Daily Hemodialysis in the Home
DESCRIPTION
Most hemodialysis patients in the U.S. undergo dialysis three times a week for 3.5 to 4 hours at each session. Some patients may receive this intermittent dialysis in the home. Medicare payment for dialysis, referred to as the “composite rate”, is premised on three times a week intermittent hemodialysis sessions.
There has been a longstanding interest in exploring different schedules for hemodialysis to create a more physiologic approach to potentially improve the morbidity and mortality associated with intermittent hemodialysis.
Daily hemodialysis is defined as dialysis 6 to 7 days a week. It has been investigated in two different time frame schedules. One schedule is for nocturnal hemodialysis and the other is for daily hemodialysis. Nocturnal dialysis involves undergoing a long period of dialysis while asleep each night. Daily hemodialysis involves sessions of 2 hours each day. The total dialysis time is similar to the conventional three-times-a-week schedule.
POLICY
Daily hemodialysis in the home is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
There is inadequate published data to permit scientific conclusions regarding daily home hemodialysis. Larger controlled studies are needed to demonstrate clinical significant improvements in patient-oriented outcomes, such as morbidity, mortality and improved generalized health. Ongoing studies are currently in progress.
SOURCES
Alhomayeed, B., & Lindsay, R. (2009). Technical aspects of home hemodialysis. Saudi Journal of Kidney Disease and Transplantation, 20 (2), 185 - 191. (Level 5 Evidence)
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2008). Home Dialysis (8.02.05). Retrieved July 6, 2010 from BlueWeb. (17 articles and/or guidelines reviewed)
Bugela, A., Dacouris, N., Thomas, A., Marticorena, R., McFarlane, P. Donnelly,S. et al. (2009). In-center nocturnal hemodialysis: another option in the management of chronic kidney disease. Clinical Journal of the Society of Nephrology, 4 (4), 778 - 783. (Level 4 Evidence)
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). End stage Renal Disease (ESRD). (Chapter 11 p. 4-127 - 4-151). The Ingenix Complete Guide to Medicare Coverage Issues.
Jaber, B., Finkelstein, F., Glickman, J., Hull, A., Kraus, M., Leypoldt, J., et al. (2009). Scope and design of the following rehabilitation, economics and everyday-dialysis outcome measurements (FREEDOM) study. American Journal of Kidney Disease, 53 (2), 310 - 320. (Level 4 Evidence)
Kjellstrand C., Buoncristiani, U., Ting, G., Traeger, J., Piccoli, G.l, Sibia-Galland, R., et al. (2008). Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years. Nephrology Dialysis Transplantation, 23 (10), 3283 - 3289. (Level 4 Evidence)
McLaughlin, K., Jones, H., VanderStraeten, C., Mills, C., Visser, M., Taub, K., et al. (2008). Why do patients choose self-care dialysis? Nephrology Dialysis Transplantation, 23 (12), 3972 - 3976. (Level 2 Evidence)
National Guideline Clearinghouse. Westmead NSW(Australia): CARI - Caring for Australasians with Renal Impairment. (2005 October). Duration and freqeuency of haemodialysis therapy. Retrieved July 6, 2010 from: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=11970&string=daily+AND+hemodialysis.
National Institute for Health and Clinical Excellence. (2005, August). Guidance on home compared with hospital haemodialysis for patients with end-stage renal failure. Retrieved March 27, 2009 from: http://www.nice.org.uk/nicemedia/live/11472/32449/32449.pdf.
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). ( 2010). Home Hemodialysis. Retrieved July 6, 2010 from: http://kidney.niddk.nih.gov/kudiseases/pubs/homehemodialysis/.
U. S. Food and Drug Administration. (1999. November). Center for Devices and Radiological Health. 510(k)Premarket Notification Database. K992894. Retrieved July 6, 2010 from: http://www.accessdata.fda.gov/cdrh_docs/pdf/K992894.pdf.
U. S. Food and Drug Administration. (2009. January). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K080964. Retrieved July 6, 2010 from: http://www.accessdata.fda.gov/cdrh_docs/pdf8/K080964.pdf.
ORIGINAL EFFECTIVE DATE: 12/13/2008
MOST RECENT REVIEW DATE: 8/12/2010
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