What we are learning about home hemodialysis in 2015

NEW ORLEANS – Home is a comfort zone for many of us. You can put your feet up, relax, enjoy family, and forget about what you do 9-5 each day. What about self-care for a chronic illness in that environment? Do you want that to be part of your home life each day?

The 9^th annual Home Hemodialysis Symposium, presented here over the weekend during the Annual Dialysis Conference, was a day-long examination of the state of home hemodialysis today. It offered us a reminder on how things started—dialysis at home was the primary approach to providing dialysis in the 1960s. While it faded when companies began to build outpatient facilities starting in the 1970s and 1980s, it has made a comeback as of late, along with the use of peritoneal dialysis. That’s a positive step, said Christopher Blagg, MD, in his opening remarks. “We must do more to make it available everywhere,” he said.

There are about 8,000 patients on home hemodialysis in the U.S. —less than 2% of the ESRD patient population. Blagg suggested steps to expand use of the modality:

Regionalize training programs. Instead of having each dialysis facility attempt to develop best practices, regionalize the training so there is consistency.

Provide more incentives for patient to return to work. Nocturnal hemodialysis, both at home and in-center, can give patients the flexibility needed to stay employed.

Education all staff on the benefits of home hemodialysis. While an overwhelming majority of nephrologists say they would do home dialysis if they had kidney disease, few prescribe the therapy to their patients.

Improve training availability. Make it available to any patient who wants it.

Good staffing of home hemodialysis programs is also important, said speaker Michelle Carver, BSN, RN, CNN. Every home hemodialysis nurse needs at least three months of training experience. And, it’s important they are home dialysis advocates.

The nurse should know about the modality selection process and read and understand the Conditions for Coverage for dialysis facilities.

Once you fill in the needed forms let the state know you are applying for new modality training. Getting a survey done for the new home hemodialysis unit could take 60 days—or years in states like California. It varies by state.
“You need a dedicated home training nurse; you need adequate training/clinical space; interdisciplinary support, and you need physician input and support,” Carver said.

The cost of home hemodialysis care
In an integrated care environment, where the incentives for both dialysis providers and hospitals are aligned, home hemodialysis can be a winner, said Brent Miller, MD.

There are other savings, too. Patients save travel time back and forth to a clinic Better CKD care and, likely, more transplants because home hemodialysis patients are in much better condition.

“There are no new dollars in ESRD, so any change in therapy has to come within the program,” Miller said.

It’s clear that home dialysis therapies can offer an alternative to the traditional in-center therapy, but both patients and staff have to be motivated. Patients should share in the economic benefit or burden of their choice of treatment.

Likewise, patients need to understand the value of longer dialysis, said Australia’s John Agar, MD. “The only prescription that matters in dialysis is time, and that should be as long as possible.” -by Mark E. Neumann