A Kaiser Permanente study reveals that the rate of people starting voluntary at-home peritoneal dialysis rose from 15% to 34% over 10 years in Kaiser’s Northern California region representing a convenient and safe way to manage advanced-stage kidney disease compared with center-based hemodialysis. Perhaps America will now catch up with some other countries for patient convenience.
In 2008, Kaiser Permanente Northern California launched a systemwide Optimal Start approach to increase at-home dialysis, which included patient and caregiver education, provider education and support tools, streamlined systems-level processes, and monitoring and continuous quality improvement.
The study was titled “Trends associated with large-scale expansion of peritoneal dialysis within an integrated care delivery models,” identified 13,500 adult members of Kaiser Permanente Northern California who initiated chronic dialysis between 2008 and 2018. Among those who initiated chronic peritoneal dialysis, 80% remained on it one year after starting, with a significant increase from 2008 (69%) to 2017 (84%). Death rates after one year for patients starting at-home peritoneal or center-based dialysis did not change over 11 years of the study.
Lead research Alan S. Go, MD research scientist, Kaiser Permanente Division of Research in Oakland, CA noted: “The large-scale expansion of in-home dialysis was made feasible using a multidisciplinary, integrated, coordinated-care approach, with excellent outcomes in patients with advanced kidney disease.”
Dr. Go emphasized that compared with rates of at-home peritoneal dialysis are substantially higher in other parts of the world when compared to the United States. For example, rates of at-home dialysis in Hong Kong (70%), Mexico’s Jalisco region (51%), New Zealand (30%), and Canada (19%). The United States rate of at-home dialysis is less than 10%.
Go continued “Peritoneal dialysis remains underutilized nationally.” He noted, “Our study shows that it is possible to greatly expand its use successfully in a large, integrated health-care system and improve outcomes for patients with chronic kidney disease.”
The study was published in JAMA Internal Medicine.
Alan S. Go, MD Research Scientist, Kaiser Permanente Division of Research
Call to Action: The move to patient-centric care; home health care and other home-based approaches will only continue—we see some of the same trends in clinical research.