Fissell Rachel B, Cavanaugh Kerri L
Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA.
Semin Dial. 2020 Nov;33(6):499-504. doi: 10.1111/sdi.12939. Epub 2020 Nov 19.
Home dialysis use as a treatment for end-stage kidney disease varies locally, nationally, and internationally. There is a call to action in the United States to significantly increase access and uptake of home dialysis as the preferred dialysis treatment option. Although most do not object to patient choice in modality selection, the reality is that there are multilevel barriers both obvious and subtle that interfere with expanding home dialysis access. Financial barriers and how payment is structured continue to be key drivers, although new models of care are emerging that include for the first time incentives rather than penalties regarding home dialysis. Resources to support implementation include expert personnel requiring educational training. Policies requiring training curriculum content that is not only specified within nephrology but also for these multidisciplinary providers requisite for successful home dialysis to ensure professional expertise is ready and available, and also to cultivate champions of home modality within the broader nephrology community. Perhaps most importantly, innovation through expanded investment in research is necessary to advance practices, elevate quality, and improve outcomes. Policy in a variety of sectors at local, regional, national, and international levels has the potential to drastically drive expansion and increasing success of home dialysis.
家庭透析作为终末期肾病的一种治疗方式，在当地、全国乃至国际范围内的使用情况各不相同。在美国，人们呼吁采取行动，大幅增加家庭透析作为首选透析治疗方案的可及性和采用率。尽管大多数人并不反对患者在透析方式选择上的自主权，但现实情况是，存在着明显和微妙的多层次障碍，阻碍了家庭透析可及性的扩大。经济障碍以及支付结构仍然是关键驱动因素，不过新的护理模式正在出现，首次将对家庭透析的激励而非惩罚措施纳入其中。支持实施的资源包括需要接受教育培训的专业人员。政策要求培训课程内容不仅要在肾脏病学领域明确规定，还要针对成功开展家庭透析所需的这些多学科提供者，以确保专业知识完备且可得，并在更广泛的肾脏病学界培养家庭透析模式的倡导者。也许最重要的是，通过扩大研究投资进行创新对于推进实践、提升质量和改善结果是必要的。地方、区域、国家和国际各级多个部门的政策有可能极大地推动家庭透析的扩展并提高其成功率。
