The patients must puncture the arteriovenous fistula by self-cannulation in home hemodialysis in Japan. At our clinic, we have been taught the buttonhole cannulation technique using blunt needle as the first selected cannulation method to the patient who will be treated with home hemodialysis in training phase. We have been thought that arteriovenous fistula-related infection using buttonhole cannulation could be prevented by removing the scab at the puncture site and thoroughly sterile operation. The survey of arteriovenous fistula-related infection rates of home hemodialysis patients in our clinic revealed that it was higher than those of rope ladder cannulation or buttonhole cannulation in in-center hemodialysis patients. From the results, we reconsidered the application of buttonhole cannulation to home hemodialysis patients. Buttonhole cannulation technique is still an advantageous method for self-cannulation for home hemodialysis, but we believe that restrictions and conditions are necessary for its application to avoid the arteriovenous fistula-related infection.

Communication between patients and healthcare providers is crucial in medical care, involving transmitting information about the patient's symptoms and treatment and decision-making. The relationship between healthcare providers and patients is evolving, transitioning from a physician-centered paternalism approach to patients-centered shared decision-making that emphasizes patients' values. In dialysis therapy, the relationship between patients and healthcare providers is unique and long-term, and good communication is believed to be related to the patients' quality of lives. In dialysis therapy, efforts are made to focus on patients' chief complaints and symptoms and adopt treatment methods that reflect patients' preferences. Additionally, patient input is now being incorporated into developing clinical practice guidelines. Dialysis therapy is a form of chronic care, and maintaining patients' motivation for treatment can be challenging. Considering such unique aspects, communication skills are crucial for maintaining a good relationship between healthcare providers and patients.

In hemodialysis, which is an intermittent treatment, treatment time affects various aspects. A large-scale prospective interventional trial conducted in the United States in the 1970s did not show a significant prognostic factor for the length of treatment, thus justifying the policy of increasing clearance and shortening treatment time. However, some uremic toxins have great resistance to move between compartments in the body, and they cannot be removed sufficiently without taking a long treatment time. Phosphorus and middle molecules fall into this category. A longer treatment time is also advantageous for avoiding the risk of dialysis hypotension and normalizing the extracellular fluid volume and is associated with a better prognosis. Even if the same dose of Kt/V is achieved, it is important to increase the time (t) to achieve it. However, in a survey of dialysis patients' requests and priorities for treatment, there were an unexpectedly high number of requests for "shorter dialysis time". Hemodialysis is a "complete obligation" for dialysis patients, whereas hemodialysis itself is an "imperfect treatment". It is similar to seeking a goal without a correct answer, and the process of discussion itself with patient could be the goal.

In the case of home hemodialysis, it is known that a patient pathophysiology, quality of life, and cost effectiveness, etc. improve compared to that of conventional HD (3 times/4 hours per a week) based on evidence of medicine and analysis of social science. In this article, opinion of the author who has received benefits of renal replacement therapy is described from a point of view of long survival patient and a researcher about home artificial organ's therapy.

Long intermittent hemodialysis can be expected to maintain a good nutritional status by providing a high degree of freedom in dietary habits, stabilizing appetite and securing food intake. Dietary guidelines are intended for standard dialysis patients and not for long intermittent hemodialysis. Also, there is no report on its proper nutrient intake. Energy and other nutritional requirements, including salt management, must be considered through an individual nutritional assessment. On the other hand, a high degree of freedom in dietary habits means that people can eat without worrying about the intake of potassium and phosphorus, which are generally restricted, but this is not a complete free diet. Even in long intermittent hemodialysis, salt management is important for body fluid volume (body weight) management. In order to make the most of the benefits of long intermittent hemodialysis, the basic dietary guidance is to "eat well and reduce salt intake". To that end, it is necessary to practice not only the expression "eat well," but also specific salt management guidance according to diversifying lifestyles.

We believe that if TCC becomes an option for vascular access (VA) in HHD, the number of HHD patients can be expected to increase. We have been examining problems and solutions for popularizing HHD.

So far, we have made the patient selection criteria transparent, created a TCC management manual, and started sharing it with medical facilities and with medical staff and patients. We propose a TCC as an option from the time of HHD introduction. We have experience with several patients who have selected TCC as VA and started HHD, and we feel its usefulness.

A major problem with TCC is the possibility of infection. This time, we evaluated the infection status of TCC-HHD cases in our clinic and implemented infection control measures. We believe that TCCHHD can be safely performed by devising and making efforts to prevent infection, and by taking appropriate measures at an early stage in the event of infection.

We examined whether a machine learning-based analysis of home hemodialysis (HHD) problems contributes to improving the efficiency of operations and the quality of responses. We analyzed 424 problems that could be handled by telephone during the period from November 2011 to July 2022. Regarding the machine learning environment, we used Windows as the as the operating system (OS), with Python 3.7.12 on Google Colaboratory. The features used were personal identification numbers (IDs), the occurrence of an alarm, the situation when a problem occurs, and the dialyzer mode at the onset of a problem. The decision coefficient was classified in binary terms, based on whether the problem was caused by a human error, such as an error when connecting to the blood circuit, or other problems, choosing from a total of 24 patterns of problems. The results were showed an accuracy of 0.9124, a recall of 0.9191, a precision of 0.9255, an F1 score of 0.9195, and an area under the curve (AUC) of 0.9639. This time, we constructed a model that classifies problems into those caused by human errors and those caused by other factors, based on the situation when a problem occurs, etc. The test data demonstrated that we were able to construct a highly accurate model with an overall accuracy of 0.9449. It is effective to use machine learning for HHD management.

A questionnaire survey was conducted to investigate the support status for caregivers at 67 HHD facilities nationwide and the current status of nursing care for 298 caregivers.

HHD facilities opportunities to hear caregivers' voices decreased after the introduction of HHD. There were few facilities that provided a place for caregivers to interact with each other or provided opportunities for regular facility dialysis to allow rest periods for the caregivers. HHD caregivers frequently assisted in situations other than treatment, such as garbage disposal and regular maintenance. The HHD caregivers were most often the spouses of the patients, and many of them were women. The caregivers feel rewarded by the results of treatment for their patients, but they also feel the emotional burden and a sense of responsibility for the treatment. The caregiver's desired support includes receiving information and psychological support from the dialysis facility, opportunities for interaction with other patients and caregivers, and providing temporary facility dialysis for allowing rest periods for the caregiver.