Exploring Home Dialysis: Insights from Dr. Venkata Raju Behara
Dr. Venkata Raju Behara, a nephrologist with 17 years of experience at NANI's Mount Prospect Kidney Care Team, recently shared valuable insights on patient selection and outcomes for home dialysis. While in-center dialysis remains the most common choice (used by 87–88% of patients), home dialysis offers two alternatives: peritoneal dialysis and home hemodialysis.
Who Is a Candidate for Home Dialysis?
Over time, the criteria for selecting patients for home dialysis have shifted. It's no longer just about a patient's intellectual or economic status. Instead, the primary factor is their interest and choice. Unfortunately, nearly half of all patients start dialysis without prior education about their options, often "crashing" into emergency care and defaulting to in-center treatment.
Debunking Myths About Home Dialysis
A common misconception is that home dialysis is unsuitable for patients with complications like low blood pressure or heart conditions. Dr. Behara explains that these patients may actually benefit the most. Home dialysis offers gentler fluid removal, better mimicking the natural function of healthy kidneys. This can result in:
- Fewer instances of low blood pressure
- Reduced fatigue after dialysis
- Better management of fluid overload
- Improved heart health
Training for Home Dialysis
Learning to perform dialysis at home requires training tailored to the type of treatment:
- Peritoneal dialysis: 2–4 weeks of training
- Home hemodialysis: 4–6 weeks, due to additional technical requirements
Patients are trained until they can confidently and safely perform the procedure on their own.
Support and Monitoring
Patients on home dialysis aren't alone in their journey. They benefit from:
- Constant communication with their care team
- Remote monitoring and monthly in-person visits
- Education on preventing infections and recognizing early warning signs to allow quick intervention
This comprehensive support ensures safety and helps prevent complications.
Insurance and Comprehensive Care
Home dialysis is covered by both Medicare and commercial insurance, making it accessible for most patients. The care team includes physicians, nurses, social workers, dietitians, and financial coordinators, providing a fully integrated support system.
Quality of Life and Outcomes
According to a 2019 study by Kaiser Permanente, home dialysis patients report a higher quality of life compared to those receiving in-center care. Dr. Behara emphasized that outcomes with home dialysis are as good as, or even better than, in-center dialysis. Importantly, patients can transition to home dialysis at any stage, even after years of in-center treatment.
A Success Story
Dr. Behara shared the story of a patient who transitioned to home hemodialysis after undergoing cardiac bypass surgery. The patient experienced better blood pressure control and overall improved health. This success highlights that home dialysis can be a viable option for anyone willing to explore it.
To learn more, listen to the full podcast here: Spotify Podcast
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