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Strengthening home dialysis training will improve fellows’ confidence and promote public policy goals, says Nupur Gupta, MD.

Study shows that gaps in training may contribute to low home dialysis rates

Nupur Gupta, MD

Nupur Gupta, MD

However, strengthening home dialysis training will improve fellows’ confidence and promote public policy goals, says Nupur Gupta, MD.

Of the nearly half a million Americans who rely on dialysis to manage their chronic kidney disease, about 80 to 90 percent receive their treatments in clinics or designated dialysis centers. The rest receive their dialysis treatments at home.

These rates are unusual in comparison to other economically developed countries, according to Nupur Gupta, MD, an Assistant Professor of Clinical Medicine and medical director of the home dialysis program at IU School of Medicine and IU Health.  

“The ratio of patients who use at-home dialysis to those who do it in clinics or centers is higher in places like New Zealand, Australia and Canada,” she said.

Despite the advantages of home dialysis, there are several reasons why it is under-utilized in the United States, most notably due to insufficient infrastructure and low compensation for physicians under Medicare. But Gupta and her colleagues, Elizabeth Taber-Hight, DO, and Brent Miller, MD, have identified that a lack of home dialysis training in nephrology programs may also be significantly contributing to low home dialysis rates nationwide.

Their article “Perceptions of Home Dialysis Training and Experience Among US Nephrology Fellows," which was published this month in the American Journal of Kidney Disease (AJKD), suggests that many trainees do not feel adequately prepared to manage either peritoneal dialysis or home hemodialysis for their patients.  

Gupta and her colleagues surveyed 76 trainees from across the country. She says the respondents reported that their programs had few institutional resources dedicated to home dialysis.

“Many respondents said there might be clinics they could attend, but no lectures or teaching focused on home dialysis,” she said.

While this is a problem, it also demonstrates an opportunity for nephrology programs to restructure their educational approach.

“We hope to encourage nephrology training programs to offer more robust educational opportunities in terms of didactics. If they don’t have the resources for that within their academic programs, they may be able to partner with private practices to develop workshops and simulations,” Gupta said.  

This particular moment is prime for educational innovation that focuses on home dialysis, according to Gupta. The COVID-19 pandemic has made it an even safer and more appealing option for patients, and in July, President Trump issued an Executive Order on Advancing Kidney Health that prioritizes increasing home dialysis rates.  

“As home to one of the largest academic home dialysis programs in the country, IU School of Medicine and IU Health are well-positioned to continue their leadership in this area,” said Gupta.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
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Hannah Calkins

Hannah Calkins is the communications manager for the Department of Medicine.