By Dr. Leslie Spry, Nephrologist and NKF Spokesperson
More than 430,000 people in the U.S. are receiving dialysis treatment for kidney failure. Surprisingly, less than 40,000 of those patients do their dialysis at home (through nocturnal, peritoneal dialysis or home hemodialysis) and only about 6,000 patients receive home hemodialysis. But home dialysis is the fastest growing segment of the dialysis population, if looked at on a percentage basis. Growing evidence has suggested better outcomes for patients on home hemodialysis therapy, including improved mortality and heart disease rates, better quality of life and improved blood pressure control. Recent evidence has suggested home hemodialysis may have a life expectancy equal to deceased donor kidney transplantation.
Why then is home hemodialysis not more popular with nephrologists and patients? In a survey sent to nephrologists and nurses, a clear majority would select home dialysis therapy and pre-emptive kidney transplantation if they required kidney replacement treatment themselves. This is a potential opportunity to increase the availability of home hemodialysis for End Stage Renal Disease (ESRD) patients in the United States today and is worth exploring further.
In order to assess why home hemodialysis is not more widespread, we must take a look at the barriers that exist to increasing home hemodialysis in United States today. According to research published in the National Kidney Foundation’s American Journal of Kidney Diseases, patients do not always receive the option of home dialysis, despite the fact that research has shown that people using short daily and nocturnal home hemodialysis live longer, experience a better quality of life, have fewer and shorter hospital stays and feel better both during and after dialysis. In addition, home dialysis—both peritoneal dialysis or home hemodialysis—allows patients more flexibility in terms of schedule, more control over their health and treatment, and the convenience of exchanging multiple visits weekly for a monthly checkup to the center.
Unfortunately, many training centers for nephrology professionals do not offer home dialysis programs. The academic community has been very slow to embrace home dialysis therapy. Large dialysis providers have invested time and resources to offer home therapy, but until patients demand this care, the dialysis community will not invest further money and effort into home dialysis. Home dialysis requires patient education prior to starting and after initiating dialysis. Providers that offer such education receive minimal payment and start up efforts have generally not been sustained. Additionally, not every small dialysis unit can afford to start and sustain the effort to maintain a home dialysis program. Taking a look at the history of peritoneal dialysis, we have seen that small units with limited numbers of patients often fail.
There’s some good news, though, Medicare has recently approved a 50% increase in payments for home dialysis training that began January 1, 2014. This is an improvement because previously training didn’t even come close to compensating for the number of nursing hours and other staff time it takes to train a patient for home dialysis. Additionally, the first annual National Home Hemodialysis Day is today and is planned as an event to highlight home hemodialysis.
Learn more about home dialysis therapy by visiting the National Kidney Foundation website.