Workshop to look at new guidelines for home dialysis
Click Here to Manage Email Alerts
In the third of its controversies conference series on dialysis, Kidney Disease: Improving Global Outcomes is focusing on home dialysis for patients with end-stage kidney disease.
The conference will take place in May, bringing together experts from around the world including patients, physicians and kidney care professionals.
Taking place amid the challenges posed by the global COVID-19 pandemic, the conference will take on a virtual format whereby participants will be able to share their views and participate from the comfort of their homes.
With a globally increasing incidence of chronic kidney disease, the need for universal access to cost-effective renal replacement therapy treatment options across the world is needed, particularly in low- and middle-income countries where dialysis treatment options are currently limited and, in many cases, cost prohibitive.
Options for home
In this regard, home dialysis treatment options including peritoneal dialysis (PD) and home hemodialysis are associated with increased patient satisfaction and autonomy and, in many cases, improved quality of life. In particular, PD may be delivered at lower costs with less infrastructural requirements compared to center-based hemodialysis.
The global COVID-19 pandemic has further underscored the need to develop and accelerate home-based care across all areas of medicine. The potential advantages of home-based dialysis care are increasingly important given that home patients are able to minimize health-care facility visits, reduce dialysis delivery in congregate settings and better adhere to social distancing measures.
Despite the significant benefits of home-based dialysis therapies, the utilization of these therapies remains variable across countries. Variability in home dialysis uptake across countries is likely a reflection of cultural, educational and economic differences in addition to regional policies that have impacted differences in dialysis reimbursement. For example, in the United States, policy reform such as the Advancing American Kidney Health executive order rides on the coattails of other recent policy changes and dialysis reimbursement reforms that are leading to increasing use of home dialysis utilization in the country after years of progressive declining use.
Even within countries, where similar health care delivery and policies operate, there is significant regional variability in the use of home dialysis across facilities. Variability within countries would suggest that local expertise, treatment-team bias, training and education, and available resources may also be impacting regional rates of home dialysis utilization.
Barriers to home dialysis
From a patient and care partner perspective, many barriers exist to choosing and performing dialysis at home. Evidence-based robust strategies for patient and care partner education regarding treatment options are needed including the role of peer-peer education. The challenges in use of home dialysis need to be addressed particularly in vulnerable and historically underrepresented populations where socioeconomic and health literacy challenges need to be addressed. The degree to which barriers to home dialysis can be overcome may also depend on the presence of assisted home dialysis programs which have been successful across many jurisdictions in addressing physical and cognitive barriers to home dialysis self-care.
Taken together, the controversies conference will support an in-depth exploration of the following four key questions that are fundamental to address the rationale for and strategies to facilitate increased global use of home dialysis:
1. What is the evidence base to support increased use of home dialysis, focusing on clinical and patient-reported outcomes?
2. What are barriers at the facility level that impact home dialysis utilization and how can these be addressed?
3. What are individual-level challenges that individuals and care partners face that impact choice and use of home dialysis therapies?
4. What are the financial and policy considerations that impact global differences in rates of home dialysis utilization?
The proceedings from the conference will culminate in the generation of a consensus manuscript. The manuscript will serve as an important and definitive road map for the development and implementation of multi-pronged strategies to increase home dialysis utilization while identifying key areas in need of future evidence generation.
It is our hope that the conference leaves a long-lasting mark on the kidney care community and that when it comes to home dialysis, we need to be empowered to think globally but act locally.
For more information on the KDIGO home dialysis conference, visit www.kdigo.org.
- For more information:
- Jeffrey Perl MD, SM FRCP (C), is a nephrologist with St. Michael’s Hospital and an associate professor of medicine at the University of Toronto. He can be reached at jeff.perl@utoronto.ca.
Collapse
Read more about
Click Here to Manage Email Alerts