“Most patients start on PD, but eventually have to change to HD,” says Chris Lavanchy, Engineering Director at ECRI Institute. “It’s not usually the patient’s choice, but because of PD’s complications.” The risk of infection is higher for PD patients, especially in the abdomen or where the catheter is inserted. Permanent damage can occur at those sites and prevent the patient from receiving PD in the future.

While HD is generally performed at a clinic three times a week, studies have found that more frequent hemodialysis can improve a patient’s quality of life as well as survival rate, as it more closely imitates the constant work of a functioning kidney and helps reduce dialysis side effects such as high blood pressure. Home HD allows patients to perform the treatment every day and overnight rather than a few times a week. One study saw a 13 percent drop in mortality in home HD patients.


Homeward bound
In the 1970s, 40 percent of end-stage renal disease patients received home HD. But today, only 35,000 out of the 382,000 patients in the U.S. who receive dialysis treatment for kidney failure dialyze at home. Seven percent choose PD, and just 1 percent choose home HD.

In-center dialysis eclipsed home HD in the 1990s when Medicare policies allowed dialysis centers to charge higher fees. It was not until CMS added a financial incentive with its bundle rate for dialysis treatment in January 2011 that companies and physicians started to seriously invest in home programs again, according to Laura Schmidt, director of education and RV CARE for Renal Ventures.

CMS now covers self-dialysis training, home dialysis equipment and supplies, many drugs for home dialysis and certain home support services, such as visits from trained dialysis facility workers to check on the patient. It does not cover paid home dialysis assistance, however.

Thanks to CMS updates, PD in particular is gaining ground.

“For about a decade in the early 2000s, PD’s popularity waned, and physicians and providers stopped talking to their patients about it,” says Patricia DiGiovanni, COO at Renal Ventures, a dialysis provider. “In the last several years, physicians have again started talking to their patients about the option of PD. That, in conjunction with recent changes in reimbursement, as well as new advancements in dialysis delivery has contributed to PD’s pick up in popularity.”

And certain providers have taken notice.

Diaverum, a renal care provider, is planning to give more patients the possibility to be treated with PD to improve their quality of life. Currently, Diaverum is treating 2 percent of its patients with PD; the target is to increase this percentage to 7 percent by 2015.

December 2012 Magazine

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