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Gerald Hladik, MD, and Abhi Kshirsagar, MD

Gerald Hladik, MD, and Abhi Kshirsagar, MD, explain how changes in the Centers for Medicare & Medicaid Services are expected to increase the proportion of patients using home dialysis and receiving transplants in the New York Times.  The article also features UNC Health patient Mary Prochaska, 73, a retired dialysis and transplant social worker in Chapel Hill with advanced chronic kidney disease, who relies on dialysis while she waits for second kidney transplant.

Previously, Mary visited a dialysis center three times a week for treatment, and each treatment lasted approximately four hours. Now, she receives dialysis from home.

“It’s easier on your body and better for your health,” she explained. “And far better than exposing yourself to whatever you might get from being in a group of people” in the middle of a pandemic.

Home Dialysis and Patient Choice

For decades, nephrologists have encouraged the use of home dialysis, yet most people starting dialysis went to treatment centers for their dialysis care. Socioeconomic factors such as housing instability, inadequate family and caretaker support, and poverty are important barriers to home dialysis. Inadequate pre-dialysis education, late nephrology referrals, lack of exposure to home dialysis during nephrology training and skepticism among some nephrologists about the benefits of home dialysis likely contribute to the low uptake of home dialysis in the US. Patient choice is paramount. Some patients don’t want to burden their family with home dialysis, while some, who might otherwise be socially isolated, enjoy the opportunity for interpersonal interactions at the dialysis center.

“Some individuals with advanced kidney disease may have some degree of cognitive impairment or they may be too frail to lift bags of dialysate solution,” said Gerald Hladik, MD, the Doc J Thurston Distinguished Professor of Medicine and chief of the division of nephrology and hypertension. “They also need adequate room to store supplies in a clean, private space.”

Advancing American Kidney Health (AAKH) Initiative

The cost of care for patients with chronic kidney failure remains high, with Medicare expenditures for these patients accounting for more than 7% of all Medicare costs, despite representing only 1% of the Medicare population. The Advancing American Kidney Health (AAKH) Initiative, aims to improve outcomes for patients with kidney disease by changing the way disease is detected, treated and paid for in the US. Transplantation remains the best treatment for advanced kidney disease, providing improved quality of life, decreased mortality, and lower costs. Importantly, the AAKH will also provide incentives for transplant centers to improve transplantation rates.

Abhijit Kshirsagar, MD, said the initiative will “have a really profound impact on kidney care,” and recognized how patient-centered incentives will improve patient care. Kshirsagar is the Covington Distinguished Professor of Medicine in the division of nephrology and hypertension, chief medical director of the UNC Dialysis Care and medical director of Carolina Dialysis Siler City.

The AAKH aims to reduce the number of Americans developing end-stage renal disease by 25 percent by 2030, have 80 percent of new ESRD patients in 2025 either receiving dialysis at home or receiving a transplant, and double the number of kidneys available for transplant by 2030. To learn more, visit the US Department of Health and Human Services.

Read the New York Times article here.