Although COVID-19 has killed tens of thousands of people and plunged the United States into economic and social chaos, the pandemic could lead to positive changes in how healthcare is delivered, among them greater use of home dialysis even after the crisis is over.

Patients on dialysis are at particularly high risk for infection and a severe disease course from infection because of underlying health problems. Dialyzing at home rather than in a dialysis center has the potential to reduce the likelihood of patients becoming infected.

“The pandemic and the requirement for social distancing, and at times, isolation, have highlighted the advantages of dialysis at home,” said Jeffrey Hymes, MD, Chief Medical Officer for Fresenius Kidney Care, which is part of Fresenius Medical Care North American (FMCNA). “We expect that the increased interest in home dialysis will continue even after the acute crisis passes and help expand the strong growth in home dialysis we have experienced over the past year.”

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During the first quarter of 2020, he said, the number of home dialysis trainings FMCNA conducted grew by 25% compared with the same period in 2019. In response to this anticipated increase in demand for home-centric options, FMCNA has worked to ease the burden on both patients and physicians seeking home therapy, Dr Hymes said.

“During the past month, we also updated ProviderHub—our connected health platform for physicians and providers—to integrate more home treatment data so our physicians can better monitor these patients remotely,” he said. “We have also worked to integrate technology directly into our dialysis machines and developed machine learning algorithms to help us identify concerns earlier in the process with the goal of avoiding unnecessary hospitalizations.”

“We support any patient who feels like home dialysis is right for them, now and in the future,” said Jeffrey Giullian, MD, Chief Medical Officer at DaVita Inc. “We continue to educate our in-center patients about home treatment options as well as kidney transplant. We remain optimistic that all of our education will spur more even more discussions between patients and their physicians to explore opportunities for home dialysis as well as kidney transplantation, and our home growth remains strong.”

Even before the pandemic, the National Kidney Foundation (NKF) had been working to increase the use of home dialysis through education, its home dialysis initiative, participation in the Alliance for Home Dialysis, and advocacy, especially in support of the Advancing American Kidney Health Initiative launched by the Trump Administration on July 10, 2019, said nephrologist Joseph A. Vassalotti, MD, NKF’s Chief Medical Officer. A goal of that initiative is to provide incentives to encourage greater use of home dialysis. In response to the pandemic, NKF has stepped up efforts to expand home dialysis use.

“NKF has been working to increase access to home dialysis in a number of ways in the context of the COVID-19 pandemic that gives home dialysis that is not only a patient-centric kidney replacement therapy, but also should reduce the risk of exposure to SARS-CoV-2,” Dr Vassalotti said.

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Jeffrey Perl, MD, a member of American Society of Nephrology (ASN) COVID-19 Response Team and chair of ASN’s Home Dialysis Subcommittee, said that in the short term, compelling reasons exist to consider transitioning patients from facility-based dialysis to a home modality during the pandemic. He noted, however, that he believes the bigger consideration is the lessons that will be learned from the pandemic regarding the long-term distribution of dialysis modalities.

“I would like to think that as horrible as the COVID-19 pandemic is, it’s a wake-up call that if patients can receive home-based care, they possibly should receive home-based care for a myriad of reasons,” Dr Perl said.

In a COVID-19 ASN webinar on April 9, nephrologist Martin J. Schreiber, MD, Chief Medical Officer for DaVita Home Modalities, observed, “COVID has really been a true catalyst in transforming the care model for home patients. It’s not just reimagining what might take place, it really is re-creating how dialysis care will look today and look going forward. I don’t think that we’re going to go back to the way life was before COVID … as it relates to home dialysis.”