For patients with serious heart health conditions, home-based hemodialysis may be safer and more effective than other forms of treatment, according to a new study.
Researchers from the University of Cincinnati analyzed 68,645 Medicare claims that occurred between 2005 and 2018, comparing outcomes of patients who received home hemodialysis against those who received peritoneal dialysis. A key difference between hemodialysis and peritoneal dialysis is that the former requires an artificial kidney machine whereas the latter does not. The researchers found that home-based hemodialysis was associated with a lower risk of stroke, acute coronary syndrome, cardiovascular death and all-cause death compared to peritoneal dialysis.
“I think there may be better fluid management with home hemodialysis. So with more intensive dialysis, there is better solute clearance in blood and better control of bone and mineral metabolism parameters,” Silvi Shah, MD, the study’s lead author, told the University of Cincinnati press. “There is better reduction in ventricular volumes and regression of left ventricular mass, which is thought to help with blood pressure.”
These results are noteworthy given the large share of patients on dialysis who also suffer from cardiovascular disease, the authors noted. More than half of individuals undergoing dialysis have some form of heart disease, and their risk of cardiovascular death is more than 20 times higher than that of the average person, the researchers explained.
However, relatively few patients receive dialysis treatment at home, and hemodialysis users are in the minority. Only 13.7% of people with end-stage renal disease (ESRD) use home dialysis, with 2.1% being hemodialysis users and 11.6% being recipients of peritoneal dialysis, according to the study.
Recent initiatives may soon change this. The Centers for Medicare & Medicaid Services proposed a rule in June that would expand home hemodialysis coverage for patients with acute kidney injury. Currently, CMS covers only in-center hemodialysis for these beneficiaries. The agency has also tried to increase home kidney care utilization through new payment models — most notably, the ESRD Treatment Choices (ETC) Model, which rewards providers for offering dialysis in patients’ homes.
In the private sector, partnerships have helped fuel home dialysis participation. Recently, US Renal Care partnered with medical technology Outset Medical to offer patients accessible and easy-to-use home dialysis tools.
