Jody A. Charnow, Editor

May 24, 2016

When Blood Is Sampled Affects Dialysis Patients' Phosphorus Values

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Phosphorus levels are higher when blood specimens are collected after weekends.

Serum phosphorus levels in dialysis patients vary depending on when blood specimens are collected, researchers reported at the European Renal Association-European Dialysis and Transplant Association 53rd Congress in Vienna. Levels are higher when blood is collected after the weekend (interdialytic period) compared with blood samples taken on other days.

The timing of blood collection also affects the relationship between phosphorus level and mortality, investigators found.

The results are from COSMOS, a prospective 3-year, observational, open-cohort study including 6,797 dialysis patients from 227 centers in 20 European countries. Adriana Dusso, MD, of the Hospital Universitario Central de Asturias in Spain, and colleagues divided patients into 2 groups depending on whether the patients' centers drew blood specimens midweek (MW) or post-weekend (PW). Mean serum phosphorus levels were significantly higher in the PW than MW group (5.5 vs 5.2 mg/dL). In addition, the PW group had a higher proportion of patients with serum phosphorus levels above the upper targets recommended by guidelines. Despite these differences, the prescription of phosphate binders was similar between the groups: 85% for the PW and 84.8% for MW arm.

In addition, the timing of blood collection influenced the relative risk of mortality in relation to serum phosphorus. The lowest mortality ranges for serum phosphorus were 3.5–4.9 mg/dL when blood was sampled MW and 3.8–5.7 mg/dL when sampled PW. The association between high serum phosphorus and mortality risk was stronger for MW serum phosphorus measurements, according to the investigators. For serum phosphorus in the 5.5–6.3 mg/dL range (quintile 4), MW collection was associated with a significant 35% increased relative risk of mortality versus PW collection.

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The study found no differences in serum calcium or parathyroid hormone levels between the PW and MW groups.

Dr Dusso and her collaborators concluded in their study abstract “that future clinical guidelines should consider the time of blood withdrawal when recommending serum target ranges for P and therapeutic strategies for P control.”

New Med for Secondary Hyperparathyroidism in Kidney Disease Patients

Jody A. Charnow, Editor
May 24, 2016
Novel SHPT Drug Is Safe, Efficacious Long Term

No new afety concerns observed in a 52-week extension trial of etelcalcetide in hemodialysis with secondary hyperparathyroidism.
No new safety concerns observed in a 52-week extension trial of etelcalcetide in hemodialysis with secondary hyperparathyroidism.
Etelcalcetide, a novel calcimimetic agent, is safe and efficacious long-term for the treatment of secondary hyperparathyroidism (SHPT) in patients on hemodialysis, according to study findings presented at the European Renal Association-European Dialysis and Transplant Association 53rd Congress in Vienna.

In a phase 3 open-label single-arm extension study, David A. Bushinsky, MD, of the University of Rochester in New York, and colleagues identified no new safety concerns and found that the significant reductions in parathyroid hormone (PTH), serum corrected calcium, and phosphorus associated with etelcalcetide observed in 3 26-week phase 3 trials were sustained over a 52-week treatment period.

The extension study enrolled 891 subjects, of whom 77% completed the 52-week treatment period. Treatment-emergent adverse events (AEs) and serious AEs developed in 90% and 40% of patients, respectively. Investigator-reported mild, moderate, severe, and life-threatening AEs were noted for 13%, 39%, 32%, and 7% of patients, respectively. In addition, 5% of patients had AEs that led to discontinuation of etelcalcetide. The most common AEs were asymptomatic decreases in blood calcium (43% of patients), diarrhea (11%), and vomiting (10%). The most frequently reported serious AEs were hyperkalemia (3%) and congestive heart failure (2%). The most frequently reported treatment-related AEs were decreased asymptomatic blood calcium (37%), symptomatic hypocalcemia (4%), muscle spasms (3%), nausea (2%), paraesthesia (2%), and decreased blood PTH.

Anti-etelcalcetide antibodies developed in 27 patients during the study; in 11 cases, this antibody response was transient.

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Dr. Bushinsky's group also compared the efficacy of etecalcetide during 2 efficacy assessment phases (EAPs): the last 6 weeks prior to stopping the drug in patients treated for a minimum of 8 weeks (EAP) and from weeks 46 to 53, inclusive (EAP12).

The proportion of patients who had a greater than 30% reduction in mean PTH levels was 68% at both EAPs. The proportion of patients with a PTH level of 300 pg/mL or less was 57% and 56%, respectively, at EAP and EAP12. Mean PTH levels had decreased by 26% at EAP and 30% at EAP12. The changes in mean serum corrected calcium (8% decrease) and phosphorus (4% decrease) were the same at both EAPs.

RUN Treatment of Secondary Hyperparathyroidism

Jody A. Charnow, Editor

May 12, 2016

Why SHPT Remains Difficult to Treat

Ishir Bhan, MD, MPH, is Director of Nephrology Informatics at Massachusetts General Hospital and Assistant Professor in Medicine at Harvard Medical School in Boston. His research focuses on the biological actions of vitamin D. Dr Bhan recently gave a presentation on the management of secondary hyperparathyroidism (SHPT) at the National Kidney Foundation's 2016 Spring Clinical Meetings in Boston. He spoke with Renal & Urology News about the challenges in treating SHPT.

What is the current status of SHPT management?

Dr. Bhan: I think there is a lot of confusion right now. In large part, that is driven by uncertainties surrounding the benefits of vitamin D. There was a lot of excitement over the past decade about the potential effects of vitamin D beyond just the control of secondary hyperparathyroidism. Its role in secondary hyperparathyroidism has been pretty stable for some time, but there was a lot of enthusiasm for using it beyond SHPT management because a number of observational studies had suggested there were potential benefits to the cardiovascular system, survival, and the immune system. So its potential use had broadened beyond just the traditional role. In the last couple years, there have been several randomized controlled trials suggesting that all those benefits that looked promising in observational studies and animal studies did not materialize when tested under the rigor of a randomized controlled trial.

The mainstay of therapy in secondary hyperparathyroidism has been the active vitamin D compounds: calcitriol, paracalcitol, doxicalciferol. The question has been whether there has been an additional benefit in using the so-called nutritional vitamin D's, and those are the precursors to active vitamin D—ergocalciferol and cholecalciferol—which are used in the general population. The hope was that those formulations would provide additional benefit on top of the active vitamin D in advanced kidney disease. While they may have some effect early in chronic kidney disease, it doesn't look like those additional effects have been proven in advanced kidney disease.

There is a new agent, calcifidiol, which is partially activated vitamin D. It does seem to have some benefit in relatively early kidney disease, but we don't know if it will have benefit in later kidney disease.

Where do you think nephrologists fall short in their management of SHPT?

Dr. Bhan: We need to look not just at absolute [parathyroid hormone] values but at trends, and sometimes we can miss patterns until someone has severe secondary hyperparathyroidism. The control of phosphorus is underappreciated. This can have effects on secondary hyperparathyroidism separate from the effects of vitamin D treatment. If phosphorus levels get too high, this can stimulate the parathyroid glands and it's going to be more difficult to control the secondary hyperparathyroidism. So control of phosphorus is something that should be considered part of the strategy to control secondary hyperparathyroidism.

Newer phosphate binders have emerged on the market recently, but whether there's any difference in the efficacy of these binders—iron-based binders, for example, compared to the older binders—is not totally clear. One thing I've found, at least, is that a major limiting factor in the treatment of hyperphosphatemia is peoples' ability to tolerate specific binders. Certain people seem to be able to tolerate some classes compared to other classes. So having more options available is always helpful because there's a greater likelihood of finding something that people are willing to take. If they're more willing to take it, it's more likely to be effective.

Ishir Bhan, MD, MPH, is Director of Nephrology Informatics at Massachusetts General Hospital and Assistant Professor in Medicine at Harvard Medical School in Boston.

What are the challenges in developing better pharmacotherapies?

Dr. Bhan: Like with any therapy, the main limiting factor is side effects. With the vitamin D agents, the main side effect has been an undesirable increase in phosphorus levels. One aspect of management that has become increasingly clear over the past few years is that phosphate seems to be a particularly bad culprit in the development of complications in kidney disease. High phosphorus levels have been associated with increased mortality. Phosphorus appears to drive fibroblast growth factor 23, which has been strongly associated with bad outcomes in kidney disease. The concern with treating secondary hyperparathyroidism with activated vitamin D is that you will end up with worse control of hyperphosphatemia because vitamin D agents increase the absorption of phosphorus. That's been a big challenge because you can't just give as much vitamin D as you want to control secondary hyperparathyroidism. One of the new agents that has come on the scene in the past decade is cinacalcet. How to combine vitamin D with cinacalcet, or when to use one versus the other, is still an evolving area, and there haven't been a lot of studies looking at how to best combine those therapies.

What about the role of calcium-containing medications or supplements?

Dr. Bhan: The main concern has been that the calcium that we give may not end up just suppressing the parathyroid glands. It may deposit in tissues and cause vascular calcification, including calcific uremic arteriolopathy (CUA). A study by my colleague Dr. [Sagar] Nigwekar found that CUA is increasing, and one of the associated factors is the use of vitamin D. In our attempt to control secondary hyperparathyroidism, we may be inadvertently increasing vascular calcification. That's a big concern. Cinacalcet can be a very useful agent in someone who you are worried about giving too much calcium, or calcium levels getting too high, or phosphorus levels getting too high. It might be an important adjunctive treatment, perhaps in combination with vitamin D to bring down PTH levels.

Have you been testing combinations?

Dr. Bhan: Not as part of a research study. In my patient population, there have been several patients who I've started on cinacalcet as an additional agent, and I have found it useful, but there are not a lot of data to guide us in this area. We need more studies looking at how best to combine these therapies and whether it's really an optimal strategy for controlling the adverse effects.

At what point should a patient be referred for a parathyroidectomy?

Dr. Bhan: I would first try cinacalcet because that has essentially become a chemical parathyroidectomy. But there are patients who either early on or after some time do not seem to respond to cinacalcet alone. With patients who have extremely high PTH levels, I would be very concerned about effects on bone and mineral metabolism, and would consider a parathyroidectomy in that situation. In addition, I would look for evidence where the bone disease has become problematic. I would have a lower threshold for considering parathyroidectomy for patients who develop fractures or who have advanced bone disease.

Jody A. Charnow, Editor

May 19, 2016

Higher Cancer Risk in Dialysis Patients Confirmed

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The risk is most elevated among individuals aged 44 years or younger.

Chinese patients on chronic dialysis, especially younger individuals, have an increased incidence of cancer compared with the age- and sex-matched general population, according to a new study.

Chi Yuen Cheung, MD, of Queen Elizabeth Hospital in Hong Kong, and colleagues retrospectively studied 6,254 patients who started either chronichemodialysis or peritoneal dialysis from 1994 to 2014. During 14,887 person-years of follow-up, 220 patients (3.5%) were diagnosed with cancer. Overall, the cohort had a 44% higher risk of any cancer compared with the age- and sex-matched general population, the investigators reported in the American Journal of Nephrology (2016;43:153-159). The risk was highest among younger patients and decreased with age. Patients aged 44 years or younger and 45–64 years had a 40 times and 3.4 times increased risk, respectively, whereas those aged 65 years and older had a 19% decreased risk. Cancer risk was highest within the first year of dialysis.

Among the various cancers examined in the study, the risk was most elevated for kidney cancer, particularly in younger patients. The risk of kidney cancer was 12 times higher than in the age-and sex-matched general population for the entire cohort, but 550 times higher among patients aged 44 years or younger. The lowest observed cancer risk was for prostate cancer, which was 73% lower for the dialysis patients versus the general population.

During follow-up, 160 cancer patients (72.7%) died. The cancer mortality risk was similar in the dialysis patients and the general population, Dr. Cheung's group reported.

The authors noted that the cancer incidence observed in their study cohort was similar to that found in studies conducted in the United States, Australia, and Europe.

Regarding the markedly lower risk of PCa in their cohort, the researchers explained that men with end-stage renal disease, as a result of their decreased life expectancy, may receive PSA screening less frequently than other men, leading to an apparent lower incidence of PCa.

Dr Cheung and colleagues concluded that their “findings of substantially increased risks in younger patients, particularly in relation to kidney cancer, indicate we can adopt a more individualized approach to cancer screening in chronic dialysis patients.”

Nikkiso America Inc. Launches New Hemodialysis System in the U.S.

Nikkiso America Inc. launches DBB-06 Hemodialysis System in the US

Nikkiso America Inc. has launched the DBB-06 Hemodialysis System in the United States

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NN&I STAFF — MAY 19, 2016

Nikkiso America Inc. has launched the DBB-06 Hemodialysis System, equipped with a dialysis dose monitor, in the United States.  The U.S. Food and Drug Administration gave the device 510(k) clearance in March. This launch marks the entrance into the U.S. renal market for Nikkiso Medical. The company is the second largest producer of hemodialysis equipment globally with over 100,000 hemodialysis machines in clinical use.

“After achieving a strong position in the global markets due to our outstanding product reliability, we are now providing a new option in hemodialysis equipment for U.S. clinics,” said Thomas Kelly, president of Nikkiso America’s Medical Division. “Nikkiso America is committed to continuing our company’s legacy of innovation to improve hemodialysis treatment outcomes while also addressing the needs of the care team.”

The system includes a blood volume monitor, designed to help the clinician evaluate and react to the patient’s hydration status by continuously monitoring relative blood volume during treatment. The DBB-06 Hemodialysis System with DDM also includes:

• Features such as ultrafiltration profiling, ultrapure dialysate, patient blood pressure monitoring
• A touchscreen user interface and the storage and recall of up to 16 patient prescriptions
• Enhanced automation, with programmed self-test/extracorporeal circuit priming and automatic disinfection and decalcification
• Data connection to the electronic medical record
• The Dialysis Dose Monitor to assist the care provider in real-time to ensure an adequate treatment for the patient
• Safety features, including a battery backup system in the case of power failure and continuous monitoring of the fluid removal system

NN&I Kidney disease increases complication risks for hospitalized patients.

Kidney disease increases complication risks for hospitalized patients

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NN&I STAFF — MAY 16, 2016

Patients with chronic kidney disease may be at an increased risk of experiencing complications when hospitalized, according to a study published in the Clinical Journal of the American Society of Nephrology (CJASN). This risk continues to rise as the severity of CKD increases.

A team led by Scott Klarenbach MD, MSc, and Babak Bohlouli, a PhD candidate at the University of Albertas examined information on 536,549 adults hospitalized from April 1, 2003 to March 31, 2008 from a population based cohort called the Alberta Kidney Disease Network. Of these patients, 8.5% had CKD, and they tended to be older and more likely to be admitted for circulatory system diseases than those without CKD.

After adjusting for various factors, patients with CKD were 19% more likely to experience hospital acquired complications than patients with normal kidney function. There was a graded relation between the risk of complications and CKD severity, with an 81% higher risk in those with the most severe CKD.

“Determining that patients with CKD are at greater risk of hospital complications will aid the development of targeted strategies to prevent such complications in this vulnerable patient population, and will improve quality of care,” said Bohlouli.

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New Device to monitor Fluid removal NN&I

Fresenius Renal Therapies releases device to manage fluid removal in hemodialysis patients

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REBECCA ZUMOFF — MAY 16, 2016

 Getty Images/iStockphoto/ThinkStock

Fresenius Renal Therapies, a division of Fresenius Medical Care North America has launched a device that non-invasively measures hematocrit, oxygen saturation and percent change in intravascular blood volume during hemodialysis (HD) treatment.  The CLiC device is available for purchase for use with the Fresenius 2008T hemodialysis delivery system. Customers who have already purchased 2008T systems can purchase an upgrade kit.

“Fluid overload in dialysis patients is an important issue that needs to be addressed,” said Mark Costanzo, president of the Renal Therapies Group.

CLiC (Crit-Line in a Clip) is used with the 2008T machine and provides Crit-Line information on the 2008T screen display.  It replaces the traditional Crit-Line III monitor technology for the 2008T.

The device is designed to allow the health care professional to remove the maximum amount of fluid from the hemodialysis patient while preventing the common symptoms of dialysis such as nausea, cramping and vomiting, the company said in a statement.

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Health Affairs Blog

In Rural States Policy Changes To Improve Access To Home Dialysis Are Vital

Rebecca Schmidt

April 12, 2016

   

By its very nature, chronic kidney disease can rob individuals of their independence. It gradually causes a person to lose the ability to filter wastes from the body, and should kidneys fail entirely, a patient must rely on renal replacement therapy (dialysis) to live. An estimated 26 million Americans have chronic kidney disease of varying degrees; more than 600,000 have end-stage kidney failure. In my home state of West Virginia, some 3,500 patients were on dialysis in 2013, and for most of the past two decades, our state has led the nation in per capita numbers of patients starting dialysis.

Dialysis can be provided thrice weekly in a center specifically for this purpose or at home. Most patients in the US dialyze in-center despite the benefits of home dialysis and the potential for restored independence. I have seen the benefits over the course of my career. During my nephrology training at Henry Ford Hospital in Detroit, because there were more new patients than there were dialysis chairs, everyone was steered toward home-based peritoneal dialysis.

Coming to West Virginia in 1993, distance from dialysis centers led many patients to choose home dialysis. Currently, about 20 percent of our patients dialyze at home, and some are able to continue or return to work. Lengthy trips to a facility multiple times a week have the potential to interfere with a patient’s work and personal life, and research shows that over half of in-center patients are unable to maintain thesame level of employment after six months.

Home Dialysis Benefits And Barriers

Last month, a new report highlighted the economic benefits of home dialysis — and cited a “confluence of factors” that inhibit patients from choosing a home dialysis modality, three of which are highlighted below.

First, the study links low socioeconomic status with the low utilization of home dialysis. In West Virginia, I see many patients who present with kidney disease who have had little to no access to kidney disease care and education. For patients who come to care deep into their disease progression, the economic, physical, and emotional burdens of kidney disease are formidable.

They may require the totality of a patient’s energy and resources, thus the choice of in-center dialysis over home dialysis may seem easier. Similarly, research shows patients who start dialysis in a hospital or facility are more likely to continue to receive treatment there instead of transitioning to home dialysis. Our responsibility as nephrologists is to empower those for whom home dialysis is appropriate to try it.

Second, in a comparable vein, the study correctly acknowledges gaps in nephrologist training pertaining to home dialysis. I strongly believe that patients need to be informed about all available treatment options, and providers need to be equipped to discuss all of the treatment options with their patients. We require our doctors in training to spend a lot of time learning about home dialysis, and I would encourage other programs to expand their time spent in this area.

Third, the report indicates that patients may be deterred from home dialysis because they lack a care giver — but this doesn’t necessarily need to be a barrier. While some patients are not comfortable with or physically able to perform the operation of dialysis on their own, others are eager and capable. Prohibiting such patients from doing home dialysis because that they lack a partner may be appropriate for some, but not all, patients.

The use of telehealth technology for real-time monitoring and ad hoc physician-patient interaction could increase eligibility for home dialysis by providing enhanced support for face-to-face clinician visits. Unfortunately, Medicare does not reimburse telehealth services that originate in a patient’s home. Changing this policy, at least for home dialysis patients, could enable many more patients to move to home dialysis.

Other barriers include concerns on the part of physicians that coverage for patients needing more frequent dialysis will be difficult to assure for patients receiving their dialysis at home. Additionally, the lack of infrastructure and resources needed to develop and grow a home dialysis program, particularly in rural areas, can constrain the progression of these programs.

Recommendations

While the option to dialyze at home is not necessarily best for all patients, it may be beneficial for more than those who currently use it. Home dialysis gives patients more autonomy over their care and their lives, and offers certain patients tremendous clinical and quality-of-life benefits. Patients deserve to have choices in their medical care and the option to dialyze at home, when safe and appropriate, is especially key in rural states like mine where many patients live distant to a dialysis center.

I urge policymakers nationwide to make home dialysis a more feasible option for more patients by supporting policies to eliminate current barriers in access. Designating the home as an originating site for telehealth and providing targeted funding and policy initiatives addressing shortcomings in infrastructure and nephrologist training concerns would go a long way towards diminishing these barriers.

tags: chronic disease, dialysis, kidney disease, nephrology, rural health, telehealth

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Nephrology nursing and the wearable artificial kidney

Victor Gura gave an update on the Wearable Artificial Kidney at the American Nephrology Nurses Association 47th annual meeting.

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MARK E. NEUMANN — MAY 9, 2016

 Photo: Stephen Brashear

LOUISVILLE––Victor Gura is a nephrologist turned inventor. He can give you a fascinating review of progress on his project, the wearable artificial kidney. But equally of interest is the story about the patients who tested the device––and the nurse who patiently lead them through it.

Last week, Gura gave his second talk in the past two years at the American Nephrology Nurses Association 47th National Symposium. It was on the last morning of the five-day meeting––a tough assignment for any speaker. But the ballroom was filled. Gura made some general comments about innovation in the dialysis community, noting some research efforts regarding new machines, most of them for home use. He expressed support for the implantable artificial kidney undergoing development at the University of California San Francisco. “There is a lot of work being done,” he said.

The wearable artificial kidney: why do we need it?

No matter how you do it, Gura believes slow, gentle dialysis 24/7 is the best way to mimic the natural kidney and its functions––constantly cleansing the blood of toxins. But kidney research has spent little time on this because the industry has been happy with the status quo. Quoting Belding Scribner from 1999: “The renal community has convinced itself that it is providing adequate dialysis, but it is in fact woefully inadequate.”

But even  Scribner, who shared the prestigious Albert Lasker Award for Clinical Medical Research with fellow inventor Dr. Willem J. Kolff in 2002, may not have seen the practicality of doing dialysis 24/7. Maybe more home dialysis to help lengthen therapy? Gura said he likes the value of home dialysis, but questioned whether patients had the desire to store supplies, spend the time to set up the dialysis machine, and do the work to produce better outcomes. Longer and more frequent dialysis in-center is not feasible because “society cannot afford to build more clinics: and many of them are trying to resolve nursing shortages.”

Trial of a different color

Nancy Colobong Smith, MN ANP-BC CNN ARNP, of the University of Washington Med Center, brought Gura’s quest for a working wearable artificial kidney to the nursing level. Colobong Smith worked side by side with 14 patients who underwent use of the WAK prototype: a group of six patients who lived on the WAK for up to six hours, and a second group of eight that lasted up to 8 hours.

Key points of what she gleaned from the two trials:

• The wearable kidney was safe, and walking and even dancing could be done with little side effects
• Dialysate is regenerated in the artificial kidney, but it’s clear this process needs to be finetuned
• CO2 bubble traps related to kinked tubing developed through the therapy need to be fixed

But putting patients on the wearable artificial kidney was more involved than what you might see in an in-center dialysis clinic. Checklists, diagrams, tools for the process were used (patients in the study had been on dialysis a mean of 15 months); to keep track of the project’s caseload, some of the blood samples were parsed out to three different labs.

None of the patients had restrictions on their diet.  That couldn’t have pleased Chuck Lee more. He was the study’s first patient and a diabetic for 40 years. He had previously dialyzed three days a week, four hours a day. “I thought it worked well for me…it was heavy and cumbersome. But it gave me so much more freedom” away from the commitment of in-center dialysis treatment, said the 70-year-old in a video played for attendees.

“He was so happy to eat everything, drink everything, but his tests always came back normal,” his wife added.

Colobong Smith and Gura want to see the wearable kidney start its next trial with a new smaller, lighter prototype. They want to prove that 24/7 dialysis can keep hypertension in check, eliminate the need for phosphate binders, and reduce the need for anemia drugs.

Stay tuned.

NN&I Education Key to Increasing Home Dialysis

HOME DIALYSIS

Education key to increasing home dialysis

An interview with Kay Deck, VP of Home Therapies and Clinical Services at Satellite Healthcare

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REBECCA ZUMOFF — MAY 4, 2016

Out of the ten largest U.S. dialysis providers, Satellite Healthcare has the largest number of its dialysis patients using home therapies.  In 2015, the company had more than 20% of its patients using home dialysis. In 2014, the total was almost 22%.  Kay Deck, VP Home Therapies and Clinical Services at Satellite Healthcare, told NN&I how the provider achieved that number, and why home dialysis is important.

NN&I: Why do you think increasing home dialysis should be a priority for dialysis providers?

Kay Deck: We know that home dialysis allows patients to live their lives with dialysis; not having dialysis run their life. Studies show that patients actively involved in their health and care empowers patients and improves health outcomes. Additionally, the choice of home dialysis allows patients to use therapy options with increased frequency and time to achieve their best quality of life.

NN&I: CEO Rick Barnett told NN&I in February that he wants Satellite to significantly increase the use of home dialysis among its patients. What steps will Satellite take to increase its home dialysis population? Is there a specific goal in mind?

Deck: Satellite Healthcare’s strategic plan is to grow awareness and implementation of home and alternative therapies.

NN&I: Among the 10 largest providers, Satellite has consistently had the highest percentage of patients on home dialysis. What factors do you think contributed to this? What role did patient and physician education play?

Deck: Since our launch of Satellite WellBound home dialysis in 2002, we’ve built more than 20 dedicated home dialysis Centers of Excellence. Satellite was the first health care services company to focus on personalized self-care training for home dialysis patients, as well as on expert pre-dialysis patient wellness education. Our focus on training and education has contributed greatly to our patients’ outcomes, overall quality of life and choice in home modalities.

NN&I: Do you see any barriers to increasing home use? If so, how would you overcome them?

Deck: It’s all about education and patient choice. The patient, with their nephrologist, should choose the modality best for their lifestyle and health needs. An industry-wide barrier could be that education of all modalities, home and in-center, is not effectively provided. This presents an opportunity for Satellite WellBound, which offers free modality options classes to help patients make the choice that’s best for them, their family and with their care team.

NN&I: A recent report by economist Alex Brill highlighted ways Congress and federal regulators can remove barriers to home dialysis. Do you think reimbursement for home dialysis is adequate?

Deck: Satellite Healthcare supports many of the points made in Alex Brill’s report, especially the goal to improve patient education and awareness to facilitating certification of more facilities to provide home dialysis services.

The current structure of home dialysis training has been found to not fully cover the actual costs of training. This could be a potential barrier for some dialysis providers. Future improvement of the financial models that allow for the time and skill it takes to develop strong staff and patient success will enable home therapy to thrive in the United States.

NN&I:  Do you think care partner requirements hinder home use in some regions?

Deck: The support of a friend or loved one as a care partner is vital to anyone needing specialized care, such as dialysis. When looking across the United States and in the regions where Satellite Healthcare provides care, we along with all providers, have to be aware of and flexible with the specific care partner requirements. We understand the needs and concerns of the government to ensure patient safety. However, our care is inclusive of the patient and the patient’s family. In order to humanize dialysis, Satellite Healthcare values the needs and goals of the whole patient. In many instances, a home dialysis patient’s family member is that key care partner. They are an integral player in the care team – along with the nephrologist and Satellite Healthcare’s multi-disciplinary team – who helps to make the best decision for the individual patient.