More Diabetes Means More Dialysis

The number of home hemodialysis patients in the U.S. jumped by 35% between 2003 and 2007, from 1,787 to 3,374, Gary Inglese, RN, director of Renal Reimbursement for Baxter Healthcare Corporation, told attendees at the American Society of Nephrology meeting.

Combining the number of patients on home hemodialysis and those on peritoneal dialysis (PD), another form of home therapy, Inglese and colleagues found a 9.6% increase during this period, from 28,683 to 31,423.  Those numbers came from the end-stage renal disease (ESRD) Network Annual Data Reports. Using 2008 data from the United States Renal Data System (USRDS), the investigators also found that the growth in home dialysis is fueled largely by urban and suburban residents.

In 1978, 35% of home dialysis patients lived in rural areas, but that number has now dropped to less than 10%.  "Patients need this option and it's imperative that physicians provide information to them that with this option they don't have to come into a center, they can do this at home while they sleep," said Inglese.

One of the forces behind this change is lower costs, said Inglese. The USRDS data shows a 35% lower annual cost for peritoneal dialysis, compared with in-center hemodialysis.  "The total annual healthcare costs for peritoneal dialysis in patients with end stage renal disease is about $53,000, compared with almost $72,000 for in-center hemodialysis," he said.

And two earlier studies have shown that home hemodialysis performed up to six times a week is generally between 10% and 20% less costly than thrice-weekly in-center dialysis, he added. 

Previously, lack of data on efficacy and survival may have been a barrier to patient and physician acceptance of home dialysis, said Inglese.  But the 2008 USRDS report shows the survival gap between peritoneal dialysis and in-center hemodialysis has closed, and there is an increasing survival advantage of peritoneal dialysis compared with hemodialysis in the first five years of treatment, he said.

"We think home dialysis is growing in popularity for a number of other reasons including emerging patient-friendly technologies, and the younger population that it is serving," said Inglese.

The average age of first-time dialysis patients is now just under 65, he said.  "With this younger, working population, home dialysis gives a lot more freedom to go into work compared with traditional dialysis where patients have to go into the center for three or four hours, three days a week. It's really an accommodating and flexible therapy that allows people to maintain a more normal lifestyle."

Payers are also taking notice of the cost of differences, Inglese said, and "Medicare is now considering home dialysis as more cost-effective."  He added that Congress passed legislation earlier this year allowing payment for up to six sessions of chronic kidney disease education, including a better understanding of dialysis options. "Even Congress is saying if we educate people, maybe more of them will choose a therapy that is more convenient for them and also more cost-effective."

Practice Pearls:
Explain to interested patients that home dialysis is equally efficient and probably more cost-effective than in-center hemodialysis.

Presented at the American Society of Nephrology meeting, Nov. 2008