For the more than 350,000 people in the U.S. with kidney failure, dialysis is essential. This treatment takes over the important tasks performed by the kidneys, including filtering toxins and removing fluid from the body.

In-center dialysis typically requires three clinic visits every week, lasting three to four hours each. Not only is this disruptive to a patient’s normal routine, these frequent visits are often associated with undesirable risks. Most notably today, of course, is the potential for exposure to carriers of coronavirus, which can be especially detrimental for people with kidney disease or other chronic medical conditions.

Thus, this pandemic response is bringing into focus what many have emphasized for quite some time: home dialysis is a viable option for many patients with end-stage kidney disease.

Currently, only 12 percent of end-stage kidney disease patients receive dialysis at home, according to U.S. Health and Human Services Secretary Alex Azar. An executive order signed by President Trump in July 2019 sets significantly higher targets. By 2025, administration officials would like to see 80 percent of patients with incident end-stage kidney disease receiving home dialysis or kidney transplants.

Home dialysis allows patients to have treatment on their own schedule, without the need to travel to a dialysis unit. In addition, when administered at home, the treatment can be given gradually over a 24-hour period, which studies have shown to be a more natural option and to have certain advantages over in-center dialysis.

Telehealth technology helps limit clinic visits

At-home dialysis removes much of the logistical burden of in-center treatment. However, patients who receive home dialysis need to continue with monthly visits to their dialysis clinic for multidisciplinary visits with their physicians, dialysis nurses, social workers and dietitians.

UVa nephrologists are working to change that with a pilot initiative. Designed to reduce home dialysis patients' in-person visits from 12 a year to just four, the initiative came about after a recent decision by the Centers for Medicare and Medicaid Service (CMS) to allow physicians to conduct virtual clinic visits for home dialysis patients.

With support and guidance from the team at the Karen S. Rheuban Center for Telehealth at UVa, patients in the pilot program are trained to use a secure software to connect with their providers virtually via videoconferencing technology. Each month, during their scheduled appointments, the patients will have physical exams and may discuss lab results and any prescription changes with their providers. Each patient is then expected to have an in-person visit at the clinic every third month.

Utilizing all available resources to keep patients safe

Due to the added precautions currently being taken to ensure patient safety during the COVID-19 pandemic, UVa nephrologists have expanded the use of virtual appointments beyond this pilot program to care for other home dialysis patients. Using a broader variety of software platforms, clinicians are conducting clinic visits, while adhering to current self-isolation and social distancing guidelines.

To learn more about home dialysis and other dialysis treatment options available at UVa, visit uvahealth.com/services/dialysis.

Dr. Sana Khan is a nephrologist at UVa Health.

VITAL SIGNS This column, which promotes community health, is sponsored by Sentara Martha Jefferson Hospital, Region Ten Community Services Board, Thomas Jefferson Health District and the University of Virginia Heath System.

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