Report: Home kidney dialysis underused

Fewer than 10 percent of kidney patients undergo dialysis at home even though the treatment costs less and may be more effective at prolonging life, a new investigation has found.

An estimated 382,000 people are receiving kidney dialysis nationwide, but only 35,000 are on one of the two forms of home-based dialysis, say doctors in a special American Journal of Kidney Diseases report.

Most patients choose to undergo dialysis in a center, either a freestanding facility or one connected with a medical center.

Home dialysis methods have existed for decades, doctors said, but have not been widely pursued or publicized. One is known as home hemodialysis; the other, peritoneal dialysis.

Home hemodialysis is performed almost identically to dialysis in a center. Peritoneal dialysis uses a solution that is self-infused into the abdomen that flushes out excess fluid and toxins. Both can be performed daily.

The report revealed three-quarters of newly diagnosed patients were unaware of those options.

"Home hemodialysis isn't new, it has been around since the 1970s but it fell off the radar after dialysis centers wound up on just about every other corner," said Dr. Beth Piraino, one of the study's senior authors and president-elect of the National Kidney Foundation.

Undergoing dialysis in a center costs about $70,000 a year, Piraino said Friday, but undergoing the procedure at home can shave $20,000 or more off annual costs, she said.

Federal and private insurers, Piraino added, cover costs associated with home care.

In Hong Kong, Piraino said, all patients undergo home hemodialysis. Not only is life expectancy longer, she said, patients have fewer complications than their U.S. counterparts.

"I think those technologies are underutilized and that's really unfortunate," said Dr. Steven Fishbane, vice president of Network Dialysis Services at the North Shore-Long Island Jewish Health System. Fishbane was not associated with the new research.

Piraino noted an increased risk of death -- usually from heart attack or stroke -- within the first three months of in-center dialysis, a risk not shared by those who undergo dialysis at home.

According to the National Kidney Foundation, people using short daily or nocturnal home hemodialysis live longer than those on medical facility dialysis, experience a better quality of life, have fewer and shorter hospital stays, and feel better both during and after dialysis.

More frequent dialysis better approximates the function of healthy kidneys, doctors say.

However, Piraino, a nephrologist at the University of Pittsburgh, emphasized that home treatment is not for everyone, nor is it perfect.

Patients must be aware of infection control, and peritoneal dialysis, she said, is perhaps best used as a "bridge" while awaiting transplant because it is not best used as a long-term therapy.

Deaths, Piraino added, inexplicably increase when patients use that method for years.

But home hemodialysis carries benefits, which she said have been long recognized. "I've known people on home hemodialysis who've lived for 30 years," Piraino said. "No one will live 30 years on peritoneal dialysis or in-center dialysis."

Home dialysis

There are two types of home dialysis, and both require a filter to remove wastes. In peritoneal, the filter is the abdominal lining. In home hemodialysis, the filter is plastic tubing.

Home hemodialysis

A "fistula" is surgically placed in arm or under collarbone to allow access to patient's blood supply. It is done in one of several ways:

Three times per week, each lasting four to five hours.

Daily, five to six times per week for two to three hours each.

Three or more times per week while patient sleeps, six to eight hours each.

Peritoneal dialysis

A permanent catheter must be implanted in the abdomen, in one of two ways:

While patient sleeps, using tube that connects to catheter. Dialysis fluid flows into patient's abdomen, using the abdominal membrane to filter wastes.

Tube connects to the catheter. Solution is infused from a bag hung on an IV-type pole.

Source: National Kidney & Urologic Diseases Information Clearinghouse