We’ve made great strides in health equity in outpatient dialysis. Here’s why it’s not enough.

One in seven American adults are impacted by chronic kidney disease (CKD), which may cause the kidneys to fail over time if untreated. Patients who experience kidney failure need a kidney transplant or dialysis treatment to live. This disease disproportionately affects communities of color, and the disparity grows as patients reach end stage kidney disease. 

Fortunately, access to high-quality care in outpatient dialysis centers is largely equitable. This is true as an industry and specifically for DaVita’s more than 2,800 outpatient centers, where clinical metrics such as hospitalizations, readmissions and infection rates are largely equitable across patient demographics, including socio-economic status, race, gender and geography. 

While this progress is encouraging, our work is far from complete.

Our goal is to facilitate equity at every step of the kidney care journey. Disparities remain within CKD treatment, home dialysis, transplant and end-of-life care. 

Let’s focus on home dialysis as an example. 

Although the choice of home dialysis may provide certain clinical and quality-of-life benefits for many patients, white dialysis patients are nearly twice as likely to choose home treatment compared to Black or Hispanic patients.

Today, 15% of DaVita patients choose to treat at home. By 2025, we have a bold goal to help more patients treat at home and to nearly double the current industry average.

Driving greater equity in home dialysis is right for our patients and imperative if we are to reach this audacious goal. To do so, we are differentially addressing the disparities Black and Hispanic patients face. And if we are to level the playing field, as we have for patients receiving outpatient dialysis, we must work together. 

This starts with transparency. We have made ourselves accountable for identifying where and why disparities exist in kidney care and for driving greater understanding of these areas within our care teams. As part of this effort, we’ve started sharing health equity reports that highlight progress and gaps. We believe that making this data available will help drive awareness of inequity among our care team members and physician partners.

We also recognize that one-size-fits-all patient education may not effectively bridge the gap for diverse patient populations, so we have engaged recognized experts in medical diversity to help us evaluate and evolve our approach. Every DaVita patient receives ongoing education about their treatment options, including home dialysis. We are committed to ensuring this education is both culturally competent and structured in such a way to engage our patients to participate in their own care. This approach is designed to enhance trust and credibility between patients and their care teams so that every individual becomes empowered to work with their physicians to find the best treatment option for their health and lifestyle. 

There are three key inflection points in a patient journey where we can identify and reduce disparities to help drive adoption of home dialysis:

1. Equipping patients with education and clinical support to choose to start dialysis at home
2. Helping patients transition from in-center treatment to home with the support of their treating nephrologist
3. Helping home dialysis patients stay on their modality of choice

Our vision is to equitably enable every dialysis patient to have the potential of benefitting from a convenient, confident and connected experience at home, if that is their choice. 

This focus has helped DaVita treat more patients at home than any other provider since 2002. It is also why we feel passionate about addressing this and other disparities along the kidney care journey to help close gaps for Black and Hispanic patients.

We’ve never been more optimistic about reaching our 2025 home dialysis goal. But we aren’t focused solely on hitting our targets; we are focused on reaching them equitably.

Jeffrey Giullian, MD, serves as chief medical officer of DaVita Kidney Care. Dr. Giullian leads the transformation of kidney care through his commitment to providing holistic, integrated care that addresses the clinical and psychosocial needs of patients. Dr. Giullian is focused on pushing the boundaries on exemplary clinical care through innovation and expanding what is possible for patients living with kidney disease.

For more information about DaVita's home dialysis programs, please visit davita.com/home.