BioTrends is pleased to announce the publication of a new syndicated report, Special Report: Dialysis Modalities in the US. This report covers the use of various dialysis modalities including peritoneal dialysis (PD) and home hemodialysis, as well as attitudes and perceptions toward these modalities, advantages and disadvantages, ideal patient types, barriers to growth, and expected future use. This report is based on responses to an online survey completed by 78 dialysis center medical directors and 34 dialysis nurses. Qualitative interviews were also conducted with three PD and three home hemodialysis thought leaders.

Currently, the vast majority of patients receiving dialysis in the US are on in-center hemodialysis. Medical directors recognize that alternative modalities are under-utilized and report that patient preference is the largest influencer in modality choice. Consequently, medical directors view lack of patient interest as the largest barrier to increased use of home modalities. Thought leaders in this area tend to feel that if nephrologists were more comfortable with these modalities, patients would be better educated about the options, and there would be an increased use of home modalities. While there are a number of co-morbidities that encourage or discourage use, and certain patients who are not appropriate for home therapies, thought leaders feel that a significant number of patients who currently receive in-center hemodialysis are candidates for home therapies.

The majority of medical directors and dialysis nurses expect their use of both PD and home hemodialysis to increase in the near future, although the increase is likely to favor one modality over another. This change is mainly financially driven in light of bundling, although in line with best clinical practice according to a rank order completed by medical directors regarding perceptions of modality choice on patient outcomes. Interestingly, despite the fact that the vast majority of US dialysis patients are currently treated with in-center hemodialysis, 98% of the medical directors surveyed would choose a home modality for themselves if they needed dialysis. The increased use of home modalities could have implications for the use of medications as both overall treatment prevalence and medication dose for renal anemia and bone and mineral metabolism drugs tend to be impacted, according to clinicians, by the use of home modalities relative to in-center hemodialysis.

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