Shawn M. Carter , 2025-05-06 13:54:00
Key takeaways:
- Common peritoneal dialysis and home hemodialysis barriers included equipment storage issues.
- Struggles with machine setup were also an obstacle to home care.
LAS VEGAS — Education and training can encourage home dialysis uptake for pediatric patients and enable more successful transitions to home care, according to a speaker here.
“Choosing the right modality to fit a patient’s lifestyle and complex health needs requires a unique set of considerations for every patient with their physician,” Mihran Naljayan, MD, chief medical officer of home modalities and pediatrics for DaVita Kidney Centers, told Healio. “To help ensure patients can consider all options available to them, there must first be adequate education for both patients and health care professionals.”
Common peritoneal dialysis and home hemodialysis barriers include equipment storage issues. Image: Adobe Stock.
Naljayan and colleagues set out to identify common barriers to home dialysis, discuss provider bias and develop processes to address inequities. Data were presented at the Annual Dialysis Conference.
Laying the groundwork
A cohort of 2,005 pediatric patients started chronic dialysis in a network of Davita Kidney Care centers under a common protocol between 2011 and 2024. All patients were younger than 18 years, with 56% aged 13 to 17 years on admission. Overall, half of the group was admitted to seven pediatric centers.
Mihran Naljayan
Patients were followed to the earliest of transplantation, death or their 20th birthday, and investigators summarized demographic factors and dialytic prescriptions. All findings were stratified by age, as well as by transplantation and death.
Peritoneal dialysis was most common at first admission, according to the findings, with rates of 93% for patients younger than 1 year, 62% for those aged 1 to 5 years, 40% for those aged 6 to 12 years and 27% for patients aged 13 to 17 years. In addition, 10 (0.5%) patients received home hemodialysis.
Of patients on PD, 92% used a cycler, and 97% had daily treatment. The median 24-hour fluid volumes increased with age, ranging from 2.9 L for patients younger than 1 year to 11.2 L for those aged 13 to 17 years. The median number of daily exchanges decreased from 10 to six for the same age groups, according to the researchers.
The median prescribed in-center hemodialysis treatment duration was 180 minutes. At 3 years after admission, the cumulative transplantation incidence was 34% for patients younger than 1 year, 60% for those aged 1 to 5 years, 52% for those aged 6 to 12 years and 44% for patients aged 13 to 17 years. Corresponding mortality rates were 6%, 8%, 4% and 3%, respectively.
Turning awareness to access
Common barriers to PD and home hemodialysis were supply and equipment storage issues, confidence struggles with machine setup and specific PD concerns about sanitation, according to Naljayan.
For home hemodialysis, the main challenges were the need for a care partner, complex machine setups and higher costs, Naljayan said.
Based on their study data, the researchers identified strategies that could ease the home dialysis burden. To start, they emphasized the importance of education to boost uptake and help address patient and caregiver concerns. Effective communication and education can help dispel myths, Naljayan said.
The researchers suggested implementing comprehensive chronic kidney disease education, interdisciplinary advanced CKD clinics and hands-on training with home dialysis equipment. Additional strategies could involve peer-to-peer education, virtual reality training and ongoing support to alleviate concerns with storage and infection issues.
“Our presentation shows that addressing the concerns of each patient and their care partner and providing education resources to overcome these barriers helps patients be successful on home dialysis,” Naljayan said.
For more information:
Mihran Naljayan, MD, can be reached at mnalj1@lsuhsc.edu.
Sources/Disclosures
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Naljayan M. Session 10: Breaking down barriers: Unlocking the potential of home dialysis. Presented at: Annual Dialysis Conference; March 13-16, 2025; Las Vegas.
Disclosures:
Naljayan reports being employed by DaVita Kidney Care.
