Increase Home-based dialysis in patients with kidney failure and CVD, recommends AHA

USA: The American Heart Association (AHA), in its recent scientific statement, published in Circulation, has supported the incorporation of interdisciplinary care models to increase the use of home dialysis therapy in an equitable manner. This, according to AHA, will contribute to the ultimate goal of improving patient outcomes in those with kidney failure and cardiovascular disease. 

In patients with end-stage kidney disease, cardiovascular disease is the leading cause of morbidity and mortality. Currently, the most common therapy worldwide for patients with treated kidney failure. is thrice-weekly in-center hemodialysis for 3 to 5 hours per session. However, thrice-weekly in-center hemodialysis yields poor outcomes. 

Recent studies have supported the overarching hypothesis that a more physiological approach for the administration of dialysis, including, in the home through home hemodialysis or peritoneal dialysis, may improve several cardiovascular risk factors and cardiovascular outcomes than thrice-weekly in-center hemodialysis. 

The Advancing American Kidney Health Initiative, which has a goal of increasing the use of home dialysis, is aligned with the American Heart Association's 2024 mission to champion a full and healthy life and health equity. 

There is a "need to empower wider adoption" of home dialysis therapies," Mark J. Sarnak and colleagues state. To achieve this objective, there is a requirement of interdisciplinary partnerships to counter the fragmented care that many patients with kidney failure experience. These partnerships work to deliver person-centered care and education to patients before the development of kidney failure, when planning for dialysis ideally occurs. 

These partnerships may include: physicians across specialties (nephrology, cardiology, vascular surgery, palliative care), advanced practice providers, nurses, social workers, dieticians, pharmacists, and many others. Building more cohesive teams can increase access to home dialysis therapies; which may ultimately reduce the risk of cardiovascular disease in these patients.

To conclude, the time is now to help more patients with kidney failure learn about the option to go "home" for dialysis.

Reference:

Sarnak MJ, Auguste BL, Brown E, Chang AR, Chertow GM, Hannan M, Herzog CA, Claire Nadeau-Fredette A-C, Tang WHW, Wang AYM, Weiner DE, Chan CT; on behalf of the American Heart Association Council on the Kidney in Cardiovascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Hypertension; and Council on Lifestyle and Cardiometabolic Health. Cardiovascular effects of home dialysis therapies: a scientific statement from the American Heart Association. Circulation. 2022;146:e•••–e•••. doi: 10.1161/CIR.0000000000001088