By Peter Laird, MD
AJKD just published a testimonial essay on my own journey with kidney disease in which I also advocate for optimal home hemodialysis 0ptions, the one ignored gift of life for renal patients in America.
America continues to deny access to life-saving treatments proven by decades of observational studies which have been confirmed by at least 2 randomized and controlled trials. The ACTIVE trial (ClinicalTrials.gov identifier NCT00649298) testing the differences between more than 24 h/wk versus fewer than 18 h/wk of hemodialysis should be completed in the next couple of years, but in my opinion, we already have overwhelming evidence of the benefits of more frequent and longer duration hemodialysis rivaling deceased donor transplant survival.
Yet today, access to improved dialysis techniques is a little-heralded cause, especially in comparison to the frequent coverage in both the medical and popular press of transplant issues. Whereas the current standard of care requires all patients with ESRD to be evaluated for eligibility for transplant, only 1%-2% of the 400,000 hemodialysis patients in America have access to potentially life-saving home hemodialysis options. The ESRD “Conditions of Coverage” mandate a discussion regarding home dialysis options, but in reality this option is available only in limited areas. We have a long way to travel to match the nearly 25% home hemodialysis population seen in New Zealand and Australia. This is a cause with solutions, a cause that I will continue to champion. It is time for America to return to our pioneering days and reveal the true potential of this life-saving treatment.
Sadly, few American dialysis patients have access to the same hemodialysis options that I now enjoy in the comfort of my own home. It is time that the vision of home hemodialysis from Dr. Scribner and his many colleagues come full circle and begin to save hundreds of thousands of lives every year. The technology is now available, what is lacking is the will to purpose in our hearts to carry this vision to completion.