COVID-19 has forced many changes in healthcare. The pandemic prompted more hemodialysis patients to receive their therapy at home. And this may lead to the continued increase of home hemodialysis, say nephrology experts.

Around 85% of dialysis patients travel to a clinic for treatment. Not only are dialysis patients more at risk for contracting COVID-19 because they’re exposing themselves to other patients during sessions, but they’re also at risk for more serious complications. 

Fresenius reported it conducted 25% more home hemodialysis training sessions in the first quarter of 2020 than during the same time period last year. 

Maria Duenas, who was diagnosed with kidney failure a few days before lockdown occurred, decided to perform home hemodialysis rather than go to a center.

“To be honest, I didn’t want to do it,” she said of home dialysis. “It was scary having to think about taking care of my own treatment.”

Now, three months later, guided by training and the prompts on the dialysis machine, Duenas feels comfortable, capable and safe.

Looking back, she said, “it was a blessing in disguise.”

This increase in home hemodialysis can be attributed to factors, which include social distancing requirements, fear of the virus, and increased use of telehealth or remote monitoring technologies. 

The Advancing American Kidney Health Order and  ESKD Prospective Payment System have targets aimed at increasing home-based dialysis. 

Researchers suggest that because we are at the beginning of the pandemic, there should be efforts made to increase home dialysis use. We can do this by:

• Educating patients on dialysis options
• Providing opportunities for older patients to receive dialysis in their home or nursing home
• Increasing resources for PD catheter placement
• Developing robust telehealth strategies
• Measuring the quality of treatment based on a patient’s goals and well-being 

Despite the rise in home dialysis, patients may face obstacles like:

• Difficulty obtaining supplies due to supply chain strain
• Administration of medications and timely lab draws due to less attention from staff
• Difficulty getting help with technical issues 

The CDC notes: “Facilities should coordinate with home dialysis supply companies to ensure supplies continue to be delivered to patient homes and stored appropriately. Contactless delivery might be impractical due to the size and weight of supplies. Home programs should have a plan to enable safe in-home deliveries, even if someone in the household has tested positive for COVID-19 or has symptoms consistent with COVID-19.”

In addition to these obstacles, experts are concerned about the mental health issues that may arise from patients being isolated for long periods of time. Providers can help resolve these issues by using telehealth and Medicare coverage to closely monitor patients. 

“The advantages of home dialysis during the COVID-19 outbreak outweigh the technical issues involving patient care,” Yerram and Misra wrote, “and the tools are available to resolve any management and clinical-related issues. Telehealth, in particular, is an important part of the picture.”