What are some of the barriers to increasing use of home dialysis modalities? According to many, it may come down to nephrologists’ prior experience with the treatment options.
Peer-reviewed research suggests that nephrologists get inadequate exposure to home therapies during their fellowships. According to a perspective piece from the Clinical Journal of the American Society of Nephrology:
“There are multiple reasons for a less than optimal home dialysis clinical experience: insufficient patient on home dialysis volumes at academic centers; absence of mentors; and heavy, time-consuming inpatient rotations. Even when patients on home dialysis are encountered on the inpatient rotations, the experience is skewed as the focus is not on optimal home management.” 
This experience can increase the likelihood that patients will not start dialysis on a home modality; rather, they receive a central venous catheter (CVC) and start on in-center hemodialysis (ICHD) before they learn about their home-treatment options.
DaVita is addressing these challenges with a new educational opportunity for nephrologists and their nurse practitioners, physician assistants and fellows: The Institute of Nephrology.
Launched in February 2023, the Institute includes on-demand courses to support nephrologists in improving their competency around home dialysis. Topics were selected based on numerous interviews and surveys of practicing nephrologists to identify the most in-demand topics in home dialysis. Institute courses are available to DaVita-credentialed nephrologists at and provide Continuing Medical Education (CME) credit with the goal of improving clinical outcomes for DaVita patients. DaVita will continue adding new courses, with 20 total topics by mid-2023.
“The courses take into consideration a variety of topics related to home dialysis,” Dr. Mihran Naljayan, chief medical officer of Home Modalities at DaVita, says. “As use of home modalities grow, we, as physicians, need to ensure we understand best practices in areas like urgent starts for PD, prescription optimization, and managing or preventing modality loss.”
"Earlier in my career, I looked to experts in home dialysis to build my knowledge and experience. It helped drive my passion for home treatments. "
—Dr. Mihran Naljayan
Course content was created by DaVita nephrologists with home dialysis expertise, as well as nationally recognized external experts. External experts include Dr. John Crabtree and Dr. Joanne Bargman. Dr. Crabtree is the chairperson for the PD University for Surgeons in North America, a physician-education project sponsored by the International Society for Peritoneal Dialysis. Dr. Bargman is the past president of the International Society for Peritoneal Dialysis and the director for PD for the University Health Network in Toronto.
“Increasing nephrologists’ understanding and confidence with home modalities is crucial to increasing home therapy use,” says Dr. Naljayan. “Earlier in my career, I looked to experts in home dialysis to build my knowledge and experience. It helped drive my passion for home treatments. My goal with the Institute is to provide supportive education for others to share that passion for home treatments.”