At a Glance:
- Despite its benefits, only 12% of end-stage kidney disease patients undergo dialysis at home.
- The U.S. government has set a target to significantly increase the number of patients receiving home dialysis.
- UVA nephrologists have launched a pilot project to help reduce the number of in-person follow-up visits home dialysis patients must attend, saving patients time and money.
The advantages of home dialysis for patients with end-stage kidney disease can be compelling, according to Emaad Abdel-Rahman, MD, PhD, director of the UVA Kidney Center Clinic. “Traveling to a dialysis center three times a week and staying for three or four hours each time can be extremely disruptive,” he says. “At home, patients and their physicians can develop a dialysis schedule that is more flexible and convenient and that often helps people stay healthier.”
Although home dialysis can significantly improve a patient’s quality of life, only 12% of end-stage patients currently undergo dialysis at home, according to Health and Human Services Secretary Alex Azar. An executive order signed by President Trump in July 2019 sets significantly higher targets. By 2025, administration officials would like to see 80% of patients with newly diagnosed end-stage kidney disease receiving home dialysis or kidney transplants.
Although home dialysis relieves most of the burden of transportation for patients, it doesn’t remove all. Home dialysis patients must see their physicians for a check-up once a month. “It’s very important that we monitor patients’ health and make sure they benefit from their treatment,” Abdel-Rahman says.
Abdel-Rahman and his colleague, UVA nephrologist Sana Khan, MD, have launched a pilot telehealth examination program designed to reduce these visits from 12 a year to just four. The impetus for this initiative was the recent decision by the Centers for Medicare and Medicaid Service (CMS) to allow physicians to conduct home dialysis assessments via telehealth systems at patients’ homes.
“Previously, CMS specified that the originating site for end-stage renal disease examinations had to be a location like a clinic, physician’s office, or hospital,” Kahn says. “Home dialysis patients had to visit centers equipped for a telehealth examination or travel to UVA.” Currently, UVA is the first center in the nation to take advantage of this change.
The Advantages of a Virtual Visit — and More
Working with technical support and funding from UVA’s Karen S. Rheuban Center for Telehealth, the program’s administrator, Jessica Jenkins, RN, trained Kidney Center Clinic staff to perform home examinations and visited each of the eight patients in the initial trial. She established two-way video connections, distributed the Bluetooth-enabled devices they would use to measure their vital signs and coached them through a simulated visit.
“These systems include a lot of support for patients,” Jenkins says. “For instance, they have an iPad that tells them exactly where to put the sensors during the exam.”
The program offers benefits for physicians as well as patients. The virtual visits save patients both time and money. Abdel-Rahman points out the that UVA operates one of the few specialized centers in Central Virginia and that its patients often travel great distances for their monthly appointments. Collectively, the eight patients have already saved hundreds of hours in transportation time.
For physicians, the virtual visits give them the opportunity to actually watch patients undergo dialysis, making sure they are doing it properly and safely. “Telehealth is not just equivalent to the type of examination we can perform in the clinic,” Abdel-Rahman says. “It actually enables us to do things that we couldn’t do otherwise.”
Abdel-Rahman believes that the availability of telehealth examinations could accelerate the shift to home dialysis, helping the government meet its goals for 2025. Equally important, he sees these examinations as part of a greater shift in healthcare. “Telehealth is our future,” he says, “not just for dialysis, but for other forms of kidney disease.”
UVA Health is now open for in-person care for new and existing patients.
Call UVA Physician Direct at 800.552.3723 to refer a patient.
To transfer a patient to UVA Health, call the UVA Transfer Center at 844.XFERUVA (933.7882).