Bringing Kidney Failure Patients Home

Nicole Fauteux
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To mitigate the risk of COVID-19 infection, a recent white paper released by the Kidney Health Initiative (KHI) Board of Directors urges KHI stakeholders to accelerate the development of home-based technologies for people with kidney failure (1).

“The COVID-19 pandemic is unmasking the shortcomings of in-center hemodialysis for people with kidney failure,” the paper states, noting that people who rely on in-center dialysis do not have “the luxury of social distancing during a pandemic,” exposing them and those working in dialysis centers to potential infection.

“The global medical device development community needs to collaborate and overcome barriers to bringing more people with kidney failure home for treatment,” Raymond C. Harris, MD, FASN, co-chair of KHI, told the press when the paper was released.

The white paper describes the benefits of home therapies and lays out a long list of challenges that are ripe for technological innovation. These include the efficient use of water, point-of-care infection detection, pump and filter miniaturization, vascular access, clotting avoidance, toxin removal, fluid regulation, filtrate transport, and the use of sensors and remote monitoring.

“It’s very exciting to see that people are interested and motivated in finding technological solutions to be able to facilitate more dialysis at home, but we have to make sure that we are prepared for the education and support that go along with those advances,” said Jeffrey Perl, MD, SM FRCP, an associate professor of medicine at the University of Toronto and staff nephrologist at St. Michael’s Hospital UnityHealth. “Technology will be one piece of a whole strategy to empower patients to be able to do dialysis at home.”

The white paper’s authors also emphasize the need to remain focused on the patient experience as technologies evolve. One current KHI project aims to build the capacity of innovators to incorporate patient perspectives and preferences as they iterate new designs and approaches to kidney replacement therapy (2). The paper states, “KHI has provided tools that innovators can use to integrate patient preferences and patient-reported outcomes throughout their product’s lifecycles so that the innovative solutions match what people with kidney disease need.”

The paper also stresses that vulnerable and underserved populations must receive equal access to any new technologies that are developed. “Now is the time to bring technologies to market that have the potential to reduce disparities and improve the lives of all individuals with kidney failure,” the authors conclude.

The Kidney Health Initiative is a collaborative partnership with the U.S. Food and Drug Administration and more than 100 organizations and companies. The ASN Alliance for Kidney Health created KHI in 2012 to realize ASN’s vision of a world without kidney diseases.