March 04, 2022
2 minute read
Disclosures: Weinhandl reports having previously consulted with Fresenius Medical Care, Outset Medical and Quanta DT on epidemiological research and having held volunteer positions on the board of Home Dialyzors United and Medical Education Institute.
Despite the logistical hurdles and personal care required, patients with kidney disease will find the benefits of home dialysis outweigh in-center hemodialysis, according to a speaker at the annual virtual dialysis conference.
“Home dialysis is the proverbial moon of chronic dialysis, and we should be going for it,” said Eric D. Weinhandl, PhD, MS, senior director of data analytics and home therapies for Satellite Healthcare.
Weinhandl made the comment in reference to a speech by President John F. Kennedy at Rice University in 1962 on the flight to the moon.
As an epidemiologist who has focused much of his research on home dialysis since 2004, Weinhandl said the therapy can help patients avoid some of the drawbacks of in-center hemodialysis and provide more flexibility not only for manage the prescription, but also to dictate the schedule.
“Home dialysis is customizable,” Weinhandl said. “[Home hemodialysis] HHD offers more sessions, shorter intervals and more treatment hours. [Peritoneal dialysis] PD offers continuous or semi-continuous therapy, depending on whether daytime stays are prescribed. Both therapies also preserve residual kidney function,” he said.
The benefits, along with government initiatives placing greater emphasis on home dialysis, have been influential in the increase in home dialysis in the United States, he said.
Weinhandl said data from the U.S. Renal Data System shows the incident rate — the number of patients starting home dialysis as their first modality — rose from 7% in 2009 to nearly 15% in 2019. Similarly, the number of patients who started home dialysis home treatment after 1 year of dialysis also increased by approximately 11% to 18% over the same period. All age groups saw growth in home therapy over this 10-year period, with the 18-44 age group having the highest number of patients using home therapy, Weinhandl said. .
Home therapies also offer other clinical advantages over center-based care, Weinhandl said.
“We know that patients experience a reduction in time-integrated fluid load, blood pressure, and use of antihypertensive medications; a likely lower risk of heart failure hospitalizations and a reduction in binder dose to control serum phosphorus,” he said. “We also know that post-treatment recovery time is overcome when patients use nocturnal PD or HHD and patients experience a better quality of life.”
Patients who choose home dialysis also reduce the risk of infections spread by other patients treated within the confines of a dialysis clinic, including COVID-19. Weinhandl cited a recent Canadian study published by Perl and colleagues in the Clinical Journal of the American Society of Nephrology showing that patients on home dialysis had about half the number of SARS-CoV-2 cases compared to patients in center, and hospital days were less than half of those experienced by hospitalized patients.
“Generally, patients treated in the center face the ‘rule of thirds,'” Weinhandl said. “A third of patients face undesirable intermediate outcomes; have volume overload problems; have persistent high blood pressure; long recovery time and hyperphosphatemia – and not for lack of costly effort,” he said.