Some hospitals are trying to improve the dialysis experience by encouraging patients to do their dialysis at home, but so far fewer than 12 percent of dialysis patients choose that option, according to the 2016 U.S. Renal Data System report.
The outcomes for home dialysis are equivalent to in-center dialysis, but the quality of life is better for patients receiving home dialysis, says Brendan Bowman, M.D., University of Virginia Health System regional medical director for dialysis. “We feel very strongly that home should be a patient’s first choice unless they have a clear reason not to do that,” he says. Promoting the home-dialysis option is one of the main reasons UVA created its transitional start unit. “It’s taking patients who’ve never heard of home dialysis and giving them a chance to learn about it in a controlled environment with us.”
Home-dialysis programs have to be patient focused, heavy in training and supportive of the patient, Bowman notes. Homes are assessed to make sure they’re fit for dialysis. Patients go through an intensive in-center training process, and only when they’re comfortable do they go home to give it a try. The nurse is only a phone call away if a patient has any trouble. “Generally, they do great,” he says.
As noted in the May 2017 H&HN article “DIY Medicine Helps Improve Outcomes, Reduce Cost,” home dialysis isn’t right for everyone. People who don’t have a home-dialysis partner to assist if there is a complication or who have poor eyesight, neurologic deficits or psychiatric problems would not be home-dialysis candidates.
Another barrier is many nephrologists’ unfamiliarity with home dialysis. Nephrology fellows typically are exposed to dialysis only in the hospital setting with acutely ill patients. “When you don’t have that experience, you don’t feel comfortable yourself talking to patients about it,” says Li-Li Hsiao, M.D., director of the Brigham and Women's Hospital Asian Renal Clinic in Boston and assistant professor at Harvard Medical School. “When the nephrologist is not discussing this option with patients, how will patients know it exists?”