Is it really the pandemic?  Donald Trump’s Directive?  Or HHS pressure (read as payment incentives, which are related to Donald’s directive)?  [HHS kidney care payment protocol that began in 2021, a year later than promised, provided increased reimbursements for home dialysis]

Whatever it is, home dialysis treatments seem to be on everyone’s mind more often now.

(Now, a wearable artificial kidney would be nice- but those devices have been ‘in development’ for decades. And, a stem-cell derived kidney transplant is the gold standard- but stem cell research still has manifold restrictions.)

Which is a good thing, since it affords those on dialysis a better quality of life.  Not having to rush to a dialysis clinic thrice weekly- and that commutation time- is but a small portion of the quality of life improvement.

But, to be honest, the biggest impediment to home dialysis is technology.  Folks are going to need high quality water delivery- and a machine that is fully integrated and is easy to use for the patient and/or the caregiver.

That is one of the reasons that dialysis delivery units are now becoming more digital, with data transmission provided over the internet to afford remote access to the patient and the treatment quality.  In essence, we are talking about telemedicine, where the face to face visits with the nephrologist or nurse are now effected over the web- and remote management of the patient with shared data is also the norm.  Often these receiving units are within county health care centers- which then transmit their data (blood pressure, pulse rate, etc. plus interviews) to the dialysis clinic.

The problem is that patients over the age of 65 (a significant segment of dialysis patients), African Americans (also a significant population factor in dialysis), and rural patients are less likely to actually own (or operate) a home computer.  Not to mention that HHS demands that the vascular access of hemodialysis patients must be examined in person. (Ultrasound monitoring is not acceptable- yet- to HHS.)

Moreover, patients who dialyze at home can receive treatments five or six times a week (compared to thrice weekly in-center).  And, it seems that more frequent treatments leave the patients with more residual energy, better survival rates, higher cardiovascular function, and better hypertension control.  (Not to mention reduced hospitalizations.)   The problem is that while HHS recognizes more frequent treatments may be beneficial, its reimbursement processes do not so reflect.

Along those lines, clinicians have now adopted what are called TCUs (Transitional Care Units).  Basically, these are training centers to help the patient who is about to undergo dialysis to understand the life changes s/he must face.  And, to learn more about each various treatment modality with which they can make more educated decisions about their treatment (and match their life needs and personal values).

Outset Medical (San Jose CA) is one of the dialysis technology firms that has integrated its delivery system with digital data transmission and incorporation into patient health care records.  Their Tablo delivery unit (a three foot tall device, approved last year by the FDA for home dialysis) and its TabloHub (data analytics platform) is their current offering.

There’s also NxStage Home Dialysis, the unit (and company) acquired by Fresenius Medical is a portable system (suitable for transport via car or plane, as well).  The system has also been approved by the FDA for home use, as well.  Fresenius has developed a connected health system for this device, too.

As mentioned above, one of the driving forces is HHS’s augmented payments for home dialysis.  Training dialysis patients (hence those TCU’s) now affords payments of $ 95.57 per session- compared to the $ 50.16 that obtained previously.  Moreover, all weekly training sessions are payment eligible (previously on those for the peritoneal variety of dialysis were so covered).

Let’s hope progress continues.  For the patients’ sakes.