There are major practical barriers to home dialysis that originate at an institutional or government level, including reimbursement, challenges related to COVID-19, and more.
Two specific examples include vascular or peritoneal catheter placement and payment disparity (between in-center and home dialysis modalities), which are largely institutional or governmental in origin.1 Limited access to the procedures to place the catheters needed to enable PD has long been a challenge in many countries.