We need greater access to home hemodialysis

We need greater access to home hemodialysis

As a doctor who also happens to be an end stage renal disease (ESRD) patient, I appreciate this opportunity to reflect on the great strides that have been made to improve the lives of ESRD patients and the steps that still need to be taken to make sure kidney patients have access to the best dialysis treatment possible and the best chance to live normal and fulfilling lives.  I strongly believe the answer for many patients includes shorter, more frequent dialysis treatments made possible with home hemodialysis (HHD).

While practicing internal medicine, I had the opportunity to treat many hemodialysis patients in the hospital setting and in my office practice.  In the days that my own kidneys were healthy, I was blissfully unaware of the rigors of dialysis therapy that these patients endured in the conventional in-center unit.  That quickly changed in February of 2007 when I became a dialysis patient myself.  At that time, I started in-center hemodialysis and entered a new world of very large needles and headaches, especially after long weekends created gaps in treatment, and severe restrictions in my diet.

It has been a journey that my wife has taken with me, side by side which finally led to our decision to take my treatments home. I am one of the fortunate 1% of hemodialysis patients in America able to create my own patient centered care by being at the forefront of my health care team in the comfort of my own home.

Home hemodialysis (HHD) changes lives – and it has certainly changed mine.  The shorter, more frequent dialysis treatments at-home or on-the-go provide significant and wide-reaching therapeutic benefits, including more energy, quicker recovery, improved appetite, better blood pressure control with fewer medications, less stress on the heart, even lower risk of death.  All of these benefits result in an improved quality of life that enables patients like me to do the things we want to do.

But despite the clear benefits, we are leaving too many fellow patients behind when it comes to HHD.  Case in point:  right now, more than 90% of patients on dialysis in the United States are doing treatment three-times-a-week in center, opening them up to a host of complications that often lead to more visits in the emergency room, and are all potentially prevented with longer duration and more frequent hemodialysis.

There are a number of reasons for this lag, including disparate training reimbursement and a lack of patient education.  I can say from experience that I only had one nephrologist in the last two years of my illness prior to initiating dialysis discuss the home dialysis option as a primary treatment option. It was his information that started me down the path of home hemodialysis.  Today, I am extremely grateful for this.

The Centers for Medicare & Medicaid Services (CMS) has the power to change this.  By updating its current payment structure to provide adequate reimbursement for the up-front cost associated with HHD training, CMS can make HHD more accessible to patients.

I, for one, hope the agency will make this important change.

I am personally thankful for this extraordinary little machine that has given me the freedom and the opportunity to obtain daily dialysis.  I truly hope we can take the necessary steps to make sure it is available to more patients throughout the country.

Peter Laird is an internal medicine physician.  Since 2007, Dr. Laird has required renal replacement therapy with hemodialysis due to underlying IgA nephropathy and is an outspoken advocate for wider access to optimal dialysis strategies.   

Comments are moderated before they are published. Please read the comment policy.

  • Guest

    Who will pay to provide each haemodialysis patient in the United States with the equipment and training to do this? It’s a lovely idea, but that money will have to come from somewhere. Where? Who?

    • http://agardeninthesun.blogspot.com/ renoliz

      From the prices my friend was telling me it costs to get dialysis three times a week at a center 40 miles away from here, it might not cost more.

    • Peter Laird, MD

      Dear Guest, actually, home hemodialysis is surprisingly cheaper by far that conventional in-center hemodialysis and always has been since the early 1970′s when Home Hemo was about $14,000 the first year and a little over $7000 each year after. Conventional in-center hemo at the same time approached $28,000 a year.

      In addition to direct costs, indirect costs are lower as well since home hemo patients on average are admitted to the ER and hospital less frequently. One study at Kaiser showed less hospitalizations with Home Hemo compared to PD as well.

      Couple this with significantly improved outcomes and one must question why home hemodialysis is not the first choice therapy for renal replacement therapy when a preemptive transplant is not available.

      • http://agardeninthesun.blogspot.com/ renoliz

        That is amazing. I don’t understand why it costs so many thousands of dollars a year for my friend to sit in a chair for a few hours 3 times a week. I was shocked.

        Anyway, that is interesting to know. Maybe I’ll talk to my friend about this.

  • JG91

    “Case in point: right now, more than 90% of patients on dialysis in the
    United States are doing treatment three-times-a-week in center, opening
    them up to a host of complications that often lead to more visits in the
    emergency room, and are all potentially prevented with longer duration
    and more frequent hemodialysis.”

    This might sound like a stupid question, but if it’s more cost-effective and leaves patients open to fewer complications, what’s the hold-up in implementing it more widely? Is “the system” just that big and unwieldy that nothing, no matter how much sense it makes, gets done very quickly?

    After I got out of the service I was between jobs for a while, so did some volunteer work including driving people to medical appointments. Several of my clients were dialysis patients, it never occurred to me that what they were having done could be done at home. What a blessing that would be.

    “Faster, please!”

Most Popular