Corrigendum to “Pregnancies in Women With Kidney Failure on Home Dialysis in the United States” [Kidney International Reports Volume 9, Issue 4, April 2024, Pages 907-918]

The Economics of Home Dialysis: Acting for the Individual While Planning Responsibly for the Population

Unmasking Disparities in Kidney Replacement Therapy Among Young Patients—A Call to Action

Kidney Failure Treatment: The Freedom to Choose

Policies to Support Home Dialysis Patients: Patients Need Help Too

Long, frequent hemodialysis (HD) was thought to be a sound treatment because of improved clearance of uremic toxins and control of extracellular fluid volume. After all, no solute or volume control is tantamount to no dialysis, and whatever its shortcomings, dialysis does keep people alive. The

Home versus in-centre haemodialysis for people with kidney failure.

COVID-19 among Adults Receiving Home versus In-Center Dialysis.

Changes in Fertility and Hormone Replacement Therapy in Kidney Disease

Keeping Home Dialysis Patients at Home

In May 2009, the United States Government Accountability Office (GAO) issued a report on the potential impact of Medicare's future (2011) expanded bundled payment system on home dialysis utilization rates. In this report, which was required to be issued based on 2006 legislation and was also requested by several congressional committees, the GAO concluded, not unexpectedly, that even though the cost to provide home dialysis varies widely among dialysis providers, the overall per-treatment cost to provide home dialysis is generally less than the cost per treatment to provide chronic dialysis. However, the average weekly cost to provide home dialysis may actually exceed the cost of in-center dialysis because home dialysis patients typically receive more than three treatments per week. The most interesting part of the report relates to the GAO's concerns as to whether adoption of identical bundled payment rates for both chronic and home dialysis services will increase home dialysis usage rates. Representatives of the Centers for Medicare & Medicaid Services (CMS) indicated to the GAO that they were considering a single expanded bundled payment for both home dialysis and chronic dialysis that will be based on the total cost to provide dialysis services for all modalities. CMS assumed that because the cost to provide home dialysis was lower than that for outpatient dialysis, a blended single payment rate “could … encourage” home dialysis by providing a financial incentive to do so. In response, the GAO concluded that because “CMS has not independently verified if these assumptions are correct… [,] the effect of the expanded bundled payment system on home dialysis utilization rates is uncertain.” The GAO also pointed out that the CMS premise of the cost differential between modalities ignores the fact that because home dialysis patients typically receive dialysis more than three times per week, the overall cost to provide home dialysis may actually be higher than the cost to provide outpatient dialysis. Rather than force the CMS to reconsider its position as to the use of a single reimbursement rate regardless of modality, the GAO ultimately recommended that CMS establish and implement a formal plan to monitor the impact of the expanded bundled system on home dialysis utilization rates. As expected, CMS agreed with this recommendation. It remains to be seen whether Medicare's expanded bundled payment rate, that will become effective as of January 1, 2011 will be identical for acute, home, and chronic dialysis services. However, as evidenced by the Report and the April 2008 final conditions for coverage issued by CMS, efforts to increase home dialysis utilization rates through financial, regulatory, and other means will continue and will undoubtedly accelerate with recent Congressional and Presidential focus on ways to reduce the cost of health services of all types in the United States.

CKD is a unique character on the stage of noncommunicable diseases in the United States: high prevalence (>20% in adults), significant expense to public payers ($114 billion among Medicare fee-for-service enrollees), and relatively little investment in research ($29 per patient in National

Advancing American Kidney Health—New Opportunities for Collaborative Care

Cost savings of home nocturnal versus conventional in-center hemodialysis

The D&T Report

Rural residence is associated with increased peritoneal dialysis (PD) utilization. The influence of travel distance on rates of home dialysis utilization has not been examined in the United States. The purpose of this study was to determine whether travel distances to the closest home and in-center hemodialysis (IHD) facilities are a barrier to home dialysis. ♢ This was a retrospective cohort study of patients aged ≥ 18 years initiating dialysis between 2005 and 2011. Unadjusted PD and home hemodialysis (HHD) rates were compared by travel distances to both the closest home dialysis and closest IHD facilities. Adjusted PD and HHD utilization rates were examined using multivariable logistic regression models. ♢ There were 98,608 patients in the adjusted analyses. 55.5% of the dialysis facilities offered home dialysis. IHD, PD and HHD patients traveled median distances of 5.4, 3.5 and 6.6 miles respectively to their initial dialysis facilities. Unadjusted analyses showed an increase in PD rates and decrease in HHD rates with increased travel distances. Adjusted odds of PD and HHD were 1.6 and 1.2 respectively for a ten mile increase in distance to the closest home dialysis facility, while for distances to the closest IHD facility the odds ratios for both PD and HHD were 0.7 (all p < 0.01). ♢ In metropolitan areas, PD and HHD generally increased with increased travel distance to the closest home dialysis facility and decreased with greater distance to an IHD facility. Examination of travel distances to PD and HHD facilities separately may provide further insight on specific barriers to these modalities which can serve as targets for future studies examining expansion of home dialysis utilization.