Speaker: For better outcomes, home dialysis is superior
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Despite the logistical hurdles and required self-care, patients with kidney disease will find the benefits of home dialysis outweigh in-center hemodialysis, according to a speaker at the virtual Annual Dialysis Conference.
“Home dialysis is the proverbial moon of chronic dialysis, and we should go,” Eric D. Weinhandl, PhD, MS, senior director of data analytics and home therapies for Satellite Healthcare, said.
Weinhandl made the comment in reference to a speech by President John F. Kennedy at Rice University in 1962 about flying to the moon.
As an epidemiologist who has focused much of his research on home dialysis since 2004, Weinhandl said the therapy can help patients avoid some drawbacks of in-center hemodialysis and provide more flexibility in not only managing the prescription, but also dictating the schedule.
“Home dialysis is customizable,” Weinhandl said. “[Home hemodialysis] HHD offers more sessions, shorter gaps and more treatment hours. [Peritoneal dialysis] PD offers continuous or semi-continuous therapy, depending on whether daytime dwells are prescribed. Both therapies also preserve residual renal function,” he said.
The advantages, along with government initiatives placing a stronger focus on home dialysis, has had an influence on increasing home dialysis in the United States, he said.
Weinhandl said data from the U.S. Renal Data System show the incident rate – the number of patients starting on home dialysis as their first modality – increased from 7% in 2009 to almost 15% in 2019. Similarly, the number of patients who started on a home therapy after 1 year on dialysis also increased from approximately 11% to 18% during the same time. All age groups had growth in home therapy during that 10-year period, with the 18- to 44-year-old age group having the highest number of patients using home therapy, Weinhandl said.
Home therapies also offer other clinical benefits compared to in-center care, Weinhandl said.
“We know patients see a reduction in time-integrated fluid load and blood pressure and antihypertensive medication use; a likely lower risk of heart failure hospitalizations and reduction in the binder dose to control serum phosphorus,” he said. “We also know that the recovery time after treatment is vanquished when patients use PD or nocturnal HHD and patients experience an improved quality of life.”
Patients who choose home dialysis also reduce the risk of infections spread by other patients treated in the confines of a dialysis clinic, including COVID-19. Weinhandl cited a recent Canadian study published by Perl and colleagues in the Clinical Journal of the American Society of Nephrology showing that patients on home dialysis had about one-half the number of cases of SARS-CoV-2 compared with in-center patients, and hospitalization days were less than half of those experienced by in-center patients.
“In general, patients treated in-center face the ‘rule of thirds,’” Weinhandl said. “One-third of patients face undesirable intermediate outcomes; have issues with volume overload; have persistent hypertension; long recovery time and hyperphosphatemia – and not for a lack of costly efforts,” he said.
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