At-home Dialysis on The Rise

Because of concerns over community spread of COVID-19, the pandemic has greatly accelerated patient interest in home hemodialysis treatments. There’s also a need to find solutions that will improve the quality of life of people living with kidney failure.

For these reasons, Fresenius Medical Care North America, based in Waltham, Massachusetts, encourages many to consider home dialysis for greater scheduling flexibility, fewer food restrictions and improved clinical outcomes.

“These aspirations are shared by CMS, which has launched payment initiatives to support a greater uptake of home dialysis in the U.S.,” says Joe Turk, president, home and critical care therapies, Fresenius Medical Care North America. “While our company was aligned toward home dialysis well before this federal effort, the entire industry is now clearly focused on advancing technology, education and support for home dialysis.”

Theresa Mottes, M.S.N., RN, president of the Nephrology Nursing Certification Commission, has more than 25 years of pediatric renal replacement therapy experience in the critical care and outpatient dialysis settings and spent 15 years with the pediatric dialysis program at C.S. Mott Children’s Hospital in Ann Arbor, Michigan. She says she has witnessed a big shift from predominantly in-center to home dialysis, either hemodialysis or peritoneal dialysis.

“Technological advancements will be necessary for the success of home dialysis,” she says. “For a paradigm shift to home dialysis, the industry will need technology to develop a machine that is fully integrated and improves the ease of use.”

Although some are out there already, in development are several smaller, potentially wearable devices that reduce the burden of chronic kidney disease treatments, Mottes says.

Home dialysis also makes it much easier for physicians to prescribe individualized therapy without the constraints of an in-
center schedule, which is typically three days per week for all patients.

“We’ve seen significant improvement in cardiovascular-related hospitalizations for patients dialyzing at home five or six days a week, and many patients report having more energy with a more frequent schedule,” Turk says. “We also have studies showing that the use of connected health can also help reduce hospitalizations, allowing for more timely interventions.”

Transitional care units (TCUs) continue to be important to in-home dialysis. Industry experts reveal half of patients experiencing kidney failure who start dialysis do so without any ability to prepare for this life change. This means they do not have the chance to be fully educated on all treatment options and make informed decisions aligning with their life needs and values.

According to Turk, TCUs give patients a better chance to stabilize, offering the ability to start dialysis in a simpler, more focused fashion. “It also tends to lead to more patients pursuing home dialysis because patients are better prepared and empowered to make this choice,” he says. “In fact, FMCNA (Fresenius) has seen over 40% of patients who go through a TCU ultimately choose a home modality: hemodialysis or peritoneal dialysis.”

Connectivity is another important development. Dialysis machines traditionally have been very analog, but today’s systems can instantly, securely transmit data to the cloud for providers to access remotely. This makes kidney disease treatment more convenient for patients and providers. In the home setting, utilizing smart sensors and wireless data transfer frees patients from manual data entry and ensures that providers get the information they need.

Tools to use

Leslie Trigg, CEO of Outset Medical in San Jose, California, notes that the company has always believed dialyzing at home was vital to restoring identity, autonomy and a sense of self-worth for those managing kidney disease. “Due to reported patient satisfaction, compounded with the government’s initiative to shift towards home dialysis, we’re expecting to see this segment expand significantly over the next few years,” she says.

To deliver on its promise, Outset embarked on a clinical trial in 2016 to generate data showing the safety and efficacy of dialyzing at home with Tablo. The clinical and regulatory journey took four years and culminated in FDA clearance of the device in 2020 for the home setting.

Tablo combines the technology of multiple machines into one compact, 36-inch-tall unit that is approved for use from the hospital to the home.

“Our vision is to create a seamless and supported transition to the home, and the Tablo Hemodialysis System offers a new level of operational simplicity aimed at improving patient adoption, experience and retention,” Trigg says.

Recently, Outset Medical heard from clinicians that the pandemic introduced a critical need to reduce patient proximity during dialysis treatments to reduce COVID-19 transmission rates. In response to this, it incorporated their feedback to update the design of Tablo’s data analytics platform, TabloHub.

“TabloHub uses data transmitted securely and wirelessly from Tablo systems to the cloud to enable physicians to remotely support and monitor this vulnerable patient population with live and historical data,” Trigg says. “Clinicians have the ability to view real-time patient data without needing to be in the same room as their patients.”

Fresenius’ The NxStage home hemodialysis machine is the first and only portable hemodialysis system cleared for home use in the U.S., according to the company, and the only machine small enough to take on the road or even on a plane.

“While the machine itself has been transformative, the 37% growth in home hemodialysis treatments among our patients in 2020 is also attributed to the depth of patient and staff training and real-time support that surrounds the device,” says Turk of Fresenius. “We also recently expanded our long-standing collaboration with DaVita (another dialysis company) to help bring NxStage home hemodialysis to more patients than ever before.”

Fresenius’ connected health solutions also include TheHub that comprises three integrated applications allowing patients, care teams and physicians to better collaborate and monitor patient treatments. Fresenius is also using artificial intelligence to develop and apply predictive models that can help pinpoint the reasons for hospitalizations. “Importantly, we incorporate these algorithms and data into our clinical care models across our 2,600 dialysis clinics to ensure these insights are converted into actionable intelligence,” Turk says.

Looking ahead

Many people involved in kidney disease care expect the use of home hemodialysis to continue to increase over the next five years.

“This past year has shown health professionals and patients that remote dialysis treatment works due to the benefits home dialysis provides — independence and convenience for patients and the reduction of resources and staffing needs for providers,” Trigg says. “Dialysis clinics are already reporting higher home dialysis growth rates as a result of the COVID-19 pandemic and telehealth utilization.”

CMS’ new kidney care payment model, which began this year in January, increases the incentive for the home dialysis care with increased payments. This federal push for more at-home kidney disease treatment is expected to seed more innovation in kidney care.

Value-based care in collaboration with private insurers and the federal government will continue to play an important role as the industry advocates for more timely referrals to a nephrologist and early, upstream efforts to slow the progression of kidney disease. As a result, clinicians will have more time to educate patients about the advantage of home therapies.

“We believe every patient should be considered for home dialysis” comments Turk. “The best way to help grow adoption of home dialysis is to have more patients prepared to make this choice earlier in the process.”

Keith Loria is a freelance writer in the Washington, D.C., area.