Abstract: FR-PO0521
Leveraging Champions and Personalized Education to Improve Home Dialysis Initiation Rates
Session Information
- Home Dialysis: Clinical Epidemiology
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Bermudez, Maria, Geisinger Health, Danville, Pennsylvania, United States
- Wagner, Amy, Geisinger Health, Danville, Pennsylvania, United States
- Brubaker, Lauren, Geisinger Health, Danville, Pennsylvania, United States
- Stivale, Avery, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States
- Green, Jamie Alton, Geisinger Health, Danville, Pennsylvania, United States
Background
Despite national efforts to promote home dialysis, fewer than 15% of patients in the U.S. initiate dialysis with a home-based therapy. Barriers exist at the patient, provider, and system levels. While various strategies have been attempted to improve access to home dialysis, success has been limited, and the optimal approach remains unclear.
Methods
In January 2024, we launched a quality improvement initiative at Geisinger aimed at increasing home dialysis utilization. Patients with advanced chronic kidney disease (CKD) not yet on dialysis were identified through referrals for modality education, panel management, or provider outreach. The program features a physician-nurse champion team that delivers personalized, patient-centered education, identifies and addresses barriers to home dialysis, collaborates with nephrologists, and coordinates care. A real-time electronic health record (EHR) dashboard supports tracking and facilitates timely steps toward home dialysis initiation. Patients are stratified by estimated glomerular filtration rate (eGFR) and Kidney Failure Risk Equation (KFRE) scores to prioritize support for those at highest risk.
Results
To date, 156 patients have been enrolled, with 127 (81%) completing modality education and 27 (17%) pending. Among the 137 patients with a documented modality preference, 89 (65%) chose home dialysis. Of the 37 patients who initiated dialysis, 24 (65%) either started on a home therapy (13 peritoneal dialysis [PD], 4 home hemodialysis [HHD]) or transitioned to home (1 to HHD, 6 to PD) within six months, compared to a historical baseline rate of 33% (13/40) over a comparable timeframe 2022-2023. Only 13 (35%) started and remained on in-center HD. Demographics were similar between the home initiation and in-center groups, but patients started in-center were more likely to have home dialysis barriers.
Conclusion
This program demonstrates a promising, scalable approach to increasing home dialysis utilization. The marked improvement in initiation and transition rates highlights the potential impact of dedicated home dialysis champions and system-level support. These findings may inform best practices and encourage broader adoption of similar models across healthcare systems.
Funding
- Private Foundation Support