Home Dialysis in the News
Experts Optimistic About Progress Toward Home Therapies
Home dialysis thought leaders interviewed by Mark Neumann for Nephrology News & Issues report strategies and attitude changes that support growth of PD and home HD in light of the Advancing American Kidney Health Initiative. From identifying CKD patients in the ER and emergent start PD to policies that prioritize home and coordination of services, a shift is happening, and patients will be the beneficiaries of it.
Indian Government Aims To Make PD Accessible To All
With the growing burden of CKD a major health concern for India, a large rural population, and many patients who must self-pay, PD is extremely attractive. The home treatment helps maintain residual kidney function and “gives people more freedom to enjoy life.”
Patients Who Started On PD Have Better Quality Of Life
A Canadian study of 39,318 patients between 2004 and 2012 found that the 8,170 who started dialysis with PD had more life years—and at a cost savings for PD ($83,762/year) vs. in-center HD ($104,880/year).
Transitional Care Units (TCUs) Help Dialyzors Get Home
Ohio State Wexner Medical Center worked with dialysis provider Fresenius Kidney Care to establish a Transitional Care Unit to support patients and empower them to move to PD or home HD. Dr. Boubes, a nephrologist at OSWM, notes, “Whether they choose PD or home hemodialysis, patients take on more control of their care, experience fewer ‘swings’ and generally adhere better to diet and medications. Home dialysis can significantly improve quality of life.”
With Education and Shared Decision-Making, Almost 2/3 Choose Home Dialysis
The multinational Peridialysis study of 1,071 patients who were suitable for home treatments found that following education and shared decision-making, 65.4 of patients would choose some form of home dialysis.
New NKF KDOQI Guidelines Focus on Patient-Centered PD Care
Supporting the direction of the International Society for PD, the first new KDOQI PD guidelines since 2006 recommend including patients in the prescription and avoiding a one-size-fits-all approach.
2020 USRDS Annual Report: “Strong Growth” in Home Dialysis and Preemptive Transplant
USRDS serves the kidney community through research and data analysis. This year they devoted a chapter to the patient experience.
RSN Podcast Talks About Transitioning to Home Dialysis
Michelle Pace, a Kidney Care Advocate and dialysis nurse talks with Lori Hartwell about the pros of home dialysis. She explains the options, and how they can improve day to day life.
New Medicare Payment Model to Encourage Home Dialysis
The new ESRD Treatment Choices (ETC) Model requires 30% of U.S. clinics to take part—and take action to increase use of home dialysis and transplant.
10-year Study Finds PD First Cuts Costs
Canadian researchers followed 39,318 patients who started dialysis between 2004 and 2013. Compared to standard in-center HD, starting with PD saved more than $21,000 per year. “A PD first approach is supported from a cost-effectiveness perspective, while also taking into account quality of life,” noted Paul Komenda, MD.
CVS HemoCare HD Machine Trial May Occur at the Manchester VA
DEKA Research in Manchester is developing the HemoCare Hemodialysis System, and the conveniently located Manchester VA’s Community Living Center may become a test site for the new device in a new public-private partnership.
Maryland Opens First Residential Onsite Dialysis Center
Lorien Healthcare, a family-owned and operating assisted living, residential services, and nursing home company with nine facilities has now added dialysis to reduce residents’ stress and improve their quality of life.
Joanne Bargman MD on the Top 5 Mistakes in Prescribing PD
Wrongly prescribing PD can make the option burdensome instead of flexible. Joanne M. Bargman MD, Professor of Medicine at the University of Toronto and global PD expert spoke about PD prescribing in a virtual ASN session. Relying too heavily on Kt/V, ignoring residual kidney function, assuming more cycles are better, not using hypertonic PD fluid, and not talking with patients before prescribing were the top five mistakes she sees.
Tailoring Home HD Training Is Key
Flexibility, adapting to different learning styles, and individualizing training to meet the needs of patients and their partners are core tenets of success, according to 20-year home HD veteran Lisa Koester, MSN, CS, CNN-NP. A renal nurse practitioner at the Washington University School of Medicine in St. Louis, Koester shared her views in a virtual ASN talk.
Most PD Barriers Can Be Overcome, Says McCormick
Brendan McCormick, MD, of Ottawa, defined PD success and shared tips for achieving it during his virtual ASN session. Offering PD to a wide range of patients and maintaining them on it is key, McCormick noted, as is being able to quickly mobilize an education team to visit hospitalized potential PD patients.
Fear Of COVID-19 Sends Dialyzors Home
Maria Duenas, in small Nipomo, CA, traveled 160 miles to LA three times a week for 2 months after she started dialysis during the COVID-19 pandemic. Then, she switched to home dialysis—and she is not alone. Fresenius reports that home dialysis training was up 25% over the same quarter last year, a trend they associate with fear of COVID.
Paris Hospital Uses Home HD Physidia S3 to Aid COVID-19 Patients
After a 15-bed ICU was tapped for COVID dialysis use, the nursing staff (not dialysis trained) needed to provide HD—in a setting that did not contain ultrapure water. The Physidia S3, which can use bagged dialysate, was so easy to use that nurses, residents, and nephrologists were able to train in just half a day.
COVID-19 Changes May Help Accelerate a Move to Home Dialysis
Telemedicine has soared in popularity during the pandemic, finds a Deloitte Consulting consumer survey, with virtual doctor visits nearly doubling. More patients are seeking answers online and doing their own research. And, during a global pandemic, the safer dialysis option is home—an option supported by the priorities of the Advancing American Kidney Health Initiative.
US Needs Radical Change to Reach Home Dialysis Goal
Lisa Koester-Wiedemann, ANP, CNN-NP told attendees of the online ANNA meeting that at our current growth rate, it will take more than 50 years to reach the home dialysis goals of the Advancing American Kidney Health Initiative. To speed up the timeline, we need more home dialysis nurses, staff-assisted home treatments, telehealth, and user-friendly equipment.
First Tablo Patient Goes Home
Tracey Amadi is making history—she is the first person use the Outset Medical Tablo automated, touchscreen hemodialysis machine at home. The Tablo was just cleared for home use by the FDA on March 31, 2020.
Telehealth Here To Stay For Home Dialysis
“In the midst of a deadly pandemic that poses a particular threat to those with serious underlying conditions, President Trump’s call for increased access to home dialysis has never been more urgent,” noted CMS Administrator Seema Verna, explaining a rule change to increase support for telehealth.
Concerto Renal Services Expands SNF Home Dialysis Program to WI
Concerto is partnering with Ignite Medical Resorts to bring home dialysis to a new 144-bed SNF in Milwaukee. Founded by nursing home operators who became frustrated by the risks of transporting residents to dialysis clinics, the Chicago-based company is the largest SNF dialysis provider in the U.S.
New DaVIta Home Dialysis Fact or Fiction Video—in Just 97 Seconds
No pets allowed? Infections? A sterile home needed? No! A new, brief video dispels common myths and offers facts to help support the choice of home dialysis. Watch it now.
Home HD Nurse Sees Home Patients Through Facetime and Zoom
Nurse Shawna McMichael and her team at Washington University in St. Louis, MO made a rapid switch to telehealth to keep patients at home and safe while still delivering the same level of care.
Louisiana Nephrologist Has 40% Patients on Home Dialysis
“We do not promise patients it will be easy in the beginning, but we do promise it will be better,” says Dr. Shaminder Gupta. His home dialysis program in rural Louisiana has 40% of patients home—and COVID-19 is persuading some to switch. “A strategy for home dialysis growth has always been to approach patients at moments when they are feeling stress about in-center therapies, and this is one of those moments,” he notes.
UVA Pilots Four In-Person Home Dialysis Clinic Visits Per Year
UVa nephrologists developed a pilot initiative to do quarterly instead of monthly in-person visits, after a recent decision by CMS to let doctors offer virtual clinic visits for home dialysis patients. Telemedicine is used to do exams and talk about lab test results and prescription changes.
COVID-19 Speeding Paradigm Shift to Home Dialysis
In an interview for Connecticut Public Radio, NKF President Dr. Holly Kramer says, “Home is the safest place for them [patients] to be,” while Dr. David Roer, VP of Medical Affairs at DaVita, predicts that the pandemic will be a catalyst for more home dialysis, including telehealth. Fresenius has instituted increased safety protocols. Both companies are collaborating with other dialysis providers to create a national contingency plan.
Baxter Sharesource, Other Innovations Protect PD Staff and Patients
Mt. Sinai Hospital in East Harlem, NY, describes its innovative approach to home dialysis and monitoring, which began in March. The PD unit obtained iPads, and arranged courier services and a home phlebotomist, with monthly clinic team visits conducted online. The Sharesource platform provided daily treatment data for prescription adjustments. Phone triage determined which patients needed to be seen in person, and the team developed an acute PD start program.
Facebook Offers Support for Nocturnal Home HD Patient
After PD, a failed transplant, and 8 years of in-center hemo due to kidney failure from rare dense deposit disease, Cheri Rodriguez-Jones’ nephrologist suggested nocturnal home dialysis. Now feeling well enough to work again, Cheri credits online support as part of her success story.
Nurse who Carries the Torch Receives NKF HHD Award
At the recent virtual NKF Spring Clinicals meeting, Teri Jo Kinnison, RN, BS, CNN, a home HD training nurse herself, received an award in the name of Carol Mattix, who was an inspirational home dialysis training nurse.
21-year Old Dialysis Patient Finds a New Normal With HHD
Ciara Millerwaiting for a kidney from her mom, which has been postponed due to COVID-19. Home HD helps her to stay positive during the extended wait, but she is having a very challenging time getting the hygiene supplies she needs for her treatments
Outset Tablo is FDA-approved for Home Hemodialysis
Last week, the FDA expanded approval of the Tablo hemodialysis machine to home use—just in time to offer a new option for COVID-19 related challenges. The intuitive, easy to learn system requires little set-up time. Outset’s next step will be a controlled rollout at select sites.
Large Providers are Growing Home Therapies
In a reversal of a decades-long trend, the ten largest U.S. dialysis providers started 35% of incident patients on a home option—PD or home HD—in 2018 to 2019. This result is 15% higher than the prior year, and almost triple the rate from 2016 to 2017.
To Buttonhole or Not to Buttonhole
A Fresenius poster at the Annual Dialysis Conference looked at the frequency of bloodstream infections (BSIs) among home HD patients using the Buttonhole technique. The group instituted a best-practices approach to wash the access site before cannulating, scrub to remove scabs, and perform skin prep and cannulation while training. After almost 3 years, no patients on home HD in the study group had an access-related BSI.
Volume Overload Affects PD Technique Failure
Patients who began PD with fluid overload had a higher risk of technique failure in the next year than those who did not, finds a new study.
Pilot Project Brings Home HD to Montreal Cree Community
Shirley Matoush is the first person in her Cree community to try home hemodialysis with a NxStage machine under a new program in Montreal, Canada. With just two hospitals in the region offering hemodialysis, patients like Shirley had to travel long distances or even live away from their families. The Cree Health Board hopes to expand the option to others.
DaVita: Nocturnal In-center HD Beats Standard HD
A study of 2,747 patients treated at all of the 176 DaVita in-center nocturnal HD (INHD) programs in 2017 and 2018 found an array of benefits. INHD patients had higher solute clearance, gentler water removal—for less organ stunning, higher serum albumin, and less hospitalization than those on standard HD, revealed a poster at ASN Kidney Week.
New Utah Kidney Center Has a CKD-ESRD Quality of Life Focus
Prevention and early detection are central to Intermountain Healthcare, which aims to increase access to treatment, even before dialysis is needed, and “doing the right amount at the right time” for each patient. They hope the model spreads—and so do we.
To PD Or Not To PD
Kaiser Permanente has found that an integrated approach to CKD—with surgeons, nephrologists and other well-trained staff, and education—supports PD growth. A study of 13,500 patients who started dialysis between 2008 and 2018 found that more than twice as many started PD with the integrated approach in place.
Outset Tablo Trial for Home HD at a Texas Hospital
A new article with a video highlights an 8-week trial of the Tablo machine—featuring in-center patients who take the new, easy-to-use system home. “I could set it up pretty much all by myself and just get my treatment and then get off,” noted participant Richard Crawford.
Fresenius Solo HHDer Trains Local First Responders
As the first solo dialyzor in his area of Massachusetts, Eugene Tradd showed paramedics and EMTs at Atlantic Ambulance how to use his machine to ensure his safety. “One day, I had EMS responders in my little, one bedroom apartment all being introduced to me and the system because it’s so new to the area,” reports Tradd.
Fresenius Reports Record Home Dialysis Growth
In the 6 months since purchasing NxStage, Fresenius says that home dialysis growth is 8 times the rate of in-center HD, with more than 25,000 home dialysis patients.
India’s Largest Dialysis Provider Adds PD Focus
A recent NephroPlus PD workshop at The Madras Medical Mission Hospital had the stated aim of influencing stakeholders (Nephrologists) “to work tirelessly to expand peritoneal dialysis programme to benefit patients living in far corners of India.”
Quanta Chooses a Manufacturing Partner for Launch
In another step forward for the Quanta SC+ personal HD machine, the company has selected Benchmark Electronics as its production partner—and the first batch of prototypes was completed earlier this year in preparation for a UK commercial launch in Q4 2019.
Catch a Glimpse of the New CVS HemoCare HD Machine
Finally—we get to SEE a photo of the much-heralded new Dean Kamen-designed HemoCare, which will begin human testing at the Rogosin Institute in New York. With a team of 150, the HemoCare is “one of our major initiatives,” said CVS Executive Vice President Alan Lotvin.
The World of PD Retention According to Mt. Sinai
In an interview for Nephrology News & Issues, Dr. Uribarri and other members of the Mt. Sinai Home Dialysis Program shared thoughts about how to keep people successful at home on PD, after they complete training. What matters? A committed multidisciplinary team, a larger PD program, troubleshooting sleep problems and burnout, and technology innovations.
DIY Team Transforms UK Garage Into Home Dialysis Unit for Two Girls
The Collins family has triplet daughters—two of whom who need dialysis—and had to drive to another town a few days each week to receive it. A team of 100 DIY volunteer tradespeople helped build a home dialysis room to give this family back their time together. The result will be unveiled in a show that will air on BBC.
LDO Stocks Down Slightly after AAKHI Announcment
WaPo Reports AAKHI as Biggest Improvement in Kidney Care since 1973
New Payment Models will Focus on Growth in Home Therapies
Read the Full AAKHI Report to See the Home Dialysis Focus and New Goals
Shocker: Aligning Care to Patient Goals Could Improve Dialysis
Which matters more to dialyzors: lab test results or being treated like people? You won’t be shocked to learn that yet another study finds that providers and patients have very different goals. Will person-centered care planning help? Stay tuned.
Fresenius Home Dialysis Workshop for Nephrologists
"There is a shortage of docs who understand every aspect on how to prescribe at home dialysis," said Dr. Dinesh Chatoth, Fresenius Associate Chief Medical Officer, speaking to professionals in Salt Lake City.
CMS and HHS Leadership Have Personal Kidney Connections
HHS Secretary Alex Azar II’s father was on dialysis and received a transplant. CMS Dupty Administrator and Director of the CMS Innovation Center (CMMI) Adam Boehler has a family connection as well. Both are poised to guide the Administration’s push for more home dialysis to improve outcomes and reduce costs, noted Rob Blaser in a presentation at the recent RPA meeting.
PD Gains Ground in Africa
As in the U.S., rising rates of obesity are driving higher levels of chronic kidney disease in Africa. A provider called Life Renal Dialysis is offering PD and saving lives.
We ♥ it When Home HD is on TV!
In a 5-minute Better Business segment, Dr. Osama Hussein from Tidewater VA gets a chance to describe home HD and even show a NxStage machine.
Giant Home Dialysis Program in Ontario
A home program at the Grand River Hospital in the Ontario Renal Network has more than 150 patients! Home treatments empower patients, who are trained by a multidisciplinary team.
Open House at DCI Home Training Clinic
Dialysis Clinic, Inc. hosted an open house last month at its new home training clinic in Yorktown Heights, NY. The new clinic will teach people with kidney disease about their treatment options and show them that home treatments are safe and convenient.
NANT’s DTX 2019 Offers a Full Day on Home HD – March 19 in Las Vegas, NV
Technicians and nurses can benefit from a focused look at home HD careers, patient retention, self-cannulation, reimbursement, technical regulations, and more! Learn more and register here:
Annual Dialysis Conference – March 16-19 in Dallas, TX
Don’t miss the cutting-edge info about PD and home HD at this year’s ADC! Find out the program details and register here: http://annualdialysisconference.org/wordpress/wp-content/uploads/2018/12/2019_PreliminaryProgram12.19.18.pdf
NICE! UK NHS is Asked to Offer ALL Dialysis Options
The National Institute for Health and Care Excellence (NICE) in the UK has released new best practice guidance for dialysis choice. The Institute recommended that patients receive education and support, and be able to choose PD, HD in a clinic or at home, and hemodiafiltration. Read the story.
Home Dialysis Changes Lives in the United Arab Emirates
Patients in the UAE were driving 7 hours or more for treatment, and their families were having to quit their jobs to be caregivers. Now, some are getting their lives back with home dialysis—and advocating for others. Read their stories.
Telehealth and Home Dialysis
Beginning in 2019, telehealth has been approved for 2 of every 3 monthly clinic visits, using patients’ homes as originating sites.
DaVita RN Knows Dialysis from Both Sides of the Needle
After Fallon Bell’s kidneys failed at 19, she finished a business degree, got a transplant. Even though her kidney failed, felt compelled to give back to her fellow warriors by going back to school and becoming a dialysis nurse. By the time her second transplant came through, she was ready to become a DaVita teammate. Read her story.
Center for Dialysis Innovation's IDEAS Symposium in Seattle
The symposium is bringing together innovators, bioengineers, nephrologists, patients and more to discuss ways to transform dialysis. It's sure to be an interesting event -- lots of great speakers lined up.
A Day of Home Dialysis CME Education in Sacramento
Learn the what, how, and why of home dialysis on October 5th.
Steps Along the Road Home
Enjoy a lyrical intro to a new series of journal articles about how and why to help patients get to home dialysis.
For PD Programs, Size Matters
Which is better—large PD programs, or smaller ones with more personal attention?
PD is Less Traveled—Why?
Although PD is more cost-effective than in-center HD, it is still underutilized in the U.S. This well-researched article—containing interviews with key thought leaders—helps explain some of the reasons.
Chicago Home Therapies Workshop for Clinicians September 20-21
The Advanced Renal Education Program (AREP), and international societies for PD (ISPD) and HD (ISHD) are offering a 2-day workshop on PD and home HD.
Webinar - Home Hemodialysis: Is it Your Best Treatment Option?
Dr. Michael Kraus and veteran dialyzer Vanessa Evans are presenting on a NxStage-produced free webinar on Tuesday, August 28.
Which is Safer—a Smaller PD Program or a Larger One?
In Australia and New Zealand, larger PD programs had less PD catheter removal, higher success rates for treatment peritonitis, and fewer patients who had to switch to HD because they weren’t doing PD correctly. Read the story.
Home HD Expanding In Dorset, UK
The Dorset County Hospital is funding a project to give more people the chance to do home HD—since independence and even health can be impaired by in-center treatments. Home dialysis “puts patients back in control of their own lives,” notes a nurse.
A KidneyX Champion at Health & Human Services
HHS Chief Technology Officer, Bruce Greenstein learned about kidney disease firsthand by watching his mother struggle—and nothing changed during her 14 years on dialysis. He is a champion of ASN’s KidneyX initiative to accelerate innovation.
The Hottest Dialysis Option in India
Work-friendly cycler PD is becoming the preferred treatment of choice in Hyderabad. But, there is problem: insurance does not yet pay for it.
Implications of Drugstore Dialysis
We’ve all seen by now that CVS—which now includes CareMark Rx and is looking to purchase Aetna—is developing a home dialysis device and planning to start a home dialysis service. What will that mean to current players? No one yet knows—but we’re hoping for a home dialysis renaissance ourselves...
Self-Care Dialysis in India
As in the US, there are not as many available kidneys as would-be recipients in India. PD and home HD reduce costs, improve independence and control, are more flexible than in-center treatment, and offer better quality of life. Yet, not enough people are aware of home treatment options. (Sound familiar?)
PD + HD = Better Outcomes
Patients treated with both hemodialysis and peritoneal dialysis from the start had better outcomes than those who used just one or the other, found researchers from Japan who presented at the Annual Dialysis Conference. Residual kidney function was stable, and patients were able to stay on the combined therapy for a decade.
Manual Exchanges for Urgent Start PD?
A new study of 20 patients found that cyclers do not have to be used for urgent start PD—manual exchanges worked just as well and had a similar side effect profile.
PEI says Go Home
PD was quite a late-comer to Prince Edward Island, Canada, arriving in 2016. Now, the island would like to double the number of patients who do PD instead of traveling to Halifax to get their treatment in clinics.
35 Years of Home HD
A published case report of a 65 year old man with Alport’s who has spent 35 years doing conventional home HD—while working—proves that there’s no place like home for dialysis.
MACs Threaten Nephrologists’ Ability to Provide Patient-Centered Care
Dr. Robert S. Lockridge Jr. argues in an NN&I policy article opposing the MACs proposal to limit HD payment to three treatments per week that the renal community needs to defend the rights of physicians to prescribe more frequent HD for patients who can benefit from it it.
Visually Impaired Couple Succeed with Home HD
An indomitable will and good problem-solving skills helped Canadian Sheena King take a NxStage machine home after 6 weeks of training—despite being legally blind. Now, she feels much better with the gentler treatments, and she is able to travel!
UK Camper Vans Introduce PD
If seeing is believing, it makes sense to show people a treatment option they might not be able to imagine. Patients on PD demonstrated the technique for other patients and families in campers parked outside of a dialysis clinic.
Fast Track to the Future
The U.S. Department of Health and Human Services announced its intent to launch a Kidney Innovation Accelerator—a public-private innovation fund to foster breakthroughs in dialysis and other treatments for kidney failure and help clear the path to market. Contact them if YOU have an idea! Read the story.
Canadian Province to Offset HHD Costs
A new grant program proposed for home HD patients in Alberta, Canada will help to offset the extra water costs of the treatment, which could be up to $700 a year. The new program can help more patients choose home HD, improving their quality of life.
Care Partners: Put on Your Own Oxygen Masks First
Caring for care partners is important! ER visits were 23% higher among patients whose care partners scored high for fatigue—or low for their own health status—and their Medicare costs were higher as well.
Attend a Rogosin “It’s Your Life” Info Session in NYC on Tuesday, Oct. 17
If you are in the NYC area, you can learn more about PD and home HD from doctors, nurses, and your fellow patients at a free seminar in Queens. It’s worth a subway ride to learn how your life can be better—and they will serve light food and beverages.
PD in India
NIMS is the first ISPD-recognized dialysis clinic in South India to provide PD training.
Home is a Win-Win for Dialysis Patients—and Their Neighbors
Dialysis patients in one Nashville, TN public housing complex no longer have to take public transportation to get to their clinics. Some of their neighbors have graduated the first training class to become in-home dialysis technicians.
Flying High on Nocturnal Home HD
Maddy Warren, 33, a banking consultant and skydiver who lost her kidney function as a teen and now does nocturnal home HD, was part of a Firefly formation team that took a silver medal at the UK Skydiving National Championships!
A pilot project of nocturnal home HD at home at Duke University is now one year old, and its organizer is very enthusiastic about it. “From a patient’s perspective, this offers a very convenient way to deal with the burden of dialysis,” says Dr. Ruediger W. Lehrich. “It’s the least intrusive method to manage renal replacement therapy.”
Home Again, Home Again…
Labrador, Newfoundland, Canada does not have its own dialysis clinic. So, for 4 years, Sheena King was forced to live hours from her home to receive her treatments. Now, thanks to home HD with Nxstage, she is finally able to go home.
Dialysis on the Fly
Katrina Aliengena loves the quality of life she has on home HD—including travel to her favorite vacay spot: Aruba. Her doctor reports that the home HD population has tripled in the last year! (Maybe it’s the beach views?)
Nocturnal HD Coming to a Fresenius clinic in Lubbock, TX
We are always happy to hear that new nocturnal HD programs are starting! The nocturnal option will let people continue to work—which improves the quality of life for patients and their families. Kudos!
Will Home be Where the Telehealth Is?
The Congressional Budget Office says Medicare coverage for telehealth in the CHRONIC Care Act would be budget neutral. If passed, starting in 2019 home dialyzors could do monthly visit at a dialysis clinic—or their own homes.
Home HD comes to Grafton, WV
A Fresenius clinic in Grafton WV is pleased to offer PD as well as both daytime and nocturnal home HD, so patients can treat themselves in the comfort of their own homes.
Eeny, Meeny, Miney, Mo
A new 30- to 60-day online program, called Modality Choice, for patients with advanced CKD to learn end-stage renal disease (ESRD) treatment options is led by a “virtual clinical care team” of nurses and patient mentors.
Clinic Is Where the Home Is
The Chronic Care Act would lift the geographic limits, starting in 2019, and extend the originating sites for monthly clinical assessments to patient’s homes. Home dialysis patients would need to have a face-to-face visit with a nephrologist every 3 months.
A Bundle of Joy for PD
After CMS began bundled payments in January 2011, the number of patients starting dialysis at home—especially with PD—has trended upward.
Going Home in Guam
US Renal Care will offer home dialysis through a new clinic that will open soon in Guam. The new, $7M clinic will be one of four on the island.
New Portage, Indiana Center Offers Home Options
American Renal Associates recently opened the Portage Clinic, their largest home program of four in the area, where their physicians are focused on home treatments.
Short daily home HD can burden patients and care partners—enough to cause drop out. When Satellite conducted a 6-center study (n=18) to see if every other day nocturnal treatments would be a good alternative, most participants decided to switch to nocturnal.
Let Education Be Your GUIDE
A new pre-dialysis program in the Netherlands called GUIDE increases the number of patients who choose and receive home dialysis.
Relo or NO?
Thanks to a pilot project in rural Canada, a First Nation man on dialysis does not have to quit his job and move 600 kilometers away to receive dialysis. Instead, he self-dialyzes in a home HD clinic for one.
Be Your Own Boss
Part-time funeral home employee and county commissioner W.E. “Bubber” Wilkes finds that PD suits his still-busy lifestyle at 66.
ICAHPS Still Misses the Mark for Home!
CMS has added six new ratings on patients’ experiences with care, including three that cover patient experience and three that rate doctors, clinic staff, and the clinics themselves, but there are still NO questions that apply to home therapies.
Education Key to Options Choice for Urgent Start Dialyzers
Emergency dialysis start (UPS) lead to worse outcomes than planned starts, and giving people education really does help them to choose a modality—including home dialysis.
Quality vs. Quantity of Dialysis—Which Matters Most?
The Kidney Care Quality Alliance aims to establish better quality metrics, including an ultrafiltration rate (UFR) rate of less than 13mL/kg/hour (which is still too fast).
You asked and CMS Listened—Finally
CMS finalized a rule that will update Medicare reimbursement rates for ESRD and dialysis, update the related Quality Incentive Program, and nearly double the training allowance for home HD.
Home Dialysis is Rewarding for Nurse
Shawn Kroft finds that helping her patients transition to home dialysis and improve their quality of life improves hers as well.
Dallas TV News Story Features Sam Trevino
A terrific article and live interview segment on Dallas TV help spread awareness of home HD using NxStage!
Satellite + Nx2me Connected Health = More Home HD?
Ever in the lead for home therapies, Satellite has signed a 3-year agreement to use the NxStage Nx2me iPad-based platform to help better link patients and clinicians and allow wireless transmission of flowsheet data.
Home Again, Home Again, Jiggety Jig!
The University of Alabama at Birmingham is piloting a 3-year PD telemedicine trial, thanks to a Baxter grant. Patients speak with their UAB doctor via videoconference from their hometown county health department, where their labs are also done as part of a “virtual visit”.
Going Home in Malaysia
With their NKF “Dialysis at Home” initiative, Malaysia intends to ease the burden on both patients and their dialysis organization. Sending patients home to do PD while sleeping allows patients to enjoy greater quality of life and be able to return to work.
CMS Proposed Rule for 2017 Meets with Mixed Reactions
While applauding CMS for increasing the payment add-on for home dialysis training by almost 50%, many advocates found the proposal for payment for more than 3x weekly dialysis needlessly complex and ambiguous.
Satellite Seeks Another Home Run.
Once again, Satellite is ahead of the curve, bringing dialyzers together to brainstorm new technology and ideas in an effort to double its home dialysis rate (again!) to 40%.
CMS May Increase the Home Training Payment
After 3 years of promises, CMS finally included additional training dollars for home dialysis in its 2017 Proposed Rule. Now, let’s see if this makes the final cut…
Home Dialysis in Skilled Nursing Facilities
Reliant Renal Care is committed to providing quality home dialysis—even when home is a Skilled Nursing Facility. Residents get short daily HD five times a week, and don’t have to take transport to a dialysis center.
Structured Predialysis GUIDE Program Gets More People Home
In the Netherlands, a structured pre-dialysis education program recommended a home treatment for 62.8% of the 102 patients studied—and of these, 34.2% chose PD, 8.2% chose HHD—and 32.1% actually did a home option, an increase of about 50% over the 19.5% who chose a home treatment before the new program.
Can You Hear Me Now?
Dr. Eric Wallace’s first long distance patient, Ellen McGowan, couldn’t be happier about his new telemedicine program. She used to have to drive about 120 miles for monthly home dialysis checkups, and now her trips are just 12 miles to the local Health Department.
Relief in Sight
Home dialysis patients in parts of Canada will soon receive up to $650/year to help pay increased water bills due to home HD.
CA Gives Home HD Care Partners Legal Protection
In a new decision, Castro-Ramirez, a man who was the home HD partner for his disabled son and refused late work shifts that would have interfered sued his employer after he was fired and won in a California Court of Appeal.
PD Over HHD? Follow the Money…
The start of bundled payments for dialysis boosted PD, but reduced HHD growth in the US. The change is attributed to a higher profit margin for PD and low HHD training reimbursement.
Jumping on the Home Therapies Bandwagon!
Nocturnal HD and other forms of home dialysis are among the areas the National Kidney Foundation of Singapore is looking at building up to better meet the needs of patients.
Satellite Gets Home Treatments Right
Satellite puts its money where it counts: with 22% of patients on home dialysis, they are the leaders among the top 10 providers.
So Simple, a Teen Can Invent One!
A Canadian teenager invented a dialysis machine for less than $600—and only won a Bronze award in her country Science Fair! (You have to wonder what took silver and gold.) Anya Pogharian continues to work on bringing her machine to market to help underserved countries.
House Calls to Improve Healthcare
Dallas TX Fire and Rescue’s mobile integrated health care service saves lives. A proactive home visit from a paramedic helped a 64 year old woman who’d had multiple ER visits, but refused to start dialysis because her nephrologist did not explain it to her. The paramedic did his homework, educated her, and she is now successfully using PD.
Leveling the Playing Field for Home Treatments
NNI interviews economist Alex Brill about policies that limit access to PD and home HD.
Congress Could Make Telehealth Easier for Home Dialyzors
H.R. 2948, the Medicare Telehealth Parity Act, would remove some barriers for home dialysis patients to use telemedicine connections and remote monitoring to connect with their nephrologists.
Home Treatment in Australia: Safer, Cheaper, Better
HHD provides better care while saving as much as $60 million dollars in New South Wales alone—as well as reducing the mortality rate by as much as 20%, said researcher Andrew Page.
Why PD is Winning the US Race to Home
Higher PD profit margins and lack of adequate HHD training reimbursement are some of the reasons PD is leading the way among home therapies, finds researcher Dr. Eric D. Weinhandl.
Learn About Home HD in 4 Easy Online Lessons!
The Fresenius elearning site now offers a simple, user-friendly online course about types of home HD, prescriptions, technical needs, training, and more.
Removing Partner Requirements Could Boost Home Treatments
A new report by Alex Brill, former chief economist to the House Ways & Means Committee, reaffirms a GAO conclusion. Policy barriers—including partner requirements (not present in other countries)—keep too many from benefitting from home dialysis.
Vietnam Sends Patients Home, and That’s a Good Thing
Patients in rural Vietnam no longer have to travel several times a day for life-saving dialysis. Local centers have been set up to teach patients to do PD at home, with excellent results and no infections so far.
Compact Quanta SC for Home HD Gives Ian Hitchens Wings
A Sugar Plum Fairy has to fly! But, Hitchens, a community theater performer, was earth bound with in-center HD. UK trials of the new, portable Quanta have found it easier to learn, cost-effective, and small. Prices are TBD.
Senate Finance Committee Looks At Telehealth.
The Bipartisan Chronic Care Working Group recommends allowing telehealth use for the required monthly clinical visit for home dialysis to provide greater flexibility and encourage patient independence.
PD or HHD, That is the Question…
A comparison of major clinical outcomes on daily home hemodialysis (HHD) versus peritoneal dialysis (PD) suggest that relative to PD, daily HHD is associated with decreased mortality, hospitalization, and technique failure.
In-center Capacity and Home Dialysis
A GAO report finds that the need to fill excess capacity due to an excess of dialysis clinics built over the past 25 years—along with better profit margins for in-center patients—has led providers to de-emphasize home dialysis.
AMA Telemedicine Position is Good News For Home Dialyzors
The American Medical Association and American Telemedicine Association are leading a charge for Medicare to recognize more telemedicine services. These include remote care management for home dialyzors, so they don’t have to travel long distances for doctor visits.
Award-Winning Assisted PD Program Opens Up Possibilities
Assisted PD opens up this option to people who could not otherwise do PD themselves. A Victoria, Australia, assisted PD program is letting people with cognitive or vision problems dialyze in the comfort of their own homes. The money-saving program won an award at an industry function in Melbourne, Australia.
Why Don’t Medicaid Patients Learn About Home Dialysis Options?
A Dialysis Patient Citizens survey found significant gaps (12-17%) in the information patients received about home HD, PD, and transplant between those covered by Medicare vs. Medicaid. Patients deserve to know all of their options—regardless of their health insurance provider!
No Surprise: GAO Report Says Care Partner Rule is Home HD Barrier
A long-awaited GAO report has emerged on home dialysis! While it notes that policies requiring a home HD care partner may inhibit use of this option, it does not provide guidance to address the problem, such as Medicare payment for a home aide (permitted prior to 1990) or relaxing FDA requirements for a care partner.
Dialysis Company is Debunking Kidney Myths
NxStage addresses myths about kidney disease prevalence and treatment, assuring people that there are, in fact, technological breakthroughs and that dialysis treatments can be done in the home.
Which Treatment Option is Linked with Better Survival After Transplant?
Five-year survival rates are better when people were doing PD prior to transplant, vs. standard in-center HD, suggests a meta-analysis by Dr. Micah Chan at the University of WI—Madison. Analysis of the six studies found an 11% drop in mortality after transplant when PD was used, and less risk of delayed transplant graft function.
Money Talks: Odds of Home Dialysis Dropped with Medicare Bundled Payments
People with traditional Medicare saw a 12% drop in the odds of receiving home dialysis after CMS changed to the bundle, vs. those in Medicare Advantage plans, who were not affected, finds a new study. And, those in areas with larger clinics—where nephrologists can swing by and see (and bill for) many patients in a short time—had a 16% drop vs. those in areas with smaller clinics. Follow the money…
Yes, heart function can improve on dialysis—IF it’s done like this
Longer HD treatments reverse some heart damage, finds a new study. People who did standard in-center HD treatments had left heart ventricles that grew larger (which can lead to sudden cardiac death). But, those who did in-center nocturnal HD had a significant drop in the size of their hearts’ main pumping chamber.
Dialysis after dark in Lima, OH
Lima Memorial Hospital has a new in-center nocturnal HD program from 9pm to 5am. “There is more waste removal from the blood, so patients’ blood is cleaner and they feel better,” said Dr. Masim Mastouri, co-medical director of Lima Memorial’s Nephrology Unit. “They have less cramps and better control over their blood pressure.” Hmm. Kind of makes you wonder why everyone doesn’t longer HD treatments.
If you’re not comfortable recommending home dialysis, find someone who is
Mark Neumann of Nephrology News & Issues attended the recent Indiana University Home Dialysis meeting, and was moved by the stories of people who were using home treatments and living more fully as a result. Everyone deserves the opportunity to have a better life with better treatment.
Yet more evidence that more dialysis leads to more life…
Taller people don’t live as long on standard in-center HD, a new study finds—and the risk is higher among men than women (larger body mass) and in those whose treatment times are shorter. It seems pretty clear that a one-size-fits-all approach is costing people their lives—and more dialysis is better.
Can PD Be a Long-term Option?
Read an interview with Dr. Marty Schreiber about his preferred sequence of ESRD options, causes of PD failure, future PD technology, best PD candidates, and thoughts about the Baxter solution shortage.
Baxter PD Fluid Shortage Blamed for Plunge in New PD Starts
Despite favorable reimbursement, PD starts from May 2014 to May 2015 plummeted to 1,393—compared to 4,357 in the prior year. Baxter’s dialysate shortage was likely a key factor.
Nocturnal Home HD Comes to Hong Kong
Six patients will be trained for nocturnal home HD this year at the United Christian Hospital in Hong Kong, including Ms. Yeung, 50, who is looking forward to being able to travel to Osaka, Japan again. “Now I can do hemodialysis while sleeping and can reserve my day time for work, family, and volunteer work.
Nephrology Pros: Don’t Miss Hemodialysis University October 2-3
The International Society for Hemodialysis is offering its 2-day intensive HD course in Chicago, IL. World-class speakers make this a must-attend event.
2-day “Killer Gap” Drives Hospital Admissions
We have known since AJ Bleyer’s work in 1999 that going 2 days with no dialysis raises the risk of death. A new study also finds an significant increase in hospital admissions.
Black Patients Less Likely to be Offered Home Dialysis
Black patients are 2.2 times less likely to be offered home treatments than white patients. Physician discrimination, lack of black nephrologists, and patient beliefs may be part of the reason.
Cleveland Clinic Includes Home Dialysis in Health Essentials.
The July 15 issue of the Health Essentials newsletter includes a solid description of dialysis and the benefits of choosing PD or home HD.
U.S. Pregnant Women on Dialysis May Need More Treatment Time
A small (n=75) survey of U.S. nephrologists found that 43% said they had cared for a pregnant woman on dialysis; some of whom were pregnant before they began treatment and others who became pregnant while on dialysis. Most prescribed 24-27 hours of dialysis a week, and the live birth rate was 77%. NOTE: Canadian research finds that pregnant women who dialyzed for 36 hours/week had an 85% live birth rate.
PD trash found in Michigan landfill
Disposal of dialysis waste is a challenge for many, but one PD consumer may find the police at his or her door. Boxes of PD solution, used bags, syringes, and other supplies were found illegally dumped in a landfill—with an address on the boxes.
Speak Your Truth artist on home dialysis does exhibit to raise awareness
Christina Thomas has MS and kidney failure, and dialyzes in her home four days a week. Instead of doing physical therapy, she paints during her treatments—and her new exhibit features works that will help raise awareness of kidney disease.
NHS opens in-center self-care unit in UK
Up to 72 people will be able to come in to a newly built dialysis clinic and run their own treatments on their own schedules in St. Pancras Hospital in London. One nurse with the program said, “You have patients who are struggling to come to terms with their condition, but by learning about their dialysis and doing it for themselves they get a buzz out of it and a sense of achievement.”
Canadian province sets ambitious goal for home dialysis
Not content to settle for just 24% of dialysis consumers at home (NOTE: This is more than double the US level), Northern Alberta has now set a goal of 40%.
PD has a 25% lower risk of dementia than standard in-center HD
Among 121,623 patients starting dialysis, those who began with PD had a 25% lower chance of developing dementia than those who started with HD—even after adjusting for age, gender, and other factors. Dr. Dawn Wolfgram and her team looked at USRDS data and claims data to rule out people who had dementia when they started treatment, though doctors may have steered cognitively impaired patients away from a self-care option like PD.
Which is safer for urgent start dialysis, PD or HD?
If dialysis must start right away, which option offers a better chance of avoiding infection and living longer—PD or HD? In Dr. Arshia Ghaffari’s study, reported in abstract form at the NKF Spring Clinicals, the clear winner was urgent start PD. Urgent start HD had a 43% higher rate of hospitalization and 4.3 times the number of catheter-related infections.
Even in nursing homes, daily HD is dramatically better than thrice weekly
Compared to 3,391 nursing home residents receiving standard in-center HD (ICHD), 528 residents who did short daily HD had markedly better survival. In fact, in the first 3 months of treatment, mortality among standard ICHD patients was 70%, 72%, and 64%—while for the same 3-months, mortality with daily HD was 50%, 24%, and 17%—with albumin and hemoglobin levels similar or higher and ferritin levels lower.
See what Mark Neumann learned about home HD at the ADC meeting
Regional training programs, telling patients about home options, and incentives for returning to work were some of the take aways from the full-day home HD workshop at this year’s Annual Dialysis Conference.
What will the new PD catheter placement study learn?
PD catheter placement practices are highly variable—but some are better than others. In a new study, 40 clinics from the US and Canada have taken a 29-item survey designed to identify factors in successful PD catheter placement and establish a framework for improvement.
Home dialysis nephrologist wins highest civilian honor in Indiana
The Governor of Indiana has given the Sagamore of the Wabash award to astronauts, presidents, ambassadors, artists, and others who have contributed to the state. And, now, Michael Kraus, MD, has been honored!
Nocturnal HD has FINALLY been blessed by the FDA!
Americans on dialysis should now have far better access to gentle, overnight treatments that let them fill their days with what they value—while getting the most HD possible. What a great way to start 2015!
Home HD trumps PD for living longer
The Chronic Disease Research Group matched 4,450 NxStage users with people on PD between 2007 and 2010, based on 33 factors. Compared to those on PD, people who did daily home HD had a 13% lower risk of death from a heart problem and a 20% lower risk of death from infection. They were also more likely to keep using the treatment they chose.
Frequency of dialysis DOES affect survival
A new analysis by Austin Stack of 585,911 U.S. dialyzers between 2005 and 2010 has found the best survival among those who did PD (10% better than standard in-center HD)—and home HD at least 6 days per week (26% better than standard in-center HD).
Maybe the time is finally right for incremental PD
People who start dialysis tend to have at least some residual kidney function. So, why do we treat them as if the don’t? In light of the recent shortage of PD solution, long-time incremental PD advocate Tom Golper MD believes it makes sense to start PD gradually and build up as needed. (Note: This approach might have helped my neighbor’s dad keep doing PD, too.)
Is PD survival better than standard in-center HD?
For the first 3 years it seems to be—even when PD is compared to people who start standard HD with a fistula or graft (not a catheter). A new study done at Kaiser Permanente confirms a survival benefit that has been found in other studies.
Nocturnal in-center HD comes to…
…Singapore! The National Kidney Foundation of Singapore is opening a new clinic (one of six) that will offer in-center nocturnal HD at a time that makes sense for people’s lives: from 11pm to 6am.
Where in the world can you dialyze at night and not miss work?
How about Chennai, India? In-center nocturnal is a new option for NephroPlus clinics there. Eight hour treatments three times a week at night don’t intrude on the work schedule and allow people to feel better.
More people would dialyze at home if more clinicians recommended it
We know that 94% of U.S. nephrologists would choose a home treatment option if their own kidneys failed. Yet, an article in Modern Healthcare notes that nephrologists do not get enough training in home therapies. Despite reimbursement challenges and upfront training costs, however, home therapies continue to grow.
A whole new way to think about green dialysis
Home dialysis saves millions of kilometers of travel in BC and the Yukon. Seven million kilometers, to be precise. Just 1,000 Canadian patients doing home treatments saved that much time (20-35 years!) and gasoline. This is a whole new way to think about green dialysis.
PD Supply Shortage Story Makes a Major Newspaper
If you need to do a life-saving treatment and the supplies are back ordered, you would freak out, too… The NRAA and the Renal Physician’s Association both wrote to the FDA to ask them to allow imported PD solution into the US.
Things that people give up to do standard in-center HD
It’s great to see home therapies growing in Oklahoma! At the DaVita Tahlequah dialysis clinic, social worker Cary Odom has staff do a quality of life exercise to show them how much they would have to give up in their lives to do standard in-center HD—and how home treatment can give people back control of their lives.
Dr. Jeff Berns thinks the US could do a better job of modality education
So, 90% of U.S. patients end up doing a treatment for kidney failure (standard in-center HD), that 94% of nephrologists wouldn’t choose for themselves. Most new fellows don’t feel competent prescribing PD. Better physician training may be the key to changing the modality distribution.
Money talks. How does that affect home dialysis?
Better payment for home dialysis training and for PD under the bundle “made it more lucrative for clinics to suggest the in-home option to patients,“ doctors said, notes a new article about increased uptake of home dialysis in the US. Clinics are, of course, required to tell patients about all of their options and where to get them—regardless of how well each one pays.
Kidney community loses a PD champion
Dr. Karl Nolph, a pioneer in peritoneal dialysis, passed away in June, at age 77. Read the transcript of Dr. Dugan Maddux’s terrific interview with him on VoiceExpeditions.com.
What is “User-friendly” and gives patients more control?
Why, PD, of course! (But, you knew that, right?) Dr. Alfred Cheung, who was the program chair for the NKF Spring Clinical meeting in Las Vegas, says the NKF wants to “spark more enthusiasm” for the therapy. Changes to the bundle have made PD more appealing, and numbers are rising. Newer technology—and recognition of the downsides of doing HD just 3 days a week are driving an upsurge in home HD as well.
What helps nursing home patients live longer?
In a study of almost 4,000 nursing home residents followed for up to 6 years, those who were given short daily HD lived far longer (50 months) than who received standard in-center HD (30 months).
Find out what's up with PD in India
Costs have dropped for CAPD in India, and, at least in Aurangabad, that's great news. Various professionals including engineers, bankers, and businessmen, along with students and senior citizens are now using the convenient therapy.
Read Australian home dialysis newsletters
There is a LOT more home dialysis in Australia than in the US. Read the messages they give to patients in their newsletters on their home dialysis website.
Could regionalized training boost US home HD rates?
Dr. Chris Blagg posits that because successful home HD requires a critical mass of experienced professionals, one way to grow the therapy in the US may be to offer regionalized training—rather than try to have every clinic open a small program. Read the story to see how it could work:
Cool! Vacation dialysis with a mobile Big Red Kidney Bus!
In Victoria, Australia, a Big Red Kidney Bus will set up for 6 weeks at a time at popular holiday spots, staffed by nurses and technicians. The new bus makes vacations possible for many who would not otherwise travel.