Home dialysis success seen among undocumented, uninsured patients in Texas
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Key takeaways:
- High-risk patients can safely use peritoneal home dialysis.
- Culturally tailored education may be a key to successful adoption of peritoneal home dialysis.
Since 2017, a safety-net health care system in Texas has become a large provider of home peritoneal dialysis to mostly uninsured/undocumented Spanish-speaking patients, with good outcomes, according to data published in Kidney Medicine.
“With strong institutional support and ardent multidisciplinary teams, home peritoneal dialysis treatments can be provided safely with outcomes exceeding national standards of care, even in this historically excluded population or in those deemed high risk from a socioeconomic perspective,” Jade M. Teakell, MD, PhD, FASN, associate professor of medicine in the division of renal diseases and hypertension at McGovern Medical School, UTHealth Houston, told Healio.
Teakell and colleagues compared outcomes data from the program at Harris Health System, which serves Harris County and Houston, with national data from the US Renal Data System (USRDS) 2023.
In October 2023, Harris Health had 42 patients using peritoneal dialysis, making it one of the 10% of home dialysis clinics in the US with more than 40 patients per individual center, according to the researchers. The cohort was made up of mostly Hispanic patients who were younger than the national average and had little access to health insurance: 93.2% identified as Hispanic/Latinx with 85.3% reporting Spanish as their primary language 90% were aged younger than 64 years 86.2% had no private or public insurance and 67.9% had kidney failure due to diabetes.
Nationally, 81.7% of patients using peritoneal dialysis had public or private insurance, 54.8% were younger than 64 years, 16.2% identified as Hispanic/Latinx and 40.6% had kidney failure due to diabetes.
Most Harris Health patients had catheters placed laparoscopically (95.1%) and 48.1% used continuous ambulatory peritoneal dialysis. National data were not included in the USRDS report, according to the researchers.
Similar rates of Harris Health and national Hispanic patient cohorts received pre-dialysis kidney care education. Rates for peritonitis during the past 5 years were also similar.
“Research has shown that patients without access to regularly scheduled dialysis who receive emergency-only hemodialysis have a 14-fold increased risk of mortality,” Teakell said. “The clinical implications of the program are immense for patients who would be in this situation. Not only do they have access to standard of care dialysis services, but they have the opportunity for dialysis treatment at home with increased flexibility and improved quality of life. From a system perspective, this program has greatly improved patient outcomes and has reduced costs and utilization of emergency services.”
Teakell attribute the success of the Harris Health program in part to its education program, which is offered to every patient.
“Improving access to early education and incorporating cultural concordance greatly improves the effectiveness of the education,” she said.
For more information:
Jade M. Teakell, MD, PhD, FASN, can be reached at jade.m.teakell@uth.tmc.edu.
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