Home haemodialysis was pioneered in the United States and United Kingdom in the early 1960s. By 1971, 58.8% of patients on dialysis in the UK and 32.2% in the US received dialysis at home, mostly overnight three times a week. In 2005, these figures were only 2.7% and 0.6%. The poor availability in the UK is in spite of recent guidance from the National Institute for Health and Clinical Excellence (NICE) recommending that “all suitable patients should be offered the choice between home haemodialysis or haemodialysis in a hospital/satellite unit.”1 Estimates of the proportion of people eligible for home haemodialysis range from about 5% to 20%. In 2006, it was reported that the44 units in the UK that offer home haemodialysis provided it to only 0.6-11.1% of patients; the remaining 21 units had no such programme.2 This variation is mirrored in the US—in 2004, 0.2-2.4% of patients on haemodialysis were dialysed at home in 32 states, and no patients were on home haemodialysis in 18 states.3

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