Home-Based Renal Care Solutions

Introduction

Nowhere has innovation been more prevalent in recent years than in healthcare – but this astounding progress has not been evenly distributed throughout all sectors of medicine. Before the pandemic, around 5 million people received care at home in 2019. This number skyrocketed to 12 million by 2020, fueled by COVID-19. Why the surge? Like telehealth, at-home care was already gaining traction. Many older adults and those with chronic conditions found it more comfortable, convenient, and personalized than facilities. The pandemic further accelerated this trend. As lockdowns and social distancing became the norm, and people became wary of hospitals, 11% of discharged COVID-19 patients went into at-home care. This shift exposed entirely new patient groups – across ages and health conditions – to the benefits of home-based care.

As demand for at-home care grew, many patients with chronic conditions explored this appealing option. Dialysis treatment, which was already seeing strong adoption of at-home care, continued to grow over 2020 and 2021.

Market Dynamics of Home-Based Dialysis

With altered dynamics, the home dialysis market is experiencing a boom, driven by confluence of factors. The growing number of patients with chronic kidney disease (CKD) creates a larger demand for dialysis options. Fortunately, advancements in technology are making home dialysis machines more user-friendly and efficient. This, combined with the inherent challenges of kidney transplants, such as surgical risks, anti-rejection medication, and a persistent organ donor shortage, is making home-based treatment a more attractive and potentially superior alternative. Adding to this momentum, government initiatives and supportive policies are creating a more fertile ground for the widespread adoption of home dialysis. This confluence of rising demand, technological advancements, and favorable government support is expected to propel the home dialysis market to a staggering value exceeding $40 billion by 2030, signifying a remarkable growth trajectory.

Although the penetration of dialysis is poor among low-income countries like India and China, that can be attributed to multiple reasons like lack of trained nephrologists, limited dialysis facilities, unequal private-government owned dialysis centers, lack of proper insurance facilities, etc. there is still a significant demand of owing to enormous population wherein even a very low treatment rate results in a manageable dialysis patient population. On the contrary, it has also been observed that country’s GDP has a role to play in dialysis treatment rates, which is why US, Japan and Taiwan top the list with highest number of end-stage renal disease treatment rates, followed by Malaysia and Thailand. With over half a million patients on regular dialysis due to end stage renal disease (ESRD), and more than one in seven adults in the U.S. nearly 37 million people living with chronic kidney disease (CKD), the opportunity to improve quality of life, to better outcomes, and to lower costs with a new model of care is immense.

Another interesting factor is the amount of health care spending, and it has also been observed that provider and insurer models also impact the treatment rates. Use of private providers can enhance the associated costs, therefore publicly provided system as that in Hong Kong, can be affordable for patients and can lead to higher treatment rates. The stats depicts that though different countries have varied dynamics, but the market still has potential for more growth which can be tapped through at-home renal care services & offerings.

The reimbursement structure is another facet of how the current market dynamics of renal care segment is getting impacted. Currently, the specific strategies to decrease the financial burden of ESKD, such as programs to stimulate prevention of progression of CKD or promote the most cost-saving dialysis modalities are underutilized. To manage the cost effectiveness of the dialysis related treatment, the government are planning & adopting different payment models and system. The objective of the government is to offer quality care along with medications at controlled costs, that can be little overwhelming for dialysis providers. Bundled payment are getting adopted highly across different countries because it has encouraged dialysis provider to focus on how they can achieve the best patient outcomes while restraining costs.

Bundled payments cover everything needed for outpatient dialysis, including medications (except pills until 2025), supplies, and other services previously billed separately. The government agency in charge of dialysis payments (CMS) expected to pay around $9 billion to 6,000 clinics in 2017 for these bundled costs. Since bundling, there’s been a shift in treating other complications like hyperparathyroidism with medications. New drugs have also been approved for managing end-stage kidney disease. Additionally, there’s been a small increase in patients using home dialysis, especially peritoneal dialysis (PD), instead of in-clinic hemodialysis (HD). Studies suggest home dialysis could be better for many more patients than currently use it. Doctors are taking note of this data and trying to improve patient outcomes and quality of life on dialysis, which often means encouraging home dialysis use.

With evolving ecosystem, innovation solutions can increase the adoption of for example, establishing community houses for home hemodialysis (HD) can be one such way. Additionally key players are also focusing on developing better and smart home dialysis machines, due to multiple benefits like, cost efficient, greater convenience, flexibility, and quality of life.

Rise of Startup Players in Home Care Dialysis

The emergence of innovative startups such as Outset Medical, renowned for their groundbreaking Tablo Hemodialysis System designed to simplify dialysis treatment while incorporating advanced remote monitoring capabilities. Similarly, Somatus stands out for its emphasis on value-based kidney care, leveraging technology and personalized approaches to drive improved outcomes for patients. Diality, on the other hand, has garnered attention for its portable hemodialysis system, the C3 System, which has revolutionized home dialysis by offering unparalleled convenience and ease of use. Aksys has made strides in peritoneal dialysis with its Personal Dialysis System (PDS), prioritizing user-friendliness and patient comfort. Quanta Dialysis Technologies rounds out this cohort with its SC+ System, a compact hemodialysis machine that not only provides flexibility in treatment options but also integrates advanced features for enhanced patient management.

In addition to enhancing patient care, these startup innovations have also brought about notable cost-efficiencies in home dialysis, making it more accessible and sustainable for a broader range of patients. By incorporating remote monitoring, data analytics, and connectivity features into their solutions, these startups have not only improved patient outcomes but also paved the way for more efficient management of home-based renal treatment. Overall, the rise of startup players in home care dialysis represents a significant step forward in the field, offering promising avenues for continued innovation and improvement in home dialysis options.

Challenges in Home Care Dialysis Implementation

Home dialysis, especially for older adults, presents a myriad of challenges that healthcare professionals and patients must navigate. One significant challenge is the perception and biases held by some practitioners regarding the suitability of home dialysis for older adults, particularly those with age-related impairments. Surveys and studies have shown that a significant portion of nephrology healthcare professionals may favor in-center hemodialysis over peritoneal dialysis for older patients, citing concerns about dialysis efficiency and patient age as factors influencing their preferences. This bias, whether explicit or implicit, can impact the decision-making process and access to home dialysis for older adults.

Another challenge is the complex nature of defining eligibility criteria and successful therapy outcomes for older adults on home dialysis. Chronological age alone is not a sufficient measure of a patient’s suitability for home dialysis, yet there is a lack of consensus on how to assess factors such as frailty, fitness, and functional status in this population. This leads to inconsistencies in treatment approaches and difficulty in comparing outcomes across studies and healthcare settings.

Financial and organizational factors also contribute to the challenges of home dialysis for older adults. Reimbursement schemes in many countries may favor in-center hemodialysis over home dialysis, leading to limited access and uptake of home dialysis programs. Healthcare providers may prioritize profitability over patient-centered care, further exacerbating the disparities in access to home dialysis for older adults.

Additionally, managing treatment-related complications in older adults on home dialysis poses significant challenges. Older patients are more susceptible to infections, cardiovascular complications, and protein-energy wasting, requiring a multidisciplinary approach to care that includes nutrition management, cardiovascular monitoring, and infection prevention strategies. Caregiver dependence and burnout are also major concerns, as older adults often rely on family members or caregivers for assistance with home dialysis procedures, leading to caregiver stress and potential disruptions in care delivery.

Future Directions

While current treatments offer improved results, the cost of care remains a concern. Looking ahead, we must ask: How can we make kidney care even better, easier to use, safer, and more affordable? Public-private partnerships support end-stage renal disease (ESRD) care, but adoption of cost-effective, outcome-improving technologies remains slow, therefore it can rightfully argue that cost of care will be a significant driver as we move ahead in future. To reduce costs, the healthcare industry should move away from expensive, in-person facilities and embrace home treatment.

Reducing the carbon footprint within dialysis is a crucial aspect of sustainability efforts in home-based renal care. As we explore alternative dialysis therapies beyond traditional in-center hemodialysis (HD), the focus turns to home-based treatments like peritoneal dialysis (PD) and home HD, which promote patient independence, flexibility, and environmental responsibility. While PD offers advantages such as reduced waste production and water consumption compared to HD, our sustainability goals require a comprehensive assessment of resource utilization, including water, energy, and material inputs. The transition from PD to HD, often driven by clinical considerations, presents opportunities for significant environmental gains through home HD programs, leading to substantial reductions in patient travel-related CO2 emissions. The transition to environmentally friendly renal care in home settings presents a strategic opportunity for industry players to lead the way in sustainability efforts. Continued advancements and strategic analyses within home dialysis systems are crucial to unlocking the full potential of reducing the carbon footprint in dialysis. This not only aligns with global sustainability goals but also enhances the overall quality and accessibility of renal care for patients, fostering a positive reputation and competitive advantage in the healthcare market.

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Home-Based Renal Care Solutions

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