Can Innovation Fix Kidney Failure?

Kidney failure is a serious problem in the United States.  Nearly 800,000 Americans were living with end-stage renal disease (ESRD) in 2018.  That same year, the total Medicare spending on ESRD pati...
Can Innovation Fix Kidney Failure?
Written by Brian Wallace
  • Kidney failure is a serious problem in the United States.  Nearly 800,000 Americans were living with end-stage renal disease (ESRD) in 2018.  That same year, the total Medicare spending on ESRD patients reached $49 billion.  While the industry has tended to focus on the needs of their active, middle-aged dialysis patients, the reality is that 80% of ESRD patients are older than 65.  Many of them are nursing home residents.  Nursing home residents need tailored dialysis care. It’s time to change the game and innovate to fix kidney failure.

    The best treatment for ESRD is a functioning kidney transplant, but only 30% of ESRD patients are able to receive one.  The rest undergo regular dialysis.  Despite the convenience that in-home dialysis would provide, 86% of dialysis treatment still occurs at outpatient clinics.  This arrangement is hard on nursing home residents for several reasons.  Outpatient treatment poses an extra infection risk to older, vulnerable patients.  Traveling to a dialysis clinic is disruptive, confusing, and time consuming for nursing home residents.  Transportation is especially hard for older folks who can no longer drive or whose nursing home does not provide them with transport to a dialysis clinic.  Finally, acute residents can struggle to find placement at outpatient clinics due to their extra needs.  

    Both nursing homes and their residents would benefit from the provision of on-site dialysis.  On-site treatment frees up hours of time the resident would have spent traveling to a clinic.  Having dialysis on-site also results in better collaboration of care, fewer readmissions to the hospital, and stronger relationships with hospital partners.  Nursing homes that provide transportation for their residents can cancel the cost of up to $411 every round trip their residents would have made.  Homes with on-site dialysis can also accept higher acuity patients than those which lack the service.

    In choosing what type of dialysis to provide innovation for kidney failure for nursing home patients, 3-day dialysis is preferable by far to the daily option.  98% of nursing home dialysis patients are already accustomed to 3-day outpatient dialysis.  Switching them to daily treatment requires changes in prescription, leading to confusion and potentially disrupting the continuity of care.  Daily dialysis carries greater risk of potentially leading to hospitalization or surgery.  This is because the risk of complications like difficulty surrounding the blood-access site, blood clots, and aneurysms are more common in daily dialysis.  While 3-day dialysis can occupy 9-12 hours of a patient’s time per week, daily requires a time commitment of anywhere between 10 and 21 hours.  Those who opt for 3-day dialysis have more time for other therapies and social activities.

    Though the quality of care is first priority, it is understandable that nursing homes must also be wary of the cost of their services.  The truth is that 3-day dialysis is more cost effective than daily dialysis as well.  For the same initial investment, on-site dialysis provided every 3 days gives treatment to 3 times more patients than daily dialysis does.  The same 6 chairs can serve 36 patients in 3 day dialysis compared to 12 patients in daily treatments. 

    Dialysis in Nursing Homes

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