Each year, approximately 100,000 patients transition from chronic kidney disease (CKD) to end-stage kidney disease (ESKD). These patients are undergoing many challenges and need to choose a treatment option that fits their lifestyle and health goals.
In 2016, 87.3% of incident ESKD patients (less than three months on dialysis) selected in-center hemodialysis (ICHD) while 9.7% initiated peritoneal dialysis (PD). Those rates are now shifting as a greater emphasis is placed on PD and home hemodialysis (HHD). As such, a paradigm shift in approaching home dialysis needs to occur for CKD and ESKD patients.
Patient-centered care and shared decision-making is vital to this process. By helping patients choose the treatment option that is right for them, they are empowered to participate in their care and be more successful on their treatment of choice.
What are some best-demonstrated practices for clinicians and dialysis centers to facilitate the process to help eligible patients transition to home-based therapies?
Utilize MATCH-D and educational programs
Not all patients are candidates for home dialysis. The MATCH-D tool is a standardized third-party resource that helps to identify patients who are potential PD and HHD candidates.
Every patient in a dialysis center should be evaluated through the MATCH-D tool. With an understanding of each patient’s clinical and psychosocial background, the center’s interdisciplinary team (IDT) can then discuss potential barriers for that patient before initiating the treatment transition conversation.
Educational programs play a crucial role in helping dialysis patients select their preferred modality. Many observational and retrospective studies show that education, through a standardized program and/or one-on-one visits with a home dialysis nurse, for patients increases their likelihood of choosing a home therapy.
Educate the care team, as well as the patient
Providers may have their own misconceptions about home dialysis. Educating the dialysis center staff is just as important as educating patients.
Increasing awareness about home-based therapies will help clinical staff feel more comfortable discussing modality options with patients. Patient care technicians are often the best clinicians to have thoughtful conversations about the pros and cons of each type of home-based dialysis therapy because they spend the most time with patients.
ICHD patients are medically complex patients who are used to spending three days a week in a dialysis center. Deciding to transition from one dialysis modality to another adds a new layer of complexity.
A designated “access manager” (AM) or “home admission specialist” (HAS) can help patients transitioning from ICHD to PD or HHD through the process. Depending on the dialysis center, the AM or HAS may help arrange surgical and follow-up appointments, follow-up post-operatively for PD patients and schedule training dates with the home training center.
Remain aware of potential transition issues
Transitioning from ICHD to home dialysis is not without potential roadblocks, whether that’s technique failure or adverse outcomes.
Some patients may need backup hemodialysis treatments and appropriate therapy to meet ultrafiltration goals. Developing custom training programs with input from the entire IDT may also increase a patient’s ability to successfully transition from ICHD to a home modality.