In an era when just about every medical treatment that can be done at home is moving in that direction, only about 12% of patients receiving kidney dialysis do so at home, despite it being cheaper and research showing it's just as safe.
There are a host of reasons why. Most people cite physicians' lack of training on home dialysis and their resulting reluctance to suggest it. Sometimes patients themselves are too sick or overwhelmed to take on that task.
But experts in the field say there's another major factor at play: money. More than 80% of the nearly 6,500 dialysis facilities nationally are owned by two for-profit companies, DaVita and Fresenius Medical Care. Providers aim to see a return on the money spent building and staffing those dialysis clinics, which some say means keeping patients in those dialysis chairs.
“An empty chair is kind of like an empty seat on an airplane,” said Dr. Brent Miller, professor of medicine and clinical chief of nephrology at Indiana University. “If we were just looking at this not as people and not as healthcare but just as a business like an airline, our goal would be to fill all those slots.”
On the contrary, the country's biggest dialysis providers insist they're all-in when it comes to home dialysis, and reject the notion that their own reluctance has contributed to the slow uptake. DaVita said it wants to bump its home dialysis patients from about 13% of dialysis patients currently to 25% by 2025. And Fresenius said it wants to go from 12% currently to 25% of dialysis patients receiving some home therapy by 2022. Fresenius is even looking to buy home dialysis devicemaker NxStage for $2 billion.
One potential driver of companies' apparent enthusiasm for home treatment might be CVS Health's announcement last year that it plans to disrupt kidney care by expanding home dialysis, identifying kidney disease earlier and developing new home hemodialysis technology. CVS hasn't released many details, but Dr. Harry Jacobson, a nephrologist and co-founder of the investment firm TriStar Health Partners, described it as a “breakthrough.” He declined to share more detail because of a confidentiality agreement with the company.
“It's disruptive and it's my opinion that it will be a real catalyst for increasing home hemodialysis,” he said.
Academics like Miller and Dr. Thomas Golper, a professor of medicine at Vanderbilt University, said they welcomed the innovation, but know traditional providers are nervous.
“That's the 800-pound gorilla,” Golper said. “There's a lot of people who are very nervous about that.”
CVS plans to launch a clinical trial to study the safety and efficacy of its new technology ahead of a planned Food and Drug Administration submission, a company spokeswoman wrote in an email. The device is intended to make home hemodialysis simpler and safer, and to facilitate longer, more frequent treatments.
“We expect to provide more information on the device, and our associated activities throughout this year,” she wrote.
Whatever the reason, the percentage of patients with prevalent end-stage renal disease who receive the treatment at home has grown only slightly, from 11.3% in 2013 to 11.8% in 2016, according to the U.S. Renal Data System, which publishes information about end-stage renal disease treatment.