Costs Of Home Hemodialysis Offset By Better Health, Fewer Hospitalizations

Daily hemodialysis administered
in patients' homes is associated with better health outcomes compared
with peritoneal dialysis, according to an article in the October issue
of the American Journal of Kidney Diseases, the official journal of the
National Kidney Foundation.



As a result, the extra cost of providing in-home hemodialysis is
balanced out by lower expenditures for medications and hospital
admissions, physicians at a health maintenance organization in southern
California report.



Dialysis is a way of cleaning blood when a person's kidneys can no
longer do the job. It gets rid of the body's wastes, extra salt and
water, and helps to control blood pressure. There are two kinds of
dialysis: hemodialysis and peritoneal dialysis.



In hemodialysis, blood is pumped out of the patient's body to an
artificial kidney machine where the blood is filtered through a special
membrane, called a dialyzer, and then returned to the body.



In peritoneal dialysis, the inside lining of the patient's own belly
acts as a natural filter. Wastes are taken out by means of a cleansing
fluid called dialysate, which is washed in and out of the abdomen in
cycles through a surgically placed soft plastic tube (catheter).



"You can do hemodialysis at a dialysis center where a nurse or
technician performs the tasks required during treatment," says Dr.
Kerry Willis, Senior Vice President for Scientific Activities at the
National Kidney Foundation. "You can also do hemodialysis at home
where you and a care partner are the ones doing your treatment. At
home, you may be better able to fit your treatments into your daily
schedule."



In addition to the convenience, "many reports indicate that people
using daily home hemodialysis take less medication to control blood
pressure and anemia, feel better during dialysis and less 'washed
out' afterward, and have more energy for daily tasks,," Dr.
Willis pointed out.



However, it has been suggested that better health outcomes may simply
be the result of healthier patients opting for home treatment.



In their article, Dr. Victoria A. Kumar and her associates at the
Southern California Permanente Medical Group in Los Angeles tested this
theory by comparing one group of patients treated with daily home
hemodialysis with a group of patients treated with peritoneal dialysis.
Home dialysis was performed on average 5.4 times per week.



Dr. Kumar's group treated the 22 patients in the daily hemodialysis
group and the 64 in the peritoneal dialysis group for at least 6 months
between 2003 and 2007. The groups were comparable in age, the number of
patients with diabetes, and causes of kidney failure.
















Despite these similarities, patients treated by peritoneal dialysis
spent nearly twice as many days each year in the hospital compared with
patients treated with home hemodialysis (average 5.6 days/patient-year
versus 3.3 days/patient-year).



Those treated by daily home hemodialysis were also able to reduce the
number of medications required to keep their blood pressure under
control, and had better nutritional status than they did prior to
starting treatment, as shown by higher serum albumin levels.



Dr. Kumar and her associates point out that their organization could
support the program of home hemodialysis because the cost of equipment,
supplies, and patient training was offset by lower expenditures for
hospital care and medications.



Unfortunately, many patients do not have the option of home dialysis
because Medicare does not fully reimburse health care providers for the
costs associated with such a program and not all dialysis centers offer
education and training for home hemodialysis. Another challenge relating
to home hemodialysis is the need for a care partner.



"If the costs of providing more frequent hemodialysis treatments do
not pose a financial burden on the Medicare system," Dr. Kumar and her
associates state, "the modality should be freely available to
motivated patients with end-stage renal disease."



The National Kidney Foundation, Inc. (NKF) is the major voluntary
health organization dedicated to preventing kidney disease, improving
the health and well-being of individuals and families affected by kidney
disease, and increasing the availability of all organs for
transplantation.



To learn more about chronic kidney disease, risk factors or
hemodialysis, contact the National Kidney Foundation at kidney.

National Kidney Foundation