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Medicare Home Dialysis
End-stage renal disease (ESRD) is typically diagnosed when kidney func- tions fall to 10 to 15 percent. It afflicts approximately 680,000 Americans and, other than a kidney transplant, the only treatment is dialysis.
Dialysis assumes the functions of healthy kidneys by removing toxins from the body. There are actually two types: hemodialysis and peritoneal dialysis.
A majority of ESRD dialysis pa- tients — about 63 percent — receive hemodialysis, which involves pumping the patient’s blood through an external machine that filters waste, extra salt and fluid from the blood and pumps the filtered blood back into the body. Most patients receive hemodialysis three times a week; each dialysis session averages four hours and is typically performed in a dialysis clinic (less than 2 percent of ESRD patients perform hemodialysis at home). In ad- dition to consuming time, the process is also costly — hemodialysis averages $88,000 per patient, per year.1
Peritoneal dialysis also removes 26 | InsideOut
toxins and extra fluid from the blood, yet the process is very different from hemodialysis. Peritoneal dialysis involves insertion of a catheter into the patient’s peritoneum, or the membrane that lines the stomach.
A dialysis solution, or dialysate, fills the abdominal cavity and absorbs waste and extra fluids from the peri- toneum. The fluid is then drained and replaced with fresh dialysate. Each exchange, or drain and refill, takes between 30 to 40 minutes. Patients enjoy more flexibility with peritoneal dialysis — they can perform the process anyplace that is clean and dry, including at work, at home or while traveling. No needles are involved, and diet and fluid intake is less restricted. Patients also take a more active role in their treat- ment, which studies show increases their overall sense of wellness.2
The most common types of perito- neal dialysis are continuous ambu- latory peritoneal dialysis (CAPD), where the patient manually conducts exchanges, and continuous cycler
assisted peritoneal dialysis (CCPD), where a cycler machine performs exchanges while the patient sleeps. In addition to providing more patient flexibility, peritoneal dialysis costs less — average per patient, per year cost is approximately $77,000.1
Approximately 10 percent of ESRD patients currently conduct peritoneal dialysis treatments at home, and CMS is taking steps to increase that percentage. Medicare is proposing to more than double the payment it offers dialysis providers to teach pa- tients how to perform dialysis — from $50.15 for 1.5 hours to $95.57 for 2.66 hours — beginning January 1, 2017. Some nephrologists encour- age their patients to take the time
to learn how to conduct dialysis at home, saying that patients’ involve- ment in their care produces better health results.3
Sources:
1 United States Renal Data System, Annual Data Report 2016, accessed
January 2017 at usrds.org
2 U.S. Renal Care, Peritoneal Dialysis, accessed January 2017 at 3 usrenalcare.com
Eric Whitney, Feds Say More People Should Try Dialysis At Home, October 4, 2016, accessed December 2016 at npr.org
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