Health In Focus
  • Home dialysis for kidney patients is a safe option that could be expanded to use in large, integrated health care systems.
  • In the last 10 years, the rate of people starting at-home dialysis has increased from 15 percent to 34 percent in California, US
  • However, in comparison to other countries, US still lags behind in home dialysis

At-home dialysis option is safe, and its use could be expanded to large, integrated health care system in the United States, according to a study by Kaiser Permanente.

Kidney Failure and Dialysis

Dialysis is the most sought after option to remove excess waste and maintain safe levels of minerals in blood in order to keep the body in balance when kidneys fail. Dialysis also controls blood pressure.

There are two types of dialysis that help clean the blood: hemodialysis which takes place in a hospital or a dialysis center, the cleaning is done outside the body using an artificial kidney to remove wastes thrice a week or more and peritoneal dialysis, where cleaning happens inside the body usually during sleep and could be done at home.
Home Dialysis can Improve Quality of Life for Kidney Disease Patients

A research by Kaiser Permanente has studied the rise of at-home dialysis in the United States and has found that despite the increase in rates of people choosing this option, the country still lags behind. Kaiser Permanente in Northern California has reported a rise of 15 percent to 34 percent over 10 years among people starting voluntary at-home peritoneal dialysis, making it a convenient and safe option in managing advanced-stage kidney disease when compared to the center-based hemodialysis.

The study has been published in JAMA Internal Medicine, and the lead author is Leonid V. Pravoverov, the Chief of Nephrology for Kaiser Permanente's East Bay service area. "Patients who start dialysis at home generally have a better lifestyle, fewer symptoms, and more opportunities to retain employment. The overall quality of life is known to be better for these patients," Dr. Pravoverov said.

The Optimal Starts Approach

A system-wide Optimal Starts approach was initiated by Kaiser Permanente in 2008 with the objective of increasing at-home dialysis. It also included educating patient and caregiver, educating the provider and equipping them with support tools, streamlining systems-level processes, and monitoring and constant quality improvement.

"The large-scale expansion of in-home dialysis was made feasible using a multidisciplinary, integrated, coordinated-care approach, with excellent outcomes in patients with advanced kidney disease," the senior author Alan S. Go, a Research Scientist with the Kaiser Permanente (Division of Research in Oakland, California) commented.

Observations from the Study

Around 13,500 adult members of Kaiser Permanente in Northern California who began chronic dialysis between 2008 and 2018 were identified by the study. 80 percent of patients from the group that initiated at-home peritoneal dialysis remained on it one year after starting. There was a significant increase from 69 percent in 2008 to 84 percent in 2017 in this group. Over the 11 years of the study, no change was observed in the death rates after one year for patients starting at-home peritoneal or center-based dialysis.

Dr. Go noted the rates of at-home peritoneal dialysis of Hong Kong (70%), Jalisco region in Mexico (51%), New Zealand (30%), and Canada (19%) being considerably higher than that of the United States. The less than 10 percent rates of at-home dialysis in the United States could be attributed to various reasons.

Dr. Go was also quoted saying, "Peritoneal dialysis remains underutilized nationally. Our study shows that it is possible to greatly expand its use successfully in a large, integrated health care system and improve outcomes for patients with chronic kidney disease."

Reference :
  1. At-home dialysis improves quality of life - (

Source: Medindia

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