The pandemic serves as a reminder of the advantages of receiving dialysis at home, says Dr. Anjay Rastogi, MD, PhD, a UCLA nephrologist and expert on home dialysis. In addition to reducing the risk of COVID-19 exposure, he adds, home dialysis offers other benefits and is gaining favor across the country.
“In-center dialysis is the traditional way most patients are treated,” he says. “But the push now is to get patients on home dialysis.”
Kidney dialysis is required when the kidneys are no longer functioning properly. Dialysis filters the blood to remove waste products. Ideally, Dr. Rastogi says, patients with kidney failure should undergo kidney transplantation.
But with long wait times — often five years or more — before a patient can receive a suitable donated organ, dialysis saves lives and serves as a bridge to transplantation.
About 468,000 Americans receive kidney dialysis, with only about 10 percent taking advantage of home dialysis. At UCLA, about one-third of dialysis patients choose home dialysis; in Dr. Rastogi’s practice, the number is 50-to-60 percent.
There are two main types of home dialysis, including home hemodialysis, which is like in-center dialysis but performed at home, and peritoneal dialysis. In peritoneal dialysis, a catheter is inserted into a small abdominal opening and connects to a machine to conduct the exchange of fluids.
Home dialysis has a number of advantages over in-center dialysis, Dr. Rastogi says. “Most dialysis patients typically have to go to a center three or four times a week, with each treatment taking three-to-four hours to complete. Home dialysis gives patients more flexibility and control. They can pursue work or school, and it’s easier to travel,” he says.
Moreover, studies show that kidney function is better maintained with proper home dialysis. “Patients also feel better,” Dr. Rastogi says. “When you do in-center dialysis three times a week, there are ups and downs, periods of fatigue and not feeling well.”
Home dialysis requires training that typically lasts two or three weeks. UCLA offers both a New Inpatient Dialysis Start (NIDS) program to help educate new dialysis patients on their options, as well as a Transitional Care Unit to assist patients in home dialysis training and education. “Patients need to be trained properly. The nephrology team has to feel comfortable that the patient can dialyze at home, and the patient needs to feel comfortable that he or she can dialyze at home. It is all about safety,” Dr. Rastogi says.
About one-in-three patients who try home dialysis will, for a variety of reasons, revert to in-center dialysis within a year, Dr. Rastogi says. But proper up-front training and long-term patient support can dramatically improve long-term success, he says.