Home-care modalities underused in Israel

With more than 70 dialysis centers in a small country, HD access is not an issue in Israel. HD is the main form of dialysis delivered there, with the use of PD on the decline.

“The misconception among patients and families is that HD is more efficient and confers survival advantage,” explains Suheir Assady, MD, PhD, Director of the Department of Nephrology at Rambam-Health Care Campus in Haifa. “But HD and PD each has a place within the practice of nephrology, and they are complementary. Each modality is considered the best modality when it meets patient expectations and fits his or her medical condition.”


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Although Dr. Assady said she believes that HD is appropriate for the majority of ESRD patients in Israel, she also finds self-care dialysis modalities to be underutilized, and says they should be encouraged. “Potentially, it may reduce the economic burden, both direct and indirect medical expenditures, and provide many benefits for patients—mainly improved quality of life, more freedom, fewer hospital visits, and so forth,” she remarks. “Of course, in Israel—as in other countries—kidney transplantation is the most cost-effective therapy, offering obvious survival advantage for our ESRD patients.”

Dr. Assady summarizes the main medical and nonmedical factors that inhibit the widespread use of PD in Israel:

  • Health providers generally offer low reimbursement for PD.
  • Late referral of chronic kidney disease patients to nephrologists limits time available for iterative dialysis modality education.
  • The country has a limited number of PD training programs, qualified nephrologists, and skilled dialysis nurses.
  • Patient-related factors, such as poor education and housing conditions nonconductive to home care, restrict the use of PD.

At least some of those obstacles will no doubt sound familiar to U.S. nephrologists, as will the following statement from Dr. Assady:

“Some patients are not willing to bring their illness back home, but unfortunately, some patients are not even aware of alternatives to in-center HD.”

Part 2 of this feature, which will appear next week, discusses differing practice patterns in prostate cancer screening and management in Europe and the United States.