COVID-19 pandemic may prompt future increases in home dialysis utilization
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The COVID-19 pandemic, which necessitated that greater numbers of patients receive dialysis at home, may give rise to continued increases in the utilization of such home-based therapies, according to two nephrology experts.
“As the novel coronavirus disease 2019 (COVID-19) global pandemic has unfolded, efforts to facilitate social distancing while minimizing person-to-person transmission of severe acute respiratory syndrome coronavirus has resulted in unprecedented changes across all facets of society,” Edwina A. Brown, MD, FRCP, and Jeffrey Perl, MD, FRCP, wrote in a published perspective. “The COVID-19 pandemic represents an opportunity to re-evaluate and refine existing models of health care delivery to enable provision of high-quality, comprehensive care traditionally offered within health care facilities in the home.”
Adding that patients receiving in-center hemodialysis have historically been at risk for acquiring other communicable diseases, such as viral hepatitis, the researchers contended that home dialysis holds many advantages, especially during a pandemic. For example, Brown and Perl cited data from April 2020 that demonstrated 2.9% of patients on peritoneal dialysis in the United Kingdom had contracted COVID-19 compared with 9% of patients on in-center hemodialysis. In addition, data collected in May from Ontario, Canada, showed the rate of increase in COVID-19 positivity among patients on center-based hemodialysis was three times greater than among those receiving home dialysis.
They noted that while data from the United States is still forthcoming, two health care reform initiatives — the ESKD Prospective Payment System and Advancing American Kidney Health —“directly set targets aimed at increasing home-based dialysis in an effort to reduce ESKD-related costs while improving care.”
The researchers suggested that, as we are only at the beginning of the COVID-19 pandemic, it is a “matter of urgency” to determine how to further accomplish the goal of increasing home dialysis use.
They proposed ways of doing this that include the following:
- education to patients on dialysis options;
- opportunities for older patients to receive PD in their home or nursing home;
- increased resources for PD catheter placement;
- development of “robust” telemedicine strategies; and
- measuring quality of dialysis based on the patient’s well-being and goals.
Brown and Perl also contended it is critical to acknowledge the racial and ethnic disparities that exist in dialysis care. They argued that home dialysis is less utilized in certain ethnic and racial groups and that these patients are more likely to experience inferior outcomes.
They elaborated that “[these observations] underscore social determinants of health (which include socioeconomic status, living conditions, access to health care, and other factors) that need to be addressed to facilitate greater use of home dialysis and improved health outcomes.”
“It has taken the COVID-19 pandemic to highlight the advantage of having dialysis at home,” the researchers concluded. “It is now up to the kidney care community to ensure that all people faced with starting dialysis have the opportunity to choose whether to have their dialysis at home, and to receive the assistance to do so when they need it.”
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