Home hemodialysis (HHD) may offer improved health and quality of life for patients with end-stage kidney disease (ESKD), which affects more than 800,000 Americans.[i] However, due to patient fears and access concerns, nurse shortages, and the perception of extensive training time, HHD utilization remains low. Despite its association with improved patient outcomes,[ii] far too many patients are missing the opportunities to receive a more agile, flexible treatment modality.
Comprehensive and fresh approaches to HHD training are crucial to improve patient adoption rates. Kidney care providers can help increase the uptake of this underused but vital treatment through group training, an intriguing model of patient education.
Why Increasing HHD Uptake Matters
Home dialysis uptake has climbed in the past decade, yet HHD is lagging:
- From 2011 to 2021, the percentage of incident patients on home dialysis increased to 13.4% – but just 0.4% started with HHD in 2021.iii
- Among new and preexisting patients, home dialysis use increased from 9.7% to 14.1%– but HHD only increased from 1.5% to 2.3%.[iii]
- Among the total patients with ESKD at Fresenius Kidney Care, HHD percentage increased from 1.2% in 2013 to 4.2% in 2022.[iv]
A group training model is key to increasing the number of home hemodialysis users – something a clinic in Clayton, North Carolina has seen first-hand.
Group Training in Action
Fresenius Kidney Care Stallings Station serves patients on the outskirts of Raleigh. With the patient population generally having lower health literacy, many patients have not considered home dialysis since in-center treatment has been the default modality. In 2021, the clinic piloted a new model in which training is done in groups. Participants could see others learn the steps multiple times, reinforcing each individual’s knowledge. The training is also done in sight of in-center patients who are encouraged to join.
“It all begins with education and encouragement,” says Phyllis Merritt-James, a nurse practitioner at the clinic. “Once we’re able to educate patients about the program, they’ve been much more open to exploring it.”
This approach led to a spike in HHD patients and improved patient retention at the clinic. "Our HHD group training model, despite our dialysis staffing shortage, has led to a rapid and sustained HHD growth of 25% over 12 months," said Dr. Sejan Patel, the center’s nephrologist. There are now more home patients than in-center patients. The rate of patients continuing with HHD 120 days after training completion improved from 78% before the model’s introduction to nearly 84% afterward.
More People Means Less Time
Group training can allow more patients to train more quickly than individual training. Healthcare training teams will always ensure that patients are comfortable and can safely perform their treatments before going home. In a study of HHD patients, half were trained on a NxStage system in 10 sessions in 2 weeks or less.[v] While training times vary and depend on patient experience, being able to train quickly is a testament to NxStage systems being designed for simplicity and ease of use by patients at home.
The clinic provides comprehensive training including cannulation so patients can take on this new treatment at home – something patients at the center can attest to.
“This training model is second to none,” says Rickie Corey, an HHD patient at the clinic. “When my wife and I were told we could go home after 10 days of training, we couldn’t believe it, but they prepared us so well for doing this at home. I’m feeling worlds better.”
Addressing Staff Availability
The COVID-19 pandemic spurred increased interest in home dialysis. However, nursing shortages meant that there were fewer staff to train patients. The idea of group training was born. The 4:1 patient-to-nurse ratio in training sessions has proven to be successful, as the nephrologist, nurses, and other staff have created a sense of community while supporting individual patients.
Growing a Support System
The group training model offers a built-in support system. Patients can benefit from group discussion, learn from each other and reinforce what they’ve learned. For others, the group setting helped them overcome personal fears.
“Due to my extreme fear of needles, I was in tears when I had to stick myself,” says patient Christin Elrod. “Then, I watched the other patients in the group stick themselves and that gave me the courage to do it myself. I now do it myself every day.”
Groups As the Gold Standard
The group training model offers an easy and cost-effective way to help remove barriers that prevent HHD uptake – personal patient fears, concerns over training time, and staff shortages. This approach should be considered the gold standard for dialysis centers in training new patients.
For more information on HHD products, training and education resources, visit www.NxStage.com.
Not all patients may experience these benefits.
[i] USRDS 2023 ADR: United States Renal Data System. 2023 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2023.
[ii] https://www.nxstage.com/patients/benefits-of-home-hemodialysis/
[iii] https://usrds-adr.niddk.nih.gov/2023/end-stage-renal-disease/2-home-dialysis
[iv] Data on file, Fresenius Medical Care
[v] Cherukuri et al, doi: 10.1186/s12882-018-1059-2