Systems Innovations to Increase Home Dialysis Utilization

Globally, there is an interest to increase home dialysis utilization. The most recent USRDS data reports that 13.3% of incident dialysis patients in the US are started on home dialysis, while the majority of patients continue to initiate kidney replacement therapy with in-center hemodialysis. In order to affect meaningful change, a multi-faceted innovative approach will be needed to substantially increase the use of home dialysis. Patient and provider education is the first step to enhance home dialysis knowledge awareness. Ideally, one should maximize the number of chronic kidney disease stage V patients transitioning to home therapies. If this is not possible, infrastructures including transitional dialysis units and community dialysis houses may help patients increase self-care efficacy and eventually transition care to home. From a policy perspective, adopting a “home dialysis preference” mandate and providing financial support to recuperate increased costs for patients and providers have led to higher uptake in home dialysis. Lastly, respite care and planned home-to-home transitions can reduce the incidence of transitioning to in-center hemodialysis. We speculate that an ecosystem of complementary system innovations is needed to cause a sufficient change in patient and provider behavior, which will ultimately modify the overall home dialysis utilization.