Benefits, challenges, and opportunities using home hemodialysis with a focus on Mississippi, a rural southern state

Abstract

The prevalence of end‐stage renal disease continues to increase in the United States with commensurate need for renal replacement therapies. Hemodialysis continues to be the predominant modality, though less than 2% of these patients will receive hemodialysis in their own home. While home modalities utilizing peritoneal dialysis have been growing, home hemodialysis (HHD) remains underutilized despite studies showing regression in left ventricular mass, improved quality of life, reduced depressive symptoms, and decreased postdialysis recovery time. To increase penetration of HHD will require a proactive approach from both physicians and dialysis networks to address barriers both in the system and on the level of the patients and families. We are reviewing these issues with a focus on the state of Mississippi.

The association of overhydration with chronic inflammation in chronic maintenance hemodiafiltration patients

“…However, this potential mechanism with the possible exception of mesenteric ischemia and myocardial stunning remains completely unexplored. Alternative approaches to increase treatment time and to decrease hemodynamics stress, such as vigorous advocacy and promotion of home hemodialysis remain important but underutilized pathway to improve ESRD care in the future …”

Forty‐five years on home hemodialysis, a case of exceptional longevity

“…Our patient's low comorbid disease burden and younger age at the start of ESRD undoubtedly contributed. Yet, advocating HHD successfully as a viable and doable option falls short of ideal goals and barriers for successful implementation and retention . Transitional dialysis care is an alternative approach to give patients first‐hand experience and better‐informed choices before defaulting into in‐center dialysis.…”

“…∑ The proportion of patients with chronic kidney disease and end‐stage renal disease (ESRD) keeps growing in the United States, with similar trends in our home state of Mississippi where 1,682 new incident dialysis patients were started on dialysis (2016), the majority attributed to diabetes and hypertension . Home modalities experienced a resurgence in recent years due to increasing education among nephrologists, less overhead costs, better reimbursements, and an increasing effort by large dialysis organizations . Mississippi is one of the rural states facing barriers to optimal renal care due to geographic disconnect between physician's supply and the burden of chronic kidney diseases .…”

“…1 Home modalities experienced a resurgence in recent years due to increasing education among nephrologists, less overhead costs, better reimbursements, and an increasing effort by large dialysis organizations. [1][2][3][4] Mississippi is one of the rural states facing barriers to optimal renal care due to geographic disconnect between physician's supply and the burden of chronic kidney diseases. 1 Herewith, we describe an exceptional case of extreme survival on hemodialysis for 46 years since 1972 until late 2018, of these 44 years dialyzing at home.…”

“…[1][2][3][4] Mississippi is one of the rural states facing barriers to optimal renal care due to geographic disconnect between physician's supply and the burden of chronic kidney diseases. 1 Herewith, we describe an exceptional case of extreme survival on hemodialysis for 46 years since 1972 until late 2018, of these 44 years dialyzing at home. One single physician provided for her outpatient nephrology care for almost the entire duration of her illness.…”