A top area to watch in 2020 is the new emphasis on home dialysis. On July 10, 2019, President Donald Trump signed an executive order launching Advancing American Kidney Health. Based on this executive order, the US Department of Health and Human Services (HHS) released three major goals to improve kidney health. The first goal is that 80% of incident kidney failure patients in 2025 receive a home modality of dialysis or a transplant. To facilitate this goal, mandatory and voluntary reimbursement models are being released. The mandatory model, ESRD Treatment Choices, will incentivize the provision of dialysis in the home.
In addition to the focus on home dialysis, HHS has also set goals of reducing the number of Americans reaching end stage kidney disease by 25% and doubling the number of kidneys available for transplantation by 2030, and calls for a public awareness initiative to increase awareness of kidney disease for both patients and providers as well as for funding to support the development of an artificial kidney.
There is a large anticipated educational need to meet the lofty goals of 80% of patients receiving dialysis in the home setting or a kidney transplant. A recent survey of graduating nephrology fellows in the United States found that 46% of trainees would like to receive additional instruction during fellowship in peritoneal dialysis, and a 2010 survey of 133 early career nephrologists showed 45% did not feel competent in the management of peritoneal dialysis patients. A remarkable finding of a 2010 survey of nephrologists was that 93% would choose a home modality as their initial renal replacement therapy modality. Furthermore, many myths exist regarding selection of patients suitable for peritoneal dialysis despite literature disputing the myths, including that obesity, diabetes, and autosomal dominant polycystic kidney disease are contraindications.
In 2020, Kidney News will launch a new series, Peritoneal Dialysis 101, which is meant to serve as an introduction to peritoneal dialysis, the most prevalent form of home dialysis, for physicians. The series will include articles on the history of peritoneal dialysis, outcomes, debunking myths, and basics of prescribing, and will conclude with options for further education in home dialysis.
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