Kidney failure patients should have the option of undergoing dialysis from the comfort of their own homes on a schedule that allows them to keep their jobs, rather than enduring four-hour sessions at the many dialysis centers proliferating throughout low income neighborhoods, U.S. Rep. Bobby L. Rush, D-Chicago, says.
Rush and Jason Smith, R-Mo., have introduced legislation to expand access to home dialysis for kidney patients, providing Medicare reimbursement for trained staff to visit home dialysis patients and “also ensure that all kidney patients are educated about home dialysis options early in their treatment process and given the support they need to utilize home dialysis,” Rush’s office said in a statement.
The Improving Access to Home Dialysis Act would also require the Department of Health and Human Services to conduct a study on the racial disparities in the utilization of home dialysis.
“Kidney disease is a debilitating illness that affects many people in my district, including a disproportionate number of Black Americans, who suffer from kidney failure at more than three times the rate of white Americans,” Rush said in a statement to Crain’s. “While dialysis centers play an important role in providing care for kidney patients, for many patients, home dialysis can be a much better treatment option. Home dialysis is far more flexible than in-center dialysis, and the evidence suggests it leads to better health outcomes and quality of life for patients.
“However, I have long been concerned that too many kidney patients are steered to dialysis centers without being provided adequate education about other treatment options. In the poorer parts of my district, it sometimes seems that there is a dialysis center on every corner—and the data bears that out. In recent years, there has been an explosion of dialysis centers in low-income and minority neighborhoods, and studies have shown that Black Americans are far less likely to receive home dialysis than their white counterparts.”
Rush was a key author of a letter to the U.S. Department of Health & Human Services and the Centers for Medicare & Medicaid Services Administrator in 2019, in which he expressed concern about an “explosion” of dialysis centers in poorer, largely minority communities.
“Importantly, this bill will also require a government study on racial disparities in the utilization of home dialysis and make recommendations on how to improve access to home dialysis for communities of color,” Rush said in the statement. “And it will provide concrete data on outcomes for in-center and home dialysis patients.”
“Home dialysis increases the survival, autonomy and financial stability of the 800,000 Americans living with kidney failure and is especially important during the COVID-19 pandemic, which puts the health of people with kidney diseases at extreme risk,” Susan Quaggin, president of the American Society of Nephrology said in a statement. “However, only 12.5% of people undergoing dialysis do so at home, while Black Americans, Hispanic or Latinx Americans, and Asian Americans are between 7%-35% less likely than white Americans to receive home dialysis, a disparity due entirely to social determinates of health.”
Rush’s office also pointed to a 2015 study by the Loyola University Health System that found the percentage of adults beginning dialysis for kidney failure between 1995 and 2010 rose 6.6 percentage points for adults in high-poverty ZIP codes compared to an increase of 1.5 percentage points for the general population.
Fresenius Medical Care North America, one of the largest dialysis providers in the country does not disagree that home dialysis should be expanded.
“We fully support the goal to see more people choose home dialysis and strongly believe home treatment is the first and best choice after transplant for people living with kidney failure,” Dr. Rob Kossmann, chief medical officer for Fresenius Medical Care North America said in an emailed statement to Crain’s. “We have made significant investments in home dialysis staffing, patient and physician education, transitional care units, connected health technology, as well as new home products and dialysis machines. While these efforts have helped us generate record increases in-home dialysis treatments, up more than 14% last year alone, we must continue to accelerate this shift. We look forward to fully reviewing this proposed legislation and continuing to work in partnership with Congress on these important initiatives.”
In a September 2020 statement, Kossman and Joe Turk, president of home and critical care therapies at Fresenius called the U.S. Department of Health & Human Services’ Advancing American Kidney Health Initiative, which encourages home dialysis and transplant for people living with kidney failure, “yet another step toward a paradigm shift in kidney care.”
The bill could also be good news for the renal care business of Deerfield-based Baxter International, which accounts for one-third of total sales. Baxter’s peritoneal dialysis systems can be provided at home for end-stage renal disease patients more flexibility than traditional hemodialysis since it can be done at home and more frequently. Baxter also supported the aims of the Advancing American Kidney Health Initiative.