Home Dialysis: Nephrology’s best-kept secret

I am a strong believer in home dialysis - Peritoneal or Home Hemodialysis. Doing your dialysis at home gives you immense freedom and flexibility to live life on your terms. You don’t need to rely on others. You are completely in-charge. This approach may not work for some people. For them, the hospital or centre based dialysis is always there. But for those who would like to be in control, there’s nothing that beats home dialysis.

study conducted on nephrology professionals found that more than 90% of them would prefer either PD or Home HD if they had to go onto dialysis. However, about 93% of patients on dialysis in the US are on in-centre HD, 7% on PD snd less than 1% on PD. In India, those numbers are even worse.

Though nephrologists would prefer a home based therapy for their own dialysis, why are they not recommending it to their patients?

There could be multiple reasons for this with respect to India:
  • Patient unwillingness: Patients could be scared to take the burden of care into their own or a family member’s hands. They might prefer relying on trained technicians and doctors for this task.
  • Insurance does not cover home dialysis: Most insurance policies do not cover home therapies. Even hospital based dialysis is covered only by group insurance policies and not individual policies.
  • Infrastructure unavailability: Home dialysis needs certain basis minimum infrastructure at home like storage space, availability of a clean room for the treatment, water and electricity etc. Some people do not have this infrastructure
  • Doctor’s fear of losing the patient: Some doctors fear that if they send the patient home and do not see them every week like in hospital based dialysis, then they could lose the patient to some other nephrologist 
  • Doctor’s remuneration: I have heard some nephrologists admit (in public forums) that their main source of income is hospital based hemodialysis. They make less money on PD and nothing on home hemodialysis.
While some people debunk these myths around the reasons for the poor uptake of home therapies, nothing much can be done about some of these reasons but something can definitely be done about the other reasons and some more patients can be put on home therapies.

One thing that is inexcusable is that the different modalities are not explained to newly diagnosed patients. Most of them are just asked to plan for an AV Fistula. In my view that is completely unethical. Well, you might have an opinion about what the patient might like but please, give us the choice.