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United States Lags Behind Other Countries in Home Dialysis

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The push for home dialysis in the United States is taking on a new urgency in the backdrop of COVID-19, according to nephrologist Christopher Chan, MD, head of the division of nephrology at University Health Network (UHN) in Toronto.

The first two patients in the United States known to have died from COVID-19 were outpatients at dialysis centers in the Seattle area.

“In the context of a pandemic, home dialysis makes even more sense. “End-stage kidney disease patients are relatively immunocompromised, and the current practice of in-center dialysis does not allow for social distancing. Home dialysis can provide life-sustaining therapy while minimizing exposure.”

Increasing the number of Americans on home dialysis is already on the radar, especially because the Advancing American Kidney Health  initiative — launched last year by President Trump — aims to have 80% of new patients with end-stage renal disease (ESRD) on home dialysis or receiving a transplant by 2025, Chan explained.

The 80% goal is “aspirational,” Chan said, but added that he hopes the plan will jump-start change. Two other goals are to double the number of kidneys available for transplant and reduce ESRD numbers by 25%, both by 2030.

This might help “direct nephrology in the US to get prepared and educate, and also put together the infrastructure to train patients to undergo these types of complex medical tasks,” said Chan, who was scheduled to speak at the International Society of Nephrology: 2020 World Congress of in Abu Dhabi, United Arab Emirates. The conference, which was to run from March 26 to 29, was one of many canceled in response to the COVID-19 pandemic.

Current Rates of Home Dialysis

The current rate of home dialysis in the United States is close to 10.0%, up from 6.1% in 2008 and 8.3% in 2016, according to the US Renal Data system.

“Most countries that currently have a pro-home-dialysis position tend to have around 30% to 40%,” said Chan. “That’s with a significant amount of education, at the trainee level all the way up to practicing nephrologists. Those have taken a lot of time to build.”

A lack of comprehensive education for patients and providers on the benefits of home dialysis is a barrier to uptake in the United States and in other countries.

In Toronto, multidisciplinary teams of nurse educators, pharmacists, social workers, and nephrologists work to educate patients about dialysis and manage their educational needs, he reported.

“If someone is prepared and taught about home dialysis, they are much more likely to start,” said Chan. Education and support can help patients overcome a fear of needles and any discomfort they feel at being without medical staff and separated socially,