The federal government wants 80% of kidney disease patients to get dialysis at home or receive an organ transplant by 2025. Currently, only 13.7% of Americans who use dialysis services do so at home. 

With such a large gap, LDI Senior Fellows Yuvaram Reddy, Robert Burke, Peter Reese, and Meghan Lane-Fall reviewed survey responses from more than 500 patients, caregivers, and providers—and identified the most significant barriers for home dialysis.

Getting the treatment at home offers significant benefits for patients, but it has a consistently low adoption rate. Here’s what is holding everyone back. 

Barriers for Patients and Care Partners:

1. Fear of Performing Dialysis at Home

• Many patients and care partners feel anxious about conducting dialysis procedures without professional medical supervision.
• Representative Quote: “When I started home dialysis, I didn’t have a care partner at home, and I was scared to be [there] with no backup if anything happened.” – Patient

2. Limited Space at Home

• Patients often struggle with finding enough room in their homes to accommodate the dialysis machine and the necessary supplies.
• Representative Quote: “There is heavy lifting involved for older people and supplies are overwhelming; having to mix dialysate, order supplies, centrifuge blood and get it mailed, and go two hours away for care plan meetings.” – Care Partner

3. Need for More Home-Based Support

• The lack of a support system at home makes it harder to find help if something goes wrong.
• Representative Quote: “Patients may not have a care provider at home to provide support. [There is] no medical professional to provide assistance if something goes wrong.” – Patient

Barriers for Health Care Providers:

4. Poor Home Dialysis

• Providers cite inadequate patient education on home dialysis as a critical barrier, which saps patient confidence and their desire to manage the process independently.
• Representative Quote: “Home dialysis is often offered after a failure of in-center hemodialysis, making it appear to be a last-ditch try instead of the first best option.” – Nurse Practitioner

      5. Lack of Reimbursable Mechanisms for Support

5. Lack of Reimbursable Mechanisms for Support

• There are insufficient reimbursement mechanisms for additional support services like mental health, home-based support, and kidney disease education, which hamper the provision of comprehensive care.
• Representative Quote: “Providers often struggle with the financial aspect, which limits the extent of support they can offer to home dialysis patients.”

     6. Lack of Experienced Home Dialysis Staff

6. Lack of Experienced Home Dialysis Staff

• A shortage of experienced staff trained in home dialysis affects the quality and reliability of care that patients receive.
• Representative Quote: “Providers note the challenge of finding and retaining skilled personnel to support home dialysis initiatives effectively.”

Addressing these barriers requires a multifaceted approach that includes improving patient education, enhancing support systems at home and from providers, and developing policies that support the financial and staffing needs of home dialysis programs. By tackling these challenges, we can improve the adoption and effectiveness of home dialysis.

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The study, “Identifying Major Barriers to Home Dialysis (the IM-HOME Study): Findings from a National Survey of Patients, Care Partners, and Providers,” was published on June 6, 2024 in the American Journal of Kidney Diseases. Authors include Yuvaram Reddy, Matthew D. Kearney, Michaela Ward, Robert Burke, Ann M. O’Hare, Peter Reese, and Meghan Lane-Fall.

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