New York, NY (November 28, 2011) — While 382,000 patients in the U.S. receive dialysis treatment for kidney failure, only 35,000 dialyze at home. A special report in the December issue of the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation, suggests that as a result of systematic barriers, patients are not always receiving the option of home dialysis. This is despite the therapy's advantages in terms of convenience for patients and cost-effectiveness for the health system. According to the report, 75% of patients beginning in-center hemodialysis (HD) are unaware of the option to dialyze at home. Once informed, 40% of patients are interested in this treatment option, and yet less than 10% actually initiate home dialysis.
According to the National Kidney Foundation, 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.
"Home dialysis, which allows a patient to maintain a more normal lifestyle, is a very attractive option to many individuals facing the burden of incipient dialysis. However, many barriers prevent the patient from being offered this key choice," explained Beth Piraino, MD, of the University of Pittsburgh, one of the study's senior co-authors and President-elect of the National Kidney Foundation, "We intended to focus on these barriers, which can be overcome through the collective coordinated action of dialysis organizations, the nephrology team and the government, all striving to ensure that the patient is educated and afforded proper options and is at the center of this process."
The researchers categorized the barriers to home dialysis into three groups: inadequate education, faulty regulation and provider philosophy and practice.
Insufficient education, on the part of patients unaware of their options and nephrologists inadequately educated regarding home dialysis, is a barrier to the possibility of widespread home dialysis. In addition, dialysis staff is often insufficiently informed. Therefore, they are unable to provide both accurate information regarding the option of home dialysis, and appropriate care and sufficient support for patients undergoing home dialysis.
A number of government policies stymie the possibility of widespread home dialysis. "These regulations are generally systematic rather than fundamental to providing optimal medical care," Piraino noted, "They should be reappraised in order to reverse their adverse effects on the option of home dialysis."
Regulations that serve as barriers include:
- Patients on home dialysis are inconveniently required to visit the center more often than practically necessary;
- Patients unable to perform self-care are forced to choose in-center HD, despite the fact that the Canadian and European experiences indicate that home dialysis with home-assistance is more economically efficient for the medical system than providing the same patient with in-center HD;
- Certification of home-dialysis units is lengthy, often delayed, and involves multiple sets of regulations;
- The FDA's regulatory process is significantly more protracted than its European counterparts, and therefore many advances in home-dialysis technology which have been available in Europe for years are still not available to American potential home-dialysis patients.
Provider Philosophy and Practice
The policies and practices of dialysis providers make home dialysis less efficient and less attractive to patients. The researchers recommend that a focus on these policies and practices, which are often the result of inattention rather than specific design, can help remedy these issues and make home dialysis more of an option to patients.
Practices that serve as barriers to home dialysis include:
- Exclusivity contracts and financial considerations that compel some providers to enact restrictive policies on medication and machinery for home dialysis;
- Delayed, infrequent delivery of supplies to home dialysis programs;
- Subpar services in terms of responsiveness and data processing to home dialysis patients on the part of dialysis-provider affiliated laboratory services who favor in-center HD;
- Lack of access to prompt treatment of peritonitis for peritoneal dialysis patients since currently home dialysis programs are not allowed to stock these medications.
"We believe that identifying these issues is an important first step to remedying these systematic barriers," said Joseph Vassalotti, MD, National Kidney Foundation Chief Medical Officer "and look forward to collaboratively addressing these issues through education and policy changes with the ultimate goal of enabling every patient to choose the treatment that is right for him."
For more information on home dialysis and kidney disease, visit the National Kidney Foundation at www.kidney.org