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How to make home dialysis the industry standard

Learn 3 ways to make the shift toward at-home dialysis treatments a reality for more patients, leading to better health outcomes.

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Benefits of at-home dialysis care

Around 37 million people — roughly 15%of all American adults — currently suffer from chronic kidney disease (CKD), while another 80 million are at risk for developing it.1 Further, more than 800,000 Americans suffer from end-stage renal disease (ESRD).2

All told, that means that more than 45% of American adults are either currently facing a kidney condition or are likely to encounter one in the future.3

There are 2 treatment options for end-stage kidney disease. A patient can receive a kidney transplant — though only 22,000 are performed each year, in part, because donor-recipient matches are hard to come by4 — or they can take the more common route of dialysis.

Today, roughly 557,000 patients in the U.S. receive dialysis treatments,5 the vast majority of which are performed in an outpatient clinic setting. 

When travel time is factored in, the average dialysis patient can expect to spend as much as 5 hours per session 3 times a week.6 As a result, basic activities like maintaining employment, caring for children or traveling become virtually impossible.

To further complicate patients’ schedules, standard clinic dialysis often requires extended recovery time after each session. The median range is 2–4 hours, but 25% of patients report recovery times of 6 hours or more.7

What’s more, ESRD patients may need to be on dialysis for 5, 10 or even 20 years8—meaning this cumbersome treatment process may become a constant feature of their lives for years.

To address this conundrum, a dialysis-at-home movement has been building over the past 5–10 years. Beyond improving patients’ quality of life, conducting dialysis treatments in the comfort and safety of individuals’ homes also improves health outcomes, reduces health care costs and makes long-term dialysis more accessible.

Patients who conduct their dialysis at home have may more energy, get better sleep and are better able to keep up their appetite. That’s in addition to circumventing the scheduling and travel hurdles that come with long-term, in-clinic treatments.

In addition, conducting dialysis more frequently at home can reduce long recovery times. These benefits can translate to greater treatment adherence and thus better health outcomes — not to mention significantly lower costs. A study published by the Center for Medicare & Medicaid Services (CMS) found that $23.5 million could be saved in five and a half years if just one third of its ESRD patients switched from in-clinic to at-home dialysis.9

Steps to move beyond in-center dialysis

For a variety of complex reasons, in-center dialysis continues to be the norm for most Americans with ESRD, with only ~14% of all dialysis patients using at-home options.10 In part, home dialysis has a PR problem: Many patients don’t know there’s another way beyond the in-clinic standard.

In some cases, providers simply default to what they’ve always prescribed. In others, concerns about housing stability or health literacy prevent providers from suggesting at-home dialysis methods, which require patients to commit to diligent self-care and thorough training.

These hurdles, while not insurmountable, have held thousands of people back from pursuing at-home dialysis, even if it might be better suited to their needs.

But there’s also good news. Many in the health care industry are getting the message that home dialysis is a more attractive option for patients, providers and health plans alike. In fact, enthusiasm is growing so quickly that the home dialysis market is estimated to surge by 10% annually between now and 2030 as the public gains greater awareness of its benefits.11

Here’s what must change to make this shift toward at-home treatments a reality for more patients.

1. Educate providers about home dialysis

In a recent survey published in the American Journal of Kidney Diseases, researchers asked health care providers to list their top 3 perceived barriers to greater adoption of at-home dialysis. Their answers were telling: “poor patient education; limited mechanisms for home-based support staff, mental health and education; and lack of experienced staff.”12

In other words, 2 of their 3 reasons hinged on the inadequate capacities and training of health care professionals to support patients as they undertake a home dialysis regimen.

According to the National Kidney Foundation, the wait to get trained to do home dialysis can stretch on for far too long. A nursing shortage and current regulations limit how, when and where health care providers can train patients in home dialysis, resulting in patient wait times of up to a year. And the longer the wait time, the less likely that patients will complete the training or transition to home dialysis.13

2. Provide patients with dialysis support

Another barrier to home dialysis is that often a patient is not informed of the possibility because they begin treatment in a state of emergency — a situation known as “crashing” onto dialysis. By one estimate, between 50–60% of patients begin their dialysis journey by crashing.14

Proponents of home dialysis, however, point out that once patients are out of immediate danger, they can still receive appropriate information and education about switching to home treatment.

As the National Kidney Foundation writes, patients must receive “proper education on all of their dialysis options, including making sure that even patients who crash onto dialysis with no preparation can get education on other options once they have stabilized and can make informed decisions about their future.”15

3. Partner with a dedicated team

Another key aspect of making widespread home dialysis a reality is helping to provide a strong support system to patients. To successfully complete dialysis at home, they need an ongoing network of assistance that extends well beyond initial nurse training to include regular check-ins and in-person visits.

For many health plans, providing this kind of high-touch assistance simply isn’t feasible without a partner program. Plans that cover in-home support staff for patients when they’re beginning home dialysis can help smooth the journey and prepare patients to become fully independent over time.

They can also ensure that patients with certain disabilities or other concerns receive ongoing assistance to complete successful in-home treatment.16

Optum® Kidney Solutions (OKS) offers members access to a dedicated team of nephrology-trained nurses, social workers and other support staff who can assist members with the complex array of needs that come with home dialysis:

  • Does a patient have low health literacy, housing instability, a lack of familial support or other social determinants of health-related barriers to undergoing home dialysis? OKS is there to find solutions.
  • Has a patient failed to follow up on their home dialysis training post-diagnosis? OKS can help them locate a training center and get back on track.

For every challenge, there is a way to overcome it — provided that members have access to the right resources.

As the upsides of home dialysis become increasingly evident, and as public opinion turns toward this convenient and compassionate form of care, every part of the health care landscape must come together to make it accessible to those who need it most.

This may require new approaches and a deviation from the way in which things have always been done. But it’s abundantly clear that the benefits are well worth the effort.

  1. National Kidney Foundation. “Kidney Disease: The Basics.” Accessed July 10, 2024.
  2.  American Kidney Fund. “Quick Kidney Disease Facts and Stats.” Accessed July 10, 2024.
  3. United States Census Bureau. “U.S. Adult Population Grew Faster Than Nation’s Total Population From 2010 to 2020.” Accessed July 10, 2024. (Note: the 117 million people who currently have CKD or are at risk for developing it divided by the total adult U.S. population = 0.4776, which corresponds to the “more than 45%” figure.)
  4.  National Kidney Foundation. “Kidney Disease: The Basics.” Accessed July 10, 2024.
  5.  American Kidney Fund. “Quick Kidney Disease Facts and Stats.” Accessed July 10, 2024.
  6. University of California San Francisco. “The Kidney Project.” Accessed July 10, 2024.
  7. Bolton S, Gair R, et al. “Clinical Assessment of Dialysis Recovery Time and Symptom Burden: Impact of Switching Hemodialysis Therapy Mode.” Patient Relat Outcome Meas. 2021;12:315-321
  8.  National Kidney Foundation. “How Long Can Someone be on Dialysis?” Accessed July 10, 2024.
  9. Centers for Medicare and Medicaid Services. “CMS Announces Transformative New Model of Care for Medicare Beneficiaries with Chronic Kidney Disease.” Accessed June 10, 2024.
  10. National Kidney Foundation. “Making the Case for Home Dialysis.” Accessed July 10, 2024.
  11. Skyquest. “Global Home Dialysis Systems Market Size, Share, Growth Analysis, By Type (Peritoneal Dialysis and Hemodialysis), By Product (Service, Device) – Industry Forecast 2022-2028.” Accessed July 10, 2024.
  12. Reddy, Y., Kearney, M., et al. “Identifying Major Barriers to Home Dialysis (The IM-HOME Study): Findings From a National Survey of Patients, Care Partners, and Providers.” AJKD. June 6, 2024.
  13. National Kidney Foundation. “Making the Case for Home Dialysis.” March 26, 2024.
  14. Centers for Medicare and Medicaid Services. “Fresenius Kidney Care’s Home Dialysis Program.” Accessed July 11, 2024.
  15.  National Kidney Foundation. “Making the Case for Home Dialysis.” Accessed July 10, 2024.
  16. Ibid.