcomes in patients undergoing home hemodialysis. The available evidence is derived primarily from observational studies, which generally suggest an association with improved survival, cardiovascular outcomes, and enhanced quality of life compared with conventional in-center hemodialysis. Risks include vascular access complications, accelerated loss of residual kidney function, and patient or caregiver burnout. Nevertheless, safety data suggest that major complications are rare. Home hemodialysis appears to be a clinically effective, generally safe, and economically favorable treatment option. Its broader global adoption will likely depend on coordinated efforts among healthcare authorities, policymakers, and patients to ensure long-term implementation and equitable accessibility.</jats:p>