Only 15% of dialysis patients in the United States utilize home dialysis, but Brent W. Miller, MD, board-certified nephrologist and professor of clinical medicine at Indiana University School of Medicine, thinks that this figure should be closer to 30%. Learn about the barriers to home dialysis use and what’s being done to address them.*

The Challenges of Vascular Access

One of the primary challenges in home hemodialysis is establishing and maintaining vascular access. Point-of-care ultrasound technology is now available to assist with safer and more efficient needle placement, Miller says, in the form of a “compact, handheld ultrasound device for self-cannulation and troubleshooting potential access complications.”

The new technology makes this option not only more accessible and convenient but also more affordable, he adds, “significantly benefiting home dialysis patients.”

Home dialysis machines are also growing increasingly sophisticated. According to Miller, “Modern devices incorporate user-friendly interfaces, provide step-by-step guidance, and transmit real-time treatment data to healthcare providers, allowing for immediate intervention when necessary.”

Simplified Tech Addresses Burnout

Patient fatigue is another common reason for discontinuing home dialysis, particularly for home hemodialysis. Miller stressed the importance of making these machines more intuitive and less cumbersome to operate.

“Think about how seamlessly a smartphone operates,” he explains. “If dialysis machines could be designed with that level of simplicity, it would greatly enhance patient adherence and confidence in managing their treatment.”

For peritoneal dialysis, the primary obstacles differ and are often related to treatment efficacy rather than operational complexity. “The primary reasons patients discontinue peritoneal dialysis are not due to machine fatigue but rather issues with waste removal efficiency, ultrafiltration imbalances, and infection risks. Fortunately, ongoing technological advancements are addressing these challenges.”

Miller also mentions medium-term innovations, such as personalized dialysis fluid formulations and advanced monitoring systems that can detect infections early.

Expanding Home Dialysis Use

On pondering the larger question of why home dialysis is underutilized, Miller says, “One significant factor is the lingering impact of the COVID-19 pandemic, which disrupted healthcare infrastructure and reduced our ability to deliver care efficiently. Rebuilding our workforce and restoring streamlined operations is essential.”

Another critical factor is the level of training provided to nephrologists and healthcare professionals. “Five years ago, I would have said that physician training in home dialysis was insufficient,” states Miller. “However, substantial improvements have been made, and I am optimistic that this will lead to greater adoption and better patient outcomes.”

Looking Forward

With continued advancements in dialysis technology, enhanced physician education, and efforts to simplify treatment protocols, home dialysis could see significant expansion in the coming years. Miller remains confident that these improvements will lead to increased patient satisfaction and broader accessibility to home-based renal care.

*Gavidia, M. (2022, November 4). Dr Brent W. Miller on Emerging Technologies in Home Dialysis and Strategies to Improve Uptake. American Journal of Managed Care. https://www.ajmc.com/view/dr-brent-w-miller-on-emerging-technologies-in-home-dialysis-and-strategies-to-improve-uptake 

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