Home Dialysis

Home Dialysis

In 1972, when the Medicare Act provided people in the United States with coverage for renal replacement therapy, 40 percent of patients were doing home hemodialysis (HHD). In 2003, only 0.7 percent of the dialysis population in this country were doing HHD. The Aksys Company was founded in January 1991 to develop an HHD machine that would be patient friendly; reduce the labor of setting up, putting on, and tearing down; provide ultrapure water; and reuse the dialyzer and blood tubing to reduce cost. Since then, the following advances in HHD devices have continued to evolve.

Impact of the Prospective Payment System (PPS) on Home Hemodialysis

The vast majority of patients with end stage renal disease (ESRD) undergoing dialysis receive this care through a Medicare entitlement enacted in 1972. Up until 2011, payment for dialysis treatments included one payment for the basic treatment itself, including all of the associated costs, and a separate payment for injectable medications (primarily erythropoietin, vitamin D, and iron) and some laboratory tests.

Various home dialysis systems available for consumer use.

In 1972, when the Medicare Act provided people in the United States with coverage for renal replacement therapy, 40 percent of patients were doing home hemodialysis (HHD). In 2003, only 0.7 percent of the dialysis population in this country were doing HHD. The Aksys Company was founded in January 1991 to develop an HHD machine that would be patient friendly; reduce the labor of setting up, putting on, and tearing down; provide ultrapure water; and reuse the dialyzer and blood tubing to reduce cost. Since then, the following advances in HHD devices have continued to evolve.

Home hemodialysis (HHD) has emerged as an important alternative treatment option for patients with end stage renal disease. The renaissance of HHD is based in part on several established and potential clinical benefits. In addition, HHD also acts as a conduit for intensive hemodialysis, which is otherwise not feasible in the context of dialysis centers. Various considerations and implications of establishing and implementing HHD have already been covered in this issue of ASN Kidney News. The clinical benefits of HHD will be discussed and summarized here.

When snake oil salesmen peddled their cure-alls, an undefended populace fell prey to the “best story,” the “best sell,” and the “most persuasive line.” Then, as remedy upon remedy failed to prove effective, to be safe, or to give value for money, greater scientific rigor was demanded of medical intervention. With statistical methods improving in parallel, “proof by clinical trial” emerged.

Dialysis leads to massive changes in an individual’s lifestyle. This is especially true for in-center conventional hemodialysis (CHD), which necessitates that patients constantly travel back and forth to their dialysis facility at least three times a week.

Home Dialysis: Patient Selection and Psychosocial Support

Which patients might benefit from home dialysis? Clinically, virtually all of them—a fact that nephrologists know given that only 6 percent of them would choose standard in-center hemodialysis (HD), done in a clinic thrice weekly for 3 to 4 hours, if their own kidneys were to fail (1). There is clearly an enormous disconnect between knowledge and practice, inasmuch as more than 90 percent of American patients with kidney failure are prescribed the treatment most nephrologists would not choose for themselves.