An analysis of Centers for Medicare & Medicaid Services data by UF Health researchers shows the rate of home dialysis use doubles after patients receive education about kidney disease and different types of dialysis.
The study, published Dec. 1 in the journal Peritoneal Dialysis International, also shows that between 2010, when the CMS first allowed physicians and hospitals to bill Medicare for renal education, and 2014, less than 1% of 369,968 of the Medicare recipients starting dialysis had received education.
“We are grossly underutilizing home dialysis,” said UF Health nephrologist Ashutosh M. Shukla, M.D., the study’s lead author. “One of the concerns nationally has been that medical professionals believe they don’t know how to offer education or they don’t have the resources. And what this paper shows is just the fact that education is delivered — we’re not talking about quality — just the fact that it was delivered literally doubles the rate of home dialysis.”
Shukla, an associate professor in the UF College of Medicine’s division of nephrology, hypertension and renal transplantation, said the study clearly demonstrates a lost opportunity to offer patients an alternative.
Additionally, the study shows that in the group of Medicare patients who did not receive education, 60% had seen a nephrologist in the six months before they began dialysis. Shukla said this demonstrates that physicians have the opportunity to educate this population of patients.
“We’re already seeing these patients,” Shukla pointed out.
In home dialysis, patients are trained to self-administer either hemodialysis, in which blood is directly cleansed of waste products, or, more commonly, periodontal dialysis. In this method, a special solution pumped into the body’s peritoneal cavity in the abdomen draws out wastes.
In either case, patients are freed up from the thrice weekly, four-hour sessions at a dialysis center or hospital, which can often be distant from a patient’s home. Peritoneal dialysis is easy enough that it can be done while a patient sleeps.
Both require special equipment that Shukla noted can easily be mastered after training, such as that provided by a UF Health educational program.
Shukla is the director of the Comprehensive Patient Education, or CPE, clinic for kidney disease at UF Health — and a similar clinic at the U.S. Department of Veterans Affairs, where Shukla holds a dual appointment — that has been extraordinarily successful. The UF Health clinic works in tandem with the Dialysis Clinic Inc., a Gainesville nonprofit.
Shukla said 70% of end-stage kidney disease patients who participate in the program choose home dialysis.
“I ask people, ‘If you had to take your medicine and come to the hospital every day, would you rather do that or take it at home?’” Shukla said. “Of course, they choose their home. So, it dawns on them that dialysis can very much be done safely at home with some precautions. And it gives them a good quality of life.”
The goal is still to get patients to a transplant. But Shukla said the nation needs to get basic kidney disease education to the 120,000 patients who begin dialysis each year in the U.S.
Patients can’t choose home dialysis, Shukla said, if they don’t know anything about it.