RBT Interview: Moving Forward with Home Dialysis

Editor's Note: Allen Nissenson, MD, FACP, chief medical officer, DaVita, answers RBT’s questions about the state of home dialysis, and what challenges it faces in the future.

Survival and transplant rates are higher among daily therapy patients versus conventional therapy, according to the recent NxStage registry data. Just how significant is that finding, and what could it mean for the renal community?

The NxStage data is preliminary, but are certainly of considerable interest. Improving survival and transplant rates are primary objectives for dialysis and that is why DaVita is so interested in daily dialysis. As such, we continue to support patients who are prescribed daily therapy and look forward to growing our program.

How important is the development of home hemodialysis to the overall ESRD Program, and what needs to happen to ensure its growth over the next 10 years?

Home hemodialysis is seeing renewed interest from patients, nephrologists and researchers, particularly with more frequent short daily treatments whether it is at home or in-center. If the early clinical results are confirmed, HHD will be an important modality and will likely have substantial impact on the ESRD program. To ensure that it reaches its clinical potential, however, reimbursement policies must be developed that do not discourage its use.

How much of the recent growth in new home hemodialysis patients can be attributed to new technologies?

There is no doubt that the new technology has created increased interest in HHD. The relative ease and portability of the new equipment are important to patients.

What kind of infrastructure does a clinic need in order to support home hemodialysis?

Experienced, well-trained nurses are needed to support any home hemo program. At DaVita, our nurses and committed physicians support and educate patients about the home process. DaVita’s infrastructure also includes our Empower Program, which offers home patients comprehensive training prior to the self-dialysis at home. We offer a systematic process to allow ease when patients order HHD supplies.

It is also important to have a critical mass of patients. Ideally you want 15 or more patients in a program to be cost efficient and to keep the staff highly focused and highly skilled.

In addition, building a home program requires purchasing machines up front and a favorable payer mix to help support the Medicare patients.