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A national home dialysis strategy is needed but will be challenging and multifactorial
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BOSTON — When thinking aspirationally about a national strategy for home dialysis, the kidney community should consider the priorities of patients, according to an expert here at the National Kidney Foundation Spring Clinical Meetings.
Looking at only the U.S. patient population of a recent paper by Manera and colleagues on patient and caregiver priorities in PD, Thomas A. Golper, MD, FACP, FASN, from Vanderbilt University Medical Center, said that the priorities were “infection, fatigue and flexibility of time. Mortality was not even in the top three.”
“Patients are starting to have a voice,” he said. “For younger patients, the ability to travel [is a priority] and [to] a woman, more so than a man, flexibility with time [is a priority],” Golper said.
In a national strategy, large dialysis organizations (LDOs) must consider building fewer in-center clinics and expand or build “home only” clinics, he said. LDOs must also acquire new technologies, “increase educational situations,” invest in communication technology and “seriously consolidate programs.”
Additionally, Golper said, “encourage and truly facilitate telehealth visits ... [T]here is a serious gap. If the patients are out there and they are on PD, who is going to do the phlebotomy?”
A national strategy must also include detailed nurse training, support paid care partners, support respite care in the home, detailed medical directory training on home dialysis, support transitional care units and support physician and nurse Home Dialysis University, he said.
LDOs must “promote social work and dietician face-to-face visits rather than phone visits. There are good reasons for a phone visit because it is either a phone visit or no visit. I understand that, but it leaves bad impressions.”
Golper shared that he purchased a model on cognitive training for one of his staff social workers.
“There is no reason they can’t do that. That’s why they went into social work, not to arrange transportation” and social workers should instead focus on the burden of therapy. Many in the audience clapped after hearing this.
Golper called for the end of Medicare Administrative Contractors in his national strategy concept and an overhaul of metrics, changes to reimbursement and a greater incorporation of home dialysis in graduate medical education and medical board. – by Joan-Marie Stiglich, ELS
Reference:
Golper TA. Transition from CKD to home dialysis: A call for a national strategy. Presented at: National Kidney Foundation Spring Clinical Meetings; May 8-12, 2019; Boston.
Disclosure: Golper reports financial disclosures for NxStage, Schär, Keryx and Up to Date and notes he is the Home Dialysis University course director. Golper is chair of the Nephrology News & Issues Editorial Advisory Board.