From Home Dialysis Access to Home Dialysis Quality

      The number and percentage of patients dialyzing at home has steadily increased during the past decade, and federal policy initiatives have driven interest to a new high. However, the mere utilization of home dialysis does not ensure better outcomes for patients and care partners. Although public reporting systems for dialysis quality are mature and robust, the incorporation of home dialysis quality in those systems is immature; the advent of the End-Stage Renal Disease Treatment Choices payment model brings this problem into sharp relief. The home dialysis modalities present both common and unique targets for quality measurement. For both modalities, therapy duration (or its inverse, technique failure) is a potential target. For peritoneal dialysis, peritonitis, catheter complications, and residual kidney function are additional targets; for home hemodialysis, vascular access infections, dialysis adequacy, and treatment adherence are targets. Patient-reported experience measures are also important; this domain is a long-standing disparity, as in-facility hemodialysis patients have been routinely surveyed for several years. The statistical aspect of quality measurement in home dialysis requires some adaptation, as the typical home dialysis program is small, thus presenting a threat to reliability; pooling programs may be necessary. Ultimately, promoting high-quality home dialysis will likely increase utilization of home dialysis.

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        • Centers for Medicare and Medicaid Services
        Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures. vol 85. Federal Register, 2019: 61114-61381
        • Reddy Y.N.V.
        • Mendu M.L.
        • Weinhandl E.D.
        Funding Innovative dialysis technology in the United States: home dialysis and the ESRD Transitional add-on payment for new and Innovative Equipment and supplies (TPNIES).
        Am J Kidney Dis. 2021; 78: 892-896
        • Kossmann R.J.
        • Weinhandl E.D.
        Advancing American kidney health: perspective from Fresenius medical care.
        Clin J Am Soc Nephrol. 2019; 14: 1811-1813
      1. Fresenius Medical Care North America Highlights Home Growth and Telehealth Success [press release]. Fresenius Medical Care North America, April 6, 2020. Accessed April 18, 2022.

      2. DaVita Kidney Care Expands Use of NxStage Home Hemodialysis Machines from Fresenius Medical Care [press release]. Fresenius Medical Care North America, March 23, 2021. Accessed April 18, 2022.

      3. DaVita to Further Elevate its Home Dialysis Care Experience with New Baxter Technology [press release]. DaVita Kidney Care, May 10, 2021. Accessed April 18, 2022.

      4. Quanta Raises $245 Million to Accelerate Commercialization of its SC+ Portable Hemodialysis System [press release]. Quanta Dialysis Technologies, June 23, 2021. Accessed April 18, 2022.

      5. United States Renal Data System, USRDS Annual Data Report: Epidemiology of kidney disease in the United States, 2021. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda, MD, Volume 1, Chapter 2: Home Hemodialysis.

        • Canadian Institute for Health Information
        Annual Statistics on Organ Replacement in Canada: Dialysis, Transplantation and Donation, 2010 to 2019. CIHI, Ottawa, Ontario, Canada2020
      6. UK Renal Registry (2020) UK Renal Registry 22nd Annual Report – data to 31/12/2018. Bristol, UK. Accessed April 18, 2022.

        • Mehrotra R.
        • Soohoo M.
        • Rivara M.B.
        • et al.
        Racial and ethnic disparities in Use of and outcomes with home dialysis in the United States.
        J Am Soc Nephrol. 2016; 27: 2123-2134
        • Flanagin E.P.
        • Chivate Y.
        • Weiner D.E.
        Home dialysis in the United States: a Roadmap for increasing peritoneal dialysis utilization.
        Am J Kidney Dis. 2020; 75: 413-416
        • Brown E.A.
        • Blake P.G.
        • Boudville N.
        • et al.
        International Society for Peritoneal Dialysis practice recommendations: prescribing high-quality goal-directed peritoneal dialysis.
        Perit Dial Int. 2020; 40: 244-253
        • Kolesnyk I.
        • Dekker F.W.
        • Boeschoten E.W.
        • Krediet R.T.
        Time-dependent reasons for peritoneal dialysis technique failure and mortality.
        Perit Dial Int. 2010; 30: 170-177
        • Vrtovsnik F.
        • Verger C.
        • Van Biesen W.
        • et al.
        The impact of volume overload on technique failure in incident peritoneal dialysis patients.
        Clin Kidney J. 2021; 14: 570-577
        • McGill R.L.
        • Weiner D.E.
        • Ruthazer R.
        • Miskulin D.C.
        • Meyer K.B.
        • Lacson Jr., E.
        Transfers to hemodialysis among US patients initiating renal Replacement therapy with peritoneal dialysis.
        Am J Kidney Dis. 2019; 74: 620-628
        • Sukul N.
        • Mukhopadhyay P.
        • Schaubel D.E.
        • et al.
        Peritoneal dialysis and mortality, kidney transplant, and Transition to hemodialysis: trends from 1996-2015 in the United States.
        Kidney Med. 2020; 2: 610-619.e611
        • Htay H.
        • Cho Y.
        • Pascoe E.M.
        • et al.
        Multicenter registry analysis of center Characteristics associated with technique failure in patients on incident peritoneal dialysis.
        Clin J Am Soc Nephrol. 2017; 12: 1090-1099
        • Perl J.
        • Fuller D.S.
        • Bieber B.A.
        • et al.
        Peritoneal dialysis-related infection rates and outcomes: Results from the peritoneal dialysis outcomes and practice Patterns study (PDOPPS).
        Am J Kidney Dis. 2020; 76: 42-53
      7. ANZDATA Registry. 43rd Report, Chapter 2: Prevalence of renal replacement therapy for end stage kidney disease. Adelaide, Australia: Australia and New Zealand Dialysis and Transplant Registry; 2020. Accessed April 18, 2022.

        • Centers for Medicare and Medicaid Services
        Dialysis Facility Report for Fiscal Year (FY) 2022. Centers for Medicare and Medicaid Services, Baltimore, MD2022
        • Tam P.
        Peritoneal dialysis and preservation of residual renal function.
        Perit Dial Int. 2009; 29: S108-S110
        • Seshasai R.K.
        • Mitra N.
        • Chaknos C.M.
        • et al.
        Factors associated with discontinuation of home hemodialysis.
        Am J Kidney Dis. 2016; 67: 629-637
        • Jacquet S.
        • Trinh E.
        The potential burden of home dialysis on patients and caregivers: a narrative review.
        Can J Kidney Health Dis. 2019; 6 (2054358119893335): 1-7
        • Weinhandl E.D.
        • Nieman K.M.
        • Gilbertson D.T.
        • Collins A.J.
        Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients.
        Am J Kidney Dis. 2015; 65: 98-108
        • Weinhandl E.D.
        • Gilbertson D.T.
        • Collins A.J.
        Mortality, hospitalization, and technique failure in daily home hemodialysis and matched peritoneal dialysis patients: a matched Cohort study.
        Am J Kidney Dis. 2016; 67: 98-110
        • Kotanko P.
        • Garg A.X.
        • Depner T.
        • et al.
        Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials.
        Hemodial Int. 2015; 19: 386-401
        • Chertow G.M.
        • Levin N.W.
        • Beck G.J.
        • et al.
        In-center hemodialysis six times per week versus three times per week.
        N Engl J Med. 2010; 363: 2287-2300
        • Weinhandl E.D.
        • Collins A.J.
        Relative risk of home hemodialysis attrition in patients using a telehealth platform.
        Hemodial Int. 2018; 22: 318-327
        • Dad T.
        • Grobert M.E.
        • Richardson M.M.
        Using patient experience survey data to improve in-center hemodialysis care: a practical review.
        Am J Kidney Dis. 2020; 76: 407-416
        • Rivara M.B.
        • Edwards T.
        • Patrick D.
        • Anderson L.
        • Himmelfarb J.
        • Mehrotra R.
        Development and content Validity of a patient-reported experience measure for home dialysis.
        Clin J Am Soc Nephrol. 2021; 16: 588-598
        • Suri R.S.
        • Larive B.
        • Hall Y.
        • et al.
        Effects of frequent hemodialysis on perceived caregiver burden in the Frequent Hemodialysis Network trials.
        Clin J Am Soc Nephrol. 2014; 9: 936-942
        • Assimon M.M.
        • Flythe J.E.
        Rapid ultrafiltration rates and outcomes among hemodialysis patients: re-examining the evidence base.
        Curr Opin Nephrol Hypertens. 2015; 24: 525-530
        • Hussein W.F.
        • Arramreddy R.
        • Sun S.J.
        • Reiterman M.
        • Schiller B.
        Higher ultrafiltration rate is associated with longer dialysis recovery time in patients undergoing Conventional hemodialysis.
        Am J Nephrol. 2017; 46: 3-10
        • Fanaroff A.C.
        • Cyr D.
        • Neely M.L.
        • et al.
        Days alive and out of hospital: Exploring a patient-Centered, Pragmatic outcome in a clinical trial of patients with Acute Coronary Syndromes.
        Circ Cardiovasc Qual Outcomes. 2018; 11 (.e004755): 1-10