Home Dialysis News

ORLANDO, Fla. — Patients treated with combined hemodialysis and peritoneal dialysis from the start of renal replacement therapy showed advantages over patients who used a single therapy only, according to researchers from Japan who presented at the Annual Dialysis Conference here. The combined therapy helped the study group stay on dialysis for more than 10 years.

ORLANDO, Fla. – “The addition of dialysis plastic waste to concrete leads to significant improvement in some characteristics of concrete and will lead to the environmental sustainability of health care,” John MW Agar, MBBC, FRACP, FRCP, said at the Annual Dialysis Conference.

Every day, patients with late-stage chronic kidney disease or end-stage renal disease and their families must make important decisions about issues that could impact their life with kidney failure (Figure). These critical decisions are best achieved through deliberation and discussions with diverse groups, including the health care team, the patient and the patient’s family. Managing patients’ choices requires education from the health care team to help patients achieve informed choice.

As has been widely reported, U.S. utilization of dialysis in the home setting has been on the upswing, with an 18-year high of 11.7% of patients on dialysis on either peritoneal dialysis or home hemodialysis at the end of 2015. In just the 10-year period from 2005 to 2015, the number of patients on either peritoneal dialysis or home hemodialysis has increased from a little more than 30,000 to almost 58,000.

If you have a strong interest in all aspects of dialysis care — pediatrics, in-center services, home, new technology and clinic management — the upcoming Annual Dialysis Conference offers an opportunity to interact with the innovators and experts within the nephrology profession.

The patient advocacy group Home Dialyzors United believes dialysis should always be about the patient. The choice of location, frequency, time and modality should be a decision made between the patient and his or her doctor and be based on optimal clinical care and quality of life goals as defined by the dialyzor.

Last fall, seven of the 10 Medicare Administrative Contractors proposed revisions to their payment policies that would restrict the use of more frequent dialysis. This can be defined as any form of hemodialysis beyond the standard three times a week, such as short daily dialysis or nocturnal dialysis every other day. While the MACs have defined payment codes that allow exceptions for patients who need more dialysis on a temporary basis, the revisions would eliminate these modality options for patients who want better care.

Improved residency training programs that include exposure to home dialysis, particularly home hemodialysis, might help to increase its usage and make the specialty more appealing for students considering a career in nephrology, wrote nephrologists Joel D. Glickman, MD, and Rebecca Kurnik Seshasal, MD, in a recently published article.

An analysis completed on the first year of the Comprehensive ESRD Care demonstration indicated the 13 physician-provider groups that participated in the project showed improvement in vascular access management and reducing hospitalizations, but no measurable change was seen in patient quality of life or mortality. No significant increase was seen in the use of home dialysis as well.

Medicare administrative contractors are responsible for reviewing claims from health care providers, including dialysis companies, and paying Medicare rates for provided patient services. Seven of these MACs simultaneously released proposed LCDs, or payment policy rules, last September on how these contractors would cover more frequent hemodialysis, defined as beyond the standard three times per week covered in the bundled payment rate.