Kidney Week 2025 Early Program - Home Dialysis: Expanding Access to Home Therapies in 2025 and Beyond-Facilitating Selection of Home Dialysis as a Treatment Modality

Video Transcription

Video Summary

Dr. Raj Mehrotra argues that dialysis modality choice should be patient-empowered because kidney failure creates an exceptionally high burden of disease and treatment, and the modality profoundly shapes patients’ lived experience. He describes the field’s shift from disease-centered to person-centered care, emphasizing that patients on dialysis often have multiple comorbidities, frequent hospitalizations and care transitions, major dietary limits, high pill burden, and significant symptoms. In-center hemodialysis can also dominate daily life due to rigid schedules, while home modalities may offer flexibility.<br /><br />Mehrotra contends that “who can do home dialysis” should largely be “anyone who wants to,” with very few absolute contraindications. He highlights common candidacy biases against peritoneal dialysis (PD) (e.g., obesity, socioeconomic disadvantage, dependence in activities of daily living) and stresses that programs should “meet patients where they are,” providing supports to help them succeed.<br /><br />A key barrier is inadequate education and decision support. Patients newly facing kidney failure often are processing mortality and feel rushed; iterative conversations are needed. Patients prioritize maintaining lifestyle and life participation over medical outcomes alone. He also notes the value of assisted PD and discusses urgent-start PD for late referrals, outlining practical requirements (rapid catheter placement, low-volume supine starts, and bridging to home training).

Asset Subtitle

Rajnish Mehrotra

Meta Tag

Module DIAL

Speaker Rajnish Mehrotra

Keywords

patient-empowered dialysis choice

person-centered kidney failure care

home dialysis eligibility and support

peritoneal dialysis candidacy biases

dialysis education and shared decision-making

assisted peritoneal dialysis (assisted PD)

urgent-start peritoneal dialysis protocols