The pandemic spawned a variety of new habits — mask wearing, constant hand washing and an embrace of telehealth. With all that virus-dodging came a much-needed acceleration in shifting toward healthcare within the home. It’s working and we can’t look back — particularly in the area of dialysis.
In 2020, the global home healthcare market reached $299 billion and is expected to grow around 8% annually from 2021 to 2028. What little patients might lose in in-person interactions (often nothing), they gain in flexibility, control and autonomy.
You can see it across all segments of healthcare, including a procedure that has been so complex you might have expected it to stay in the clinic for a long time: dialysis. Kidney disease patients, however, are increasingly untangling themselves from rigid clinic schedules, long drives, lengthy treatments and potentially infectious environments. Most importantly, they’re back to living their lives.
Why it matters
Simple, convenient, effective home hemodialysis is a critical solution to a burgeoning need. Nearly half a million people in the U.S. require dialysis and are treated three times a week, four hours a day. With a total of 37 million U.S. adults estimated to have kidney disease, the number of Americans who need dialysis is rising. And so is the cost to the nation’s healthcare system.
We must find a better, safer, more efficient way for kidney patients to receive high-quality dialysis care while relieving dialysis providers of staffing and supply shortages. It is our responsibility as a healthcare community to eliminate these barriers and create a system that protects our most vulnerable populations.
Kidney patients need home healthcare
Avoiding infection from COVID-19 (or any other disease) is especially critical for kidney disease patients, who often have weakened immune systems. Despite precautions, dialysis clinics, by their very nature, are riskier for infection than a patient’s home. And because of staffing issues worsened by the pandemic, many clinics have consolidated, moving more patients through fewer spaces further increasing the risk. The USRDS 2021 annual report points out that dialysis patients who tested positive for COVID were more likely to have received dialysis at a skilled nursing facility where they are surrounded by other patients than at home.
In the past, because of the stubborn complexity of conventional hemodialysis technology, only the most resourceful and supported patients have been able to manage the process at home. Among other challenges, it’s been costly to manage supplies of dialysate and time-consuming to learn and operate the machines. While an estimated 30% of the country’s 570,000 chronic dialysis patients are eligible for home hemodialysis, only 2% of patients have been receiving treatment at home.
New technology changes the calculation. The new breed of home hemodialysis device looks like a sleek dorm refrigerator or picnic cooler. You plug it into a standard outlet like a regular appliance. Connect it to tap water and the water is automatically purified. To manage it, you or your care partner push a few buttons on a touchscreen that looks like your tablet.
Most importantly, patients seem to like it. In a survey of 202 dialysis patients using the first commercial version of this new breed, Outset’s Tablo Hemodialysis System, 72% viewed the new features as a significant clinical improvement in home hemodialysis. Additionally, 77% said Tablo’s features would make them more likely to try home hemodialysis. Outset estimates that Tablo’s training requirement is one-quarter that of a traditional dialysis device.
Meanwhile, a second national survey, this one of 184 nephrologists, found that 77% of surveyed physicians agreed that the features of Tablo were a significant improvement over existing home hemodialysis devices and 98% said these features would make them more likely to recommend home hemodialysis to their patients. These results were presented in two scientific papers presented at the 2022 National Kidney Foundation (NKF) Spring Clinical Meetings in Boston.
Benefits of home dialysis
The benefits go beyond infection prevention, convenience and preference. Home hemodialysis offers the opportunity to personalize fluid removal rates, dialysis duration and treatment frequency to meet each patient’s individual needs.
Further, home hemodialysis alleviates the significant costs associated transitioning from peritoneal dialysis (PD) to hemodialysis, as detailed in a third scientific paper presented at NKF’s meetings in April. And finally, home hemodialysis addresses the many concerns the NKF and the American Society of Nephrology (ASN) expressed earlier this year regarding dialysis care, including the significant disruptions of dialysate supply.
Healthcare has moved to the home. Dialysis must continue to move there as well. Home is where the health is.
Michael Aragon, MD, is chief medical officer at Outset Medical, a medical technology company pioneering a first-of-its-kind technology to reduce the cost and complexity of dialysis. Outset is the developer of The Tablo® Hemodialysis System, which the Food and Drug Administration cleared for use from the hospital to the home, and represents a significant technological advancement that transforms the dialysis experience for patients and operationally simplifies it for providers. Aragon is board-certified in internal medicine and nephrology, receiving his training at the University of Texas Health Sciences Center in Houston. His clinical research focus has been on the expansion and improvement of home dialysis options for patients with renal disease.