NKF and Advocates Champion Home Dialysis Bill

New legislation could help improve the lives of kidney patients nationwide

Sept. 29, 2021, New York, NY — Today, new bipartisan legislation that seeks to make home dialysis more accessible and affordable to kidney patients was introduced in the House of Representatives by Bobby L. Rush (D-IL) and Jason Smith (R-MO).  The National Kidney Foundation (NKF) and its patient advocates have been working closely with champions in Congress to move this critical new legislation forward. 

The Improving Access to Home Dialysis Act will allow Medicare to pay professional staff to work with kidney patients directly in their homes to assist them in learning how to properly do home dialysis and become independent on this dialysis modality. Home dialysis, which includes peritoneal and home hemodialysis, is under-utilized in the United States, especially among historically disadvantaged groups. Only 12% of dialyzers in the U.S. use home dialysis, lagging behind Hong Kong (82%), the Jalisco region of Mexico (51%), and New Zealand (30%) among others. Additionally, a 2016 study found that compared to white Americans, Black or African Americans were 60% less likely to be treated with home hemodialysis and 47% less likely to be treated with peritoneal dialysis. This new legislation seeks to change these statistics.

“Home dialysis allows patients to decide when, how often, and for how long they dialyze.  This not only gives them more time and energy to go to work and spend time with family, but also helps reduce patients’ risk of infection, hospitalization, and depression,” said Kevin Longino, CEO, National Kidney Foundation and a kidney transplant patient. “By providing patients with the support and training they need, this legislation will lead to better patient health outcomes, improved quality of life, and reduced risk for exposure to COVID-19. We sincerely thank the bipartisan Members of Congress who stood up for kidney patients and introduced this important legislation.” 

Specifically, the new bill:

1. Provides for reimbursement through Medicare for in-home assistance by staff of the dialysis facility to patients on home hemodialysis and peritoneal dialysis for the first 90 days of their regimen;
2. Provides for in-home respite staff assistance under certain circumstances outside the initial 90 days;
3. Provides for the possibility of continuous staff assistance without a time limit for patients with certain disabilities;
4. Expands the types of healthcare professionals who can provide home dialysis training;
5. Provides for additional educational opportunities for patients to learn about the entirety of their dialysis options, including opportunities that can be provided in group settings or via telehealth;
6. Provides for training on home dialysis to occur, when possible, in the location the patient intends to use to dialyze.

“Home dialysis provides far more flexibility for patients than in-center dialysis and can lead to better health outcomes and quality of life. Therefore, it is no surprise that many kidney patients prefer home dialysis when given the option. The Improving Access to Home Dialysis Act will expand access to home dialysis by providing Medicare reimbursement for staff assistance for home dialysis treatment, and importantly, it will ensure that kidney patients are given all the information about the full range of treatment options available to them early on in their treatment process. This legislation will also track racial disparities in the utilization of home dialysis, which is especially important given concerning data showing that Black Americans are less likely to be treated with home dialysis than their white counterparts. As a longtime champion for kidney patients in Congress, I am proud to introduce this bipartisan legislation today and grateful for the support of the kidney community and my colleague Rep. Smith.”

The National Kidney Foundation has long championed making home dialysis more accessible to all kidney patients. In 2018, NKF launched a “Home Dialysis Quality Initiative,” a major, multi-disciplinary effort with clinicians, researchers, policy makers, patients, care partners, and industry representatives to remove barriers to home dialysis so more patients will treat kidney failure at home rather than in a center. In 2021, NKF released a commentary on the 2020 International Society for Peritoneal Dialysis (ISPD) which supports a holistic and patient-centered approach to care and assessment of the quality of dialysis delivered.

Kidney Disease Facts

In the United States, 37 million adults are estimated to have chronic kidney disease (CKD)—and approximately 90 percent don’t know they have it.  1 in 3 adults in the U.S. is at risk for chronic kidney disease.  Risk factors for kidney disease include: diabetes, high blood pressure, heart disease, obesity, and family history. People who are Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander are at increased risk for developing the disease. Black or African American people are almost 4 times more likely than Whites to have kidney failure. Hispanic or Latino people are 1.3 times more likely than non-Hispanic or non-Latino people to have kidney failure.

Approximately 785,000 Americans have irreversible kidney failure and need dialysis or a kidney transplant to survive. More than 555,000 of these patients receive dialysis to replace kidney function and 230,000 live with a transplant. Nearly 100,000 Americans are on the waitlist for a kidney transplant right now.  Depending on where a patient lives, the average wait time for a kidney transplant can be upwards of three to seven years.

Voices for Kidney Health

Voices for Kidney Health™ is a diverse nationwide community of dedicated kidney patient and health professional advocates working with elected officials and other public leaders to create policies and initiatives that help those living with kidney disease and to promote better kidney health.  By harnessing their life stories to enact change, Voices advocates work to ensure quality care for patients with kidney disease and advance policies that would expand access to home dialysis, protect living donors, promote healthcare equity, and spur investment in prevention and research.  Change starts with you. Become an advocate at voices.kidney.org.

About the National Kidney Foundation

The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney disease in the U.S. For more information about NKF, visit www.kidney.org.