KIDNEY CARE IS
Decentralized Dialysis Delivery
New care models will require a more versatile, portable and capable hemodialysis machine than is available today. More space will be dedicated to patient care and education rather than water treatment and supply storage.
A Better Patient Journey
New kidney-care models are emerging that seek to improve patient outcomes and quality of life while lowering overall cost of care. The future of dialysis is taking shape now, and it looks very different from today’s model of predominately large, centralized dialysis-delivery facilities. A hemodialysis machine that is at home in any setting would facilitate the patient’s journey from CKD to sustained home hemodialysis, whether dialysis is planned or not.
The transitional care unit (TCU) focuses on providing a supportive environment in which incident dialysis patients, and their caregivers and care partners, can learn about all aspects of home hemodialysis over a period of several weeks. Within a dialysis center, TCUs can be stand-alone units, or they can be integrated into existing units. The objective of a TCU is to ease the pathway from CKD to ESRD with frequent, customized doses of hemodialysis and encourage all suitable patients to consider home hemodialysis to meet their medical and lifestyle goals.
Learn more about transitional care units from these recent publications:
Morfín JA, Yang A, Wang E, Schiller B. Transitional Dialysis Care Units: A New Approach to Increase Home Dialysis Modality Uptake and Patient Outcomes. Semin Dial. 2018;31(1):82-87. doi:10.1111/sdi.12651.
VALUE-BASED KIDNEY CARE
Value-Based kidney care refers to a model of comprehensive management of patients with kidney disease, from CKD through ESRD, dialysis and transplantation. The model is physician driven with risk being shifted from payer to the physician group, and it features customized, patient-centric care with the goal of improving outcomes and quality of life while reducing cost. Providers range from venture-backed care providers to large dialysis organizations.
Some value-based kidney care providers utilize advanced health analytics, including machine-learning based algorithms, to identify high-risk patients in order to bring them under the care of a nephrologist early and potentially avoid or delay onset of ESRD. If dialysis is necessary, all suitable patients are encouraged to consider home therapies; the transitional care unit (TCU) model is thus highly compatible with the goals of value-based kidney care.
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DIALYSIS IN SKILLED NURSING
Approximately 10% of the broader US dialysis population live in nursing homes, and in 2018 CMS affirmed that Medicare-approved ESRD facilities may provide dialysis services to skilled nursing facility (SNF) residents in nursing homes with approved home training and support programs in place. In regions where this is permitted, rooms within nursing homes can be transformed into what one provider terms a “dialysis den.” The space constraints and resulting impracticality of RO water rooms in this environment potentially create challenges, particularly for patients requiring thrice-weekly dialysis therapy.
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DIALYSIS IN ACUTE
According to 2018 USRDS data, hemodialysis patients spent about 11 days/year in the hospital in 2016 on average . Additionally, studies report a prevalence of unplanned dialysis between 40% and 60% , many of which result in the patient initiating dialysis in the hospital setting. Given the varied population of patients receiving hemodialysis in a hospital, a need exists for hemodialysis machines that can be easily transported and that integrate easily into cramped bedside settings while delivering even the intense dialysis doses associated with typical thrice-weekly in-center hemodialysis (IHD).
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