Why home dialysis is not popular?

#1

Hello,

Is there a reason why home dialysis is not popular?

Theoretically every patient would like to have treatments at home, but why that doesn’t happen?

Do I miss something?

Thanks!

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#2

There are many reasons why fewer patients do home dialysis than could do it. Some things that may contribute include:

  • Nephrologists typically only have patient care experience during training with in-center patients so their lack of experience with home dialysis patients may lead them to have conscious or unconscious biases leading them to recommend in-center dialysis.

  • Some patients who could be good candidates for home dialysis are excluded from consideration due to preconceived ideas about whether they could do it successfully, e.g., the elderly, those with less education, without support, racial minorities, people who are blind or deaf, people with pets, people who live in apartments with landlords who refuse to allow it, people who are viewed as potentially noncompliant, etc.

  • Patients who have not received fact-based education about treatment options prior to the need to start dialysis may be advised by their doctor to do in-center dialysis. Once on in-center dialysis, they may be comfortable in that setting and afraid to switch to a home option or they may be getting messages from in-center staff who no nothing about home dialysis that in-center dialysis is less burdensome and safer.

  • Patients who don’t have family or friends or enough money to hire someone to help them do home HD may not know that solo home HD is possible but only if their nephrologist approves it. [The FDA approved the NxStage cycler for solo home HD.]

These are just a few off the top of my head. I’m sure there are others. On the other hand, most patients who choose home dialysis love it and would be unhappy if they had to do in-center dialysis.

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#3

I think I know one answer to this question. For 5 years I was doing incenter Hemodialysis and just watching the technicians monitor and make adjustments was a little intimidating (ok very intimidating.) I was on PD for 6 months but that almost killed me because of the slow speed the contaminants took to get across the membrane. I have a nephrologist who encouraged me to watch the techs and nurses in the activities around my machine. I soon realized the most of the time they were injecting medications into my blood circuit and not doing much else. When I realized the only thing that I considered a possible issue was self cannulation, I watched the techs closely as inserted the needles and removed them how they taped the needles, and how they removed and taped my access after treatment. I asked my nephrologist to recommend me for Home hemo and then started self cannulating in center. At first, I had difficulty with venus needle, but after a few sessions, I got that one down too.
Believe me the Home machine is quite a bit simpler to operate than you my think. I am in week 3 training and doing the daily dialysis and I cannot believe how much better I feel after treatment.
I think the lack of interest in home hemodialysis is mainly fear of the process. When I leave the training, I have a 50 mile drive home, and I do it without feeling dizzy or wiped out. The evening and next morning I feel much better than after in center treatment. Give it some thought.

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#4

One approach that may help grow home HD is to have a separate section in a dialysis clinic (some call this transitional start dialysis) where new patients dialyze for a month four times a week using the same machine that patients use at home. There are set topics of discussion/education/support each week starting with helping the patient feel better physically and emotionally and dispelling mistaken beliefs about dialysis. Here’s a description of this approach. https://www.healio.com/nephrology/home-dialysis/news/online/{2e13d7fa-083e-42ac-b561-988904ba6844}/using-a-transitional-start-dialysis-unit-to-improve-modality-selection

There is one error in this article related to when Medicare can start for a patient who chooses to start a home dialysis (PD or HD) training program during the first three months of dialysis. Although in-center dialysis patients must wait 3 months for Medicare, if a patient starts a home training program any time during that 3 months, Medicare will backdate to the first day of the first month of dialysis – not the first day of the month home training starts as stated in this article. Waiver of the waiting period can be a real incentive for a patient who has no health insurance or whose health insurance has high out-of-pocket costs.

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