Home dialysis gains momentum

December 19, 2013 by Amy Fields
Credit: BillpSea/Wikimedia

Of the 400,000 people on dialysis in the United States only 6 percent to 7 percent are treated with home dialysis. Yet, patients are significantly more likely to choose home dialysis if they are given that option. Home dialysis is also a more economical treatment option.

Modalities for dialysis include hemodialysis (in a kidney center or medical center, or at home) and (at home). In-center treatments for hemodialysis are typically required three times per week. Peritoneal dialysis is an alternative way to remove waste products from blood through the blood vessels in the abdominal lining known as the periteneum. This procedure may be performed by the patient at home or while traveling.

Dr. Rajnish Mehrotra, professor of medicine in the Division of Nephrology and nephrology section head at Harborview Medical Center, compares outcomes in patients using center or home dialysis. His findings show a similar survival of patients with either of the two types of dialysis.

Outcomes research has led to recent changes in the Medicare reimbursement structure. These changes provide a strong financial incentive for promoting the use of dialysis at home. Currently less than 1 percent of Medicare beneficiaries are on dialysis but it accounts for 8 percent to 9 percent of the Medicare budget. Home dialysis costs $20,000 less than in-center treatment, which runs an average of $90,000 per year, per patient.

Working as a single practice group led by Dr. Fionnuala Cormack, a clinical instructor in medicine specializing in chronic , the nephrologists at the University of Washington have changed the model of care for their .

In addition to the consolidated, in-center care they provide hemodialysis patients, once a week, physicians, nurses, and support staff meet peritoneal dialysis patients at one of the kidney Centers in the community to deliver multi-disciplinary care.

"We have built an infrastructure to seamlessly provide home dialysis to our patients in the community that we serve," said. Mehrotra.

Partnering with the UW Department of Surgery has also provided outstanding results, according to Mehrotra. A team of surgeons headed by Dr. Zoe Parr, assistant professor of surgery, received special training on laparoscopic placement of peritoneal dialysis catheters to provide better care for patients.

The Northwest Kidney Centers has helped expand the peritoneal dialysis patient population by offering a class called Choices for patients with kidney disease. Patients who attend the class are more than twice as likely to choose home care. Recently they made the class available at Harborview Medical Center, so it is even more convenient for patients.

Dr. Stuart J Shankland, professor of medicine and head of the Division of Nephrology, said that the model that Mehrotra and his colleagues have developed for patients at UW Medicine "is at the forefront of how patient care should be delivered to this population with a chronic illness."

Currently, a large, international and multi-centered clinical study called Peritoneal Dialysis Outcomes and Practice Patterns, or PDOPPS, is underway to identify how differences in practice patterns affect the ability of to continue to do .

Mehrotra and Dr. Gail P. Jarvik, professor of medicine and head of the Division of Medical Genetics, are working on an ancillary study – the first and largest of its kind – to look at the genetic determinants of how peritoneal dialysis works.

"What we do in peritoneal dialysis is use naturally occurring membrane that lines our abdomen as a dialysis membrane," said Mehrotra. "But there is huge variability from person to person in how efficient that membrane is in getting rid of the toxins that accumulate in people with kidney disease. We want to test the hypothesis that this variability is determined genetically."

The longstanding tradition at UW Medicine of improving began more than half a century ago under the late Dr. Belding Scribner, the inventor of long-term dialysis. Progress continues through the recruitment of Mehrotra to the Division of Nephrology.

"Dr. Mehrotra's research is pioneering," Shankland noted, "and partnering with Dr. Jarvik is almost certain to give insights that would help determine who the best candidates are to receive this therapy and potentially predict those who might develop complications."

Explore further: Peritoneal dialysis as an intervention for stroke patients

Related Stories

Peritoneal dialysis as an intervention for stroke patients

September 3, 2013
Ischemic stroke is characterized by an interruption of the blood supply to the brain, which can lead to brain damage and even death. Excess amounts of the excitatory neurotransmitter glutamate are released during stroke events ...

Snapshot of dialysis: Who's getting treated at home?

February 2, 2012
Home-based dialysis treatments are on the rise in both the developing and developed worlds, but developed countries appear to be turning to them less often, according to a study appearing in an upcoming issue of the Journal ...

Surprising results for use of dialysis for kidney failure in developing world

April 26, 2012
Researchers at Lawson Health Research Institute have discovered that developing countries have faster growing rates of use of home-based dialysis (called peritoneal dialysis) for kidney failure than the developed world. Despite ...

Dialysis for the elderly: New evidence to guide shared decision-making

November 8, 2013
New research from Mayo Clinic finds that half of elderly patients who start dialysis after age 75 will die within one year. The findings are being presented this week at the American Society of Nephrology's Kidney Week 2013 ...

Quality of life and treatment of late-stage chronic kidney disease

September 11, 2012
Renal transplantation is best treatment option for improving quality of life in people with late-stage chronic kidney disease

There's no place like home—for dialysis

October 4, 2012
Most patients with chronic kidney disease who undergo hemodialysis put up with a grueling treatment regimen that involves going into a clinic several days a week and sitting through a three-to-four hour dialysis session at ...

Recommended for you

Google searches can be used to track dengue in underdeveloped countries

July 20, 2017
An analytical tool that combines Google search data with government-provided clinical data can quickly and accurately track dengue fever in less-developed countries, according to new research published in PLOS Computational ...

MRSA emerged years before methicillin was even discovered

July 19, 2017
Methicillin resistant Staphylococcus aureus (MRSA) emerged long before the introduction of the antibiotic methicillin into clinical practice, according to a study published in the open access journal Genome Biology. It was ...

New test distinguishes Zika from similar viral infections

July 18, 2017
A new test is the best-to-date in differentiating Zika virus infections from infections caused by similar viruses. The antibody-based assay, developed by researchers at UC Berkeley and Humabs BioMed, a private biotechnology ...

'Superbugs' study reveals complex picture of E. coli bloodstream infections

July 18, 2017
The first large-scale genetic study of Escherichia coli (E. coli) cultured from patients with bloodstream infections in England showed that drug resistant 'superbugs' are not always out-competing other strains. Research by ...

Ebola virus can persist in monkeys that survived disease, even after symptoms disappear

July 17, 2017
Ebola virus infection can be detected in rhesus monkeys that survive the disease and no longer show symptoms, according to research published by Army scientists in today's online edition of the journal Nature Microbiology. ...

Mountain gorillas have herpes virus similar to that found in humans

July 13, 2017
Scientists from the University of California, Davis, have detected a herpes virus in wild mountain gorillas that is very similar to the Epstein-Barr virus in humans, according to a study published today in the journal Scientific ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.