Speaker: System barriers block Advancing American Kidney Health goal for home dialysis
SCOTTSDALE, Arizona — Many barriers stand in the way of decisions regarding home dialysis therapies, but if nephrologists individualize modality options for patients based on their current needs and goals, there is a better likelihood that patients will succeed on dialysis, a speaker said during the Southwest Nephrology Conference held here.
In July 2019, President Donald J. Trump signed an executive order declaring that 50% of new patients on dialysis should be placed on home hemodialysis instead of in-center dialysis by 2025.
“Home dialysis is growing. It was growing before the executive order and it was doing that for several reasons,” Thomas A. Golper, MD, FACP, FASN, a nephrologist at the Vanderbilt University Medical Center in Nashville, told attendees. However, he said taking steps to greater growth is impacted by physician bias, government and commercial payers, and patient choice – all which play determining roles in whether patients do home dialysis.
“There was an increased rate of people going home; they are doing better with less people dying” from inadequate dialysis, Golper said. “And with all that, many barriers still exist.”
If patient choice is preferred on modality options, educational issues dealing with patients’ knowledge on home therapies needs to be fixed, Golper said, as well as physicians’ own understanding of the patient as an individual.
“We already know that, for a fact, the fellows are saying we’ve had inadequate training” in home therapies, Golper said. “Education is a two-way street. Most of us think patients need to first learn about the therapy. I think that before they learn about the therapy, we have to learn about them.”
Golper recommended physicians learn about the psychological and physiological aspects of patients they are treating and how to exploit these differences to make the dialysis experience easier. At Vanderbilt University Medical Center’s dialysis program, 35% to 40% of patients are on home dialysis. Patients need to know that they are making the decision, and if they choose not to do one of the renal replacement therapies, physicians need to help the patient with active medical management, Golper said.
Communication and listening are also important in the dialysis environment. Physicians should communicate their struggles and discomfort with topics with their patients and listen to what patients know about dialysis therapies, what they have misconceptions about and what therapy they think is best for them.
“So, is it possible to get 50% of people on home? I don’t think so,” Golper said. “But the other question, the more important one, ‘Is it the right thing to do?’ I think we need to do the right thing for patients at the right time. That may be home, but it may not be.” – by Erin T. Welsh
Golper T. Is it possible to get 50% of patients on home dialysis? Presented at: Southwest Nephrology Conference; March 6-7, 2020; Scottsdale, Arizona.
Disclosure: Golper reports being on the advisory board for NxStage Medical, Akebia Pharmaceuticals and Reata Pharmaceuticals; is a course director for Home Dialysis University; receives honoraria and grants from the Renal Research Institute; and receives royalties from Up To Date.