Kidney Week 2025 Annual Meeting-Is Equity in Access to Home Dialysis Feasible?

Video Transcription

Video Summary

The session opens with moderators Raj Mehrotra and Dr. Simon Davies framing equity and access to home dialysis as a multilayered “onion” problem: removing one barrier reveals others, and barriers accumulate. Davies highlights major geographic variation in home dialysis use globally and within countries (e.g., wide U.S. regional differences; European PD ranging from ~1% in Romania to >30% in Denmark). European discussions identified key drivers: misaligned financial incentives (physicians may earn less for PD), variable commitment to patient-centered care, limited assisted PD, workforce shortages—especially nursing—and uneven patient advocacy. UK data show large center-level variation despite uniform payment, leading to the INTERCEPT project, which found “culture” (presumption of eligibility and shared belief in home dialysis value) mattered more than service organization; quality improvement efforts, assisted PD, and staff stress also influenced uptake.<br /><br />Christopher Chan argues equity requires patient empowerment through education. Patients choose home therapies for freedom, lifestyle, and control, but fear and perceived barriers persist; limited education is the top barrier for both patients and providers. He presents strategies: structured CKD education (including for urgent-start patients), decision aids, personalized teaching based on learning preferences, competency testing (OSCE), simulation training, virtual “ward” checklists after hospitalization, coaching roles for nurses, and digital counseling apps linked to improved quality of life and anxiety. Economic incentives help but are insufficient; U.S. ETC payment reforms show only modest gains.<br /><br />Anna Figueredo emphasizes nurses as central coordinators, educators, trainers, infection-prevention leaders, navigators, and coaches. She calls for specialized training/certification pathways, mentorship, autonomy, technological support, and measuring success via nurse retention and satisfaction to sustain home dialysis growth.<br /><br />Vivek Jha describes the International Home Dialysis Consortium (ISN/ISPD), focused on implementation via four workstreams: patient empowerment, workforce education, resources/workflows, and payment/policy integration. Examples include PD-first policies (Hong Kong, New Zealand) and new policy momentum in India expanding PD reimbursement for low-income patients.<br /><br />Michael Fischer reviews the U.S. Veterans Health Administration (VHA), a large integrated system serving an older, rural, high-comorbidity population. Historically PD fell sharply in VHA, prompting a 2019 Home Dialysis Committee. A national survey found gaps in kidney disease education, limited program availability, small program size, and wide practice variation. Responses include standardized education (TEACH-VET trial), telehealth expansion, program-startup guidance, hub-and-spoke support, performance measures, and a PD quality dashboard. Panel discussion reinforces early, repeated modality conversations, provider buy-in, assisted PD/caregiver support, and system-level culture and policy change.

Asset Subtitle

Moderator(s): Simon Davies, Rajnish Mehrotra

Presentation(s):

Introduction - Simon Davies
Empowering Patients to Increase Equity of Access to Home Dialysis - Christopher Chan
Empowering Nurses Is Key for Home Dialysis Expansion - Ana Figueiredo
International Home Dialysis Consortium: What Can the United States Learn from Global Strategies? - Vivekanand Jha
Developing an Equitable Home Dialysis Care Program: A Perspective from the US Veterans Health Administration - Michael Fischer

Meta Tag

Date 11/8/2025

Pathway 1 Dialysis

Session ID 507056

Keywords

home dialysis equity

access barriers

peritoneal dialysis (PD) variation

geographic variation in dialysis

financial incentives misalignment

patient-centered care

assisted peritoneal dialysis

nursing workforce shortages

patient advocacy

INTERCEPT project

organizational culture change

chronic kidney disease education

patient empowerment

telehealth for home dialysis

International Home Dialysis Consortium