Kidney Week 2025 Annual Meeting-Home Hemodialysis Therapies in Older and Frail Adults

Video Transcription

Video Summary

This session on home hemodialysis therapies in older and frail adults focused on dialysis delivery in skilled nursing facilities (SNFs), care logistics, geriatric-focused management, and palliative approaches.<br /><br />Dr. Eric Weinhandl reviewed the epidemiology of dialysis in SNFs, distinguishing SNF residence from actually dialyzing on-site. Claims-based work suggests ~8.5% of dialysis patients “touch” an SNF monthly, but only ~1% receive dialysis in an SNF den (“home” dialysis from a regulatory standpoint, though not self-care). About 5,000 patients currently dialyze in SNFs, with high turnover due to mortality. Outcomes from SNF-focused providers show very high mortality (~34 deaths/100 patient-years), modestly higher hospitalization than in-center, and markedly catheter-heavy vascular access. Observational studies (not randomized) suggest more frequent dialysis may improve some outcomes and rehabilitation participation, though results are mixed. Early-pandemic data suggested higher initial COVID risk in SNF dialysis, followed by lower incidence/hospitalization later, possibly due to reduced transport/exposure. He also outlined challenges and methods for identifying SNF dialysis patients in datasets.<br /><br />Dr. Jassal described three care models—consultative, “pre-clearance” (dialysis suite within SNF but separate), and integrated—arguing integrated collaboration and cross-training best addresses frailty, cognitive impairment, nutrition, delirium, safety, and realistic goals of care.<br /><br />Dr. Hall introduced the “Geriatric 5Ms” framework (Matters Most, Mind, Mobility, Medications, Multicomplexity) to shift from lab-centered to person-centered care in long-term care settings.<br /><br />Dr. Ernecoff presented “palliative dialysis” and a concurrent hospice-dialysis program example, emphasizing symptom-focused dialysis, earlier goals-of-care conversations, and policy/payment barriers to concurrent hospice and dialysis in the U.S.

Asset Subtitle

Moderator(s): Shweta Bansal, Rebecca Seshasai

Presentation(s):

Epidemiology of Patients Receiving Hemodialysis Living at "Home" in a Nursing Home - Eric Weinhandl
Logistical Support of Patients Receiving Dialysis with an On-Site Dialysis Unit and Nursing Home Staff - Sarbjit Jassal
Dialysis Is Only Part of Management for Older Patients - Rasheeda Hall
Integrating Dialysis Needs with Palliative Care and Hospice for Older Adults - Natalie Ernecoff

Meta Tag

Date 11/6/2025

Pathway 1 Dialysis

Pathway 2 Geriatric Nephrology

Session ID 507238

Keywords

home hemodialysis

older adults

frail patients

skilled nursing facilities

SNF dialysis

dialysis delivery models

integrated care model

consultative nephrology

pre-clearance dialysis suite

geriatrics

Geriatric 5Ms

person-centered care

palliative dialysis

concurrent hospice and dialysis

dialysis outcomes and mortality