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
, where cleaning happens inside the body usually
during sleep and could be done at home.
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
have a better lifestyle, fewer symptoms, and more opportunities to retain
employment. The overall quality of life is known to be better for these
The Optimal Starts Approach
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
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 :
- At-home dialysis improves quality of life - (https://about.kaiserpermanente.org/our-story/health-research/news/at-home-dialysis-improves-quality-of-life)