Can Technology Improve the Dialysis Model?

Among the vast array of health crises plaguing the US today, kidney failure is deserving of more attention.  In 2018 alone, 786,000 Americans were living with end-stage renal disease, hereafter referred to as ESRD.  While a functioning kidney transplant is the best treatment for kidney failure, only 30% of patients are blessed to receive one.  The rest must regularly undergo expensive treatment known as dialysis.  Is improving the technology, the key to solving the current dialysis model?

Meant to replicate the function of working kidneys, dialysis makes up the bulk of healthcare spending. The advancements in technology might be a step towards a machine that functions more like the organ it’s supposed to copy. Ultimately, the solution would be to not need dialysis, to begin with. 

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How the Process Works

It is no small matter to get started on dialysis treatment for all parties involved. When your doctor checks against the results of routine blood tests, many of these are screening for kidney disease. Once a person has lost 85 to 90 percent of kidney function, your general practitioner will refer you to a nephrologist specialist. Dialysis services can occur in a hospital, a dialysis unit, or at home. Dialysis may take the form of hemodialysis or peritoneal dialysis.

How is dialysis treatment normally administered?  Most patients must travel to outpatient clinics to receive their life-saving treatment.  This may be viable for the active, middle-aged patients the care industry likes to focus on, but it ignores the needs of most ESRD patients.  80% of those who suffer from ESRD are above the age of 65.  Many of these elderly patients residing in nursing homes.  They struggle to access outpatient dialysis for a variety of reasons. One reason that has become more prominent in the pandemic era is the infection risk.  When a nursing home resident has necessary contact with others in a medical facility, they risk carrying infectious disease back into the nursing home, and vice versa.  Setting COVID-19 aside can make flu and cold seasons worse.  Furthermore, traveling to a dialysis clinic is a hassle for someone who often cannot drive themselves.  Transportation arrangements quickly become disruptive, confusing, and time-consuming.

Outpatient providers have failed to address the needs of an aging ESRD patient population, especially regarding nursing residents.  To fix this error, nursing homes need to provide on-site dialysis for their patients.  Providing this service eliminates hours of travel time per week, freeing up a resident’s schedule for other therapies and social activities.  Not needing to leave the nursing home as often also decreases the risk of infection and complications associated with infectious disease.  

On the side of nursing home operators, on-site dialysis is at the forefront of clinical innovation.  It ensures better collaboration of care, fewer hospital readmissions, and stronger relationships to build with hospital partners.  On the financial side, nursing homes with on-site dialysis can accept higher acuity patients they might otherwise have to turn away.  Nursing home operators free up to $411 per round trip by eliminating transportation costs to outpatient clinics.

In deciding what kind of on-site dialysis to provide, nursing homes should elect for 3-day treatments over daily.  The reasons for this are many.  To start, 98% of nursing home dialysis patients are already accustomed to 3-day dialysis at outpatient clinics.  If one aspect of a system isn’t broken, don’t fix it.  Switching the frequency of dialysis requires prescription changes.  Changes may confuse and disrupt the continuity of care.  

Beyond consistency, daily dialysis carries a greater risk of potentially leading to hospitalization, surgery, or missed treatments.  Daily administrations are more likely to encounter difficulty with the blood-access site, blood clots, or even aneurysms.  One would need a serious reason to pursue increased risk like this, and the fact is that such a reason does not exist for most patients.

In addition to preserving a patient’s health, 3-day dialysis makes better use of a patient’s time.  3-day dialysis takes 9-12 hours per week, while daily dialysis requires 10-21 hours per week.  One nice thing about on-site dialysis is the time it saves patients.  Why not take this advantage one step further by limiting the frequency of treatment to only what is necessary?  Nursing home residents have precious little time left on this planet.  They should be able to enjoy it while they still can.  Nursing homes are more than treatment centers.  They’re a source of community for many older adults.

To again speak for the nursing home operators’ side, 3-day dialysis is a smarter financial investment for the business.  As much as nursing homes want to ensure they provide quality care, they cannot do that unless they watch their bottom line.  And when it comes to dialysis, the same initial investment in 3-day dialysis can treat up to 3 times as many patients as daily dialysis could.  Imagine a nursing home bought 6 chairs for dialysis.  3-day treatment could accommodate 36 patients, yet daily could only cover 12.

Large dialysis providers have failed to deliver effective and flexible treatment for nursing home patients, pointing to the need for a different model.  Nursing homes need in-house dialysis care designed with geriatric patients in mind.  Providing on-site, 3-day dialysis in a home-like setting is the goal that care facilities aspire to.  

The duty of healthcare providers is to put their patients first.  This means embracing their condition and all its comorbidities, such as a vent, trach, LVAD, and so on.  Collaboration with an experienced, skilled nurse facility team allows this process to run seamlessly.  Such a dream team can ensure continuity of care, create customized care plans based on patient needs, and offer nursing, nutritional, and psycho-social care, all without transportation.  Recent global developments have highlighted the benefit of in-house care for many Americans.  A new system is on its way to address the current structure’s shortcomings.

As nursing home providers install these new services, they should look for partners that specialize in dialysis provision.  The service shouldn’t be a single arm to the business, but rather the business in its entirety.  After the decimation nursing homes suffered at the hands of the pandemic, they need to look ahead to see how they can provide top-notch care in the future.  Only businesses that innovate in how they achieve their calling can survive changing circumstances.  America’s population continues to age, meaning some form of elderly care will always be needed.  The real question is, who will provide it next? Make sure it’s you.

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