Future of home dialysis requires innovation, policy changes
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KANSAS CITY, Missouri — When imagining the future of home dialysis in the United States, innovation and policy changes are required, according to a presenter at the Annual Dialysis Conference, here.
“The ‘why’ of dialysis care is to provide people who depend on dialysis care a future worth living,” Brigitte Schiller, MD, FASN, from Fresenius Medical Care said.
According to Schiller, patients on dialysis look for full life, the flexibility and freedom to do what they want to do and human connection. This can be achieved through transitional care units, which are designed to ease patients into dialysis. These units include clinical stabilization and care coordination to help patients with the transition, she said.
Schiller referenced a study on how the initiation of hemodialysis in transitional care units vs. in-center clinics impacted patient outcomes. Among the 724 patients who started at a transitional care unit, 11% had switched to home dialysis within 8 months. Whereas among 2,892 patients on in-center hemodialysis, 2% switched to home dialysis within 8 months.
However, the future of home dialysis may include innovations that have not yet been created, she said.
“People have ideas about their life, dreams and hopes. We are here to build the system and provide tools for them to do this,” Schiller said.
According to Schiller, the best way to bridge the divide between clinicians and data scientists is to use the healing power to data, which can provide clinicians with patient demographics, treatment options and medicines, hospitalization history and nurses notes. For home dialysis, data have the ability to screen patients and determine patients’ fit for the modality, she said.
Recent innovations have changed dialysis dramatically in the past few decades, Schiller said. She recalled conversations in the 1990s when nephrologists were imagining xenotransplantation, and now a pig heart has been transplanted into a patient at the University of Maryland School of Medicine.
Home dialysis has come to fruition when it was once just an idea, she said. Programs like KidneyX are making way for data-based innovations that may change the future of home dialysis completely.
Schiller said public policy will also have an impact on the future of home dialysis.
Currently, the barriers of home hemodialysis in the United States include fear of home therapy and burdening families, lack of caregiver support, loss of community at center and costs. She referenced New Zealand’s strategy of community housing for home dialysis as an innovative solution.
“The one thing that I know is that every single one of you – independent of where you are –... will contribute to shape this [home dialysis’] future,” Schiller said.
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Schiller B. Reshaping dialysis care for decades to come. Presented at: Annual Dialysis Conference. March 3-6, 2023; Kansas City, Missouri.
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