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Dialysis at home comes with a hidden cost. A large study found that patients on home hemodialysis face significantly higher rates of vascular access-related infections — including bloodstream infections, endocarditis, and spinal abscesses — compared to those treated in clinical settings, with the risk especially pronounced among arteriovenous fistula users.
Home hemodialysis has grown in popularity across the U.S., offering patients more flexibility and quality-of-life benefits. But a new study published in the Journal of the American Society of Nephrology reveals a significant trade-off: patients dialyzing at home face meaningfully higher rates of vascular access-related infections compared to those treated in clinical centers.
Researchers analyzed data from over 900,000 Medicare patients between 2016 and 2020, comparing infection outcomes across dialysis settings and vascular access types. Across the board, home hemodialysis patients had higher rates of bloodstream/sepsis infections, endocarditis, spinal abscesses, and septic arthritis — regardless of whether they used an arteriovenous fistula, central venous catheter, or arteriovenous graft.
By the Numbers:
Why it matters: The findings don't argue against home hemodialysis — they argue for smarter safeguards. Researchers point to self-cannulation technique, reduced healthcare contact, and training quality as likely contributors. The next step, they say, is identifying when and why infections occur at home so that targeted prevention strategies can be developed to keep patients safe while preserving the benefits of home-based care.
