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 thrice weekly intermittent hemodialysis.
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 schedules of nocturnal dialysis and 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. While daily dialysis has been investigated in the clinical setting, both daily dialysis and nocturnal dialysis are more feasible in the home setting.
POLICY
Daily hemodialysis in the home is considered investigational.
ADDITIONAL INFORMATION
The Centers for Medicare and Medicaid Services (CMS) is jointly sponsoring with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) two clinical trials to evaluate the effectiveness of more frequent hemodialysis sessions compared with conventional thrice-weekly hemodialysis. One of these trials compares daily in-center hemodialysis (6 times a week) with conventional in-center hemodialysis (3 times per week). The other compares nocturnal hemodialysis (6 times per week in the home) with conventional in-center hemodialysis. CMS has agreed to pay for covered patient care-related expenses for Medicare beneficiaries enrolled in these trials. The duration of the nocturnal hemodialysis trial will be 14 months after patient enrollment.
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 and mortality. A randomized trial with expected enrollment of 150 patients comparing conventional and daily nocturnal hemodialysis over 12 months, with outcomes including mortality and quality of life, is currently ongoing and its results will be important for policy considerations.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2008). Home Dialysis (8.02.05). Retrieved June 30, 2008 from BlueWeb. (17 articles and/or guidelines reviewed)
Hayes. Medical Technology Directory. (2004, June). Home Dialysis. Retrieved June 11, 2008 from https://www.hayesinc.com/subscribers. (40 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 12/13/2008
MOST RECENT REVIEW DATE: 12/13/2008
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