A new collaboration between ASN and Home Dialysis University (HDU) aims to boost nephrology trainees' knowledge and familiarity with home dialysis therapies. Starting this year, ASN is offering up to 30 scholarships for nephrology fellows to attend a 2-day, in-person HDU training course and participate in a new, 12-month virtual education program.
“ASN has been trying to understand and better assess how we can help the nephrology community in the areas of home dialysis advocacy and education,” said Jeffrey Perl, MD, FRCP, a member of ASN's Home Dialysis Steering Committee and a staff nephrologist at St. Michael's Hospital in Toronto. One key driver, he said, has been in meeting the Advancing American Kidney Health initiative, an executive order signed by former President Trump in 2019. The initiative—designed to transform how kidney diseases are managed over the next decade—called for increased utilization of home dialysis treatment and kidney transplants for Medicare beneficiaries.
Home dialysis is now coming full circle, Perl said. Most patients receiving dialysis in the 1960s did so at home, but through a series of policies and health care reimbursement changes, the majority shifted to receiving dialysis in facilities. Changes since 2011 in the Centers for Medicare & Medicaid Services' prospective payment system have equalized the payment structure for home versus in-center dialysis.
“There's quality-of-life and cost-saving benefits to patients receiving dialysis at home,” he said. “One area ASN chose to focus on was educating the nephrologists of the future…. Nephrology training and education [are key components] to our goal of universal access to home therapy and our ability to provide high-quality care.”
Some nephrology fellowship programs today still do not adequately educate their trainees in home dialysis therapy, either because faculty are not as familiar with home dialysis, or the programs do not have patients receiving the therapy, said Joel Glickman, MD, FACP, activity director of HDU and director of home dialysis programs at Penn Medicine in Philadelphia. “If you educate patients about home therapy, 30% to 40% will want to do it, but in the country, utilization is 15% or less,” he said. “There's a disconnect…and lack of education is a big part.”
In a 2010 ASN survey of recent graduates of nephrology training programs (1), only 15.8% said they felt well trained and competent in the care of home hemodialysis patients. A more recent survey that examined home dialysis training needs for fellows (2) found that only 30% of program directors felt their graduates could provide home hemodialysis management without supervision. A majority of program directors (74%) requested a virtual home dialysis mentorship program.
An initial solution is ensuring that fellowship program directors and fellows know there are available resources, such as HDU, which provide enhanced education on home dialysis, Perl said. Glickman added that the HDU curriculum covers the physiology of home hemodialysis and peritoneal dialysis, prescriptions and dialysis access and how to monitor patients and handle infectious and non-infectious complications, among other topics.
“The way HDU is structured, there's a lot of time for fellows to have contact with our faculty,” Glickman said. “We have our meals together and use frequent breaks to continue conversations about taking care of home dialysis patients. The faculty of HDU are passionate about making sure patients have the opportunity to [receive] home dialysis; promoting the use of home dialysis; and educating physicians, fellows, and other advanced practice professionals. I think that is one of the reasons we're going to be successful.”
To keep the momentum and education going in the new ASN-HDU program, following the in-person coursework, fellows will enroll in a 1-hour per month, yearlong, virtual component. In these continuing education sessions, nephrologists skilled in home dialysis will use case-based learning to continue trainees' exposure to a wide range of topics in home dialysis, Perl said. “We would like this to be the start of a greater focus on how fellowships can be enhanced to support home dialysis learning,” he said. “The ultimate goal is to train nephrologists to go into practice and feel comfortable and skilled in managing patients on home dialysis.”
Eligible applicants must be a second- or third-year nephrology fellow in an Accreditation Council for Graduate Medical Education-accredited training program, must never have attended HDU, and must have support from their training program director to attend the course and participate in the 12-month, longitudinal education program. They can have any level of prior experience with home dialysis.
Fellows selected for the program will receive meeting costs of up to $1500 to cover HDU registration, two hotel nights, meals during the meeting, and travel costs up to $300.
The in-person sessions will be held August 27–29 in Costa Mesa, CA, and September 10–12 in Charlotte, NC. For more information or to apply, visit https://epc.asn-online.org/projects/hdp/, and select “Apply for Scholarship Here.”
- 1. ↑
Berns JS. A survey-based evaluation of self-perceived competency after nephrology fellowship training. Clin J Am Soc Nephrol 2010; 5:490–496. doi: 10.2215/CJN.08461109
- 2. ↑
Reddy YNV, et al. Home dialysis training needs for fellows: A survey of nephrology program directors and division chiefs in the United States. Kidney Med (published ahead of print March 17, 2023). https://doi.org/10.1016/j.xkme.2023.100629