Abstract: FR-PO1086
Rescuing the "Unplanned Start": Effect of a Tailored Home Dialysis Education Program (HDEP) on Rapid Home Dialysis Transition
Session Information
- Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Bermudez, Maria Camila, Geisinger Health, Danville, Pennsylvania, United States
- Wagner, Amy, Geisinger Health, Danville, Pennsylvania, United States
- Brubaker, Lauren, Geisinger Health, Danville, Pennsylvania, United States
- Green, Jamie Alton, Geisinger Health, Danville, Pennsylvania, United States
Background
In the US, approximately 35% of patients receive little to no pre-dialysis nephrology care or education, often leading to "crash" starts in-center via central venous catheters. While 14% of incident patients start on home therapies, the transition rate from in-center hemodialysis (ICHD) to home modalities within the first 6 months remains strikingly low. We developed the Home Dialysis Education Program (HDEP) to advance dialysis options education and provide a pathway home for patients including those forced into ICHD due to acuity or lack of prior care.
Methods
HDEP is a quality improvement initiative utilizing: 1) Tailored Education: Standardized modules delivered to incident ICHD patients, 2) Care Coordination: Navigator bridging the gap between acute/in-center units and home programs, and 3) Extended Surveillance: Active follow-up for 6 months post-initiation to capture and support potential home candidates.
Results
Between 1/2024-4/30/2025, 49 incident ICHD patients were enrolled in HDEP. Notably, 12 of these 49 patients (24.5%) were successfully transitioned from ICHD to home modalities within 6 months of initiation. The program effectively "rescued" these patients from long-term ICHD despite their initial unplanned starts. The impact was most significant in the speed of transition: of the 12 patients who switched from in-center to home, 75% (n=9) completed the transition within the first 90 days. This rapid conversion is a critical metric, as it overcomes the clinical "inertia" typically seen after the first month of in-center therapy.
Conclusion
The HDEP model demonstrates that the "unplanned start" does not have to result in permanent in-center dialysis. By providing tailored education and coordination, we successfully transitioned nearly a quarter of our incident ICHD population within 6 months—the majority within 90 days. This framework addresses a major hurdle in US nephrology, proving that dedicated intervention can overcome the 35% gap in pre-dialysis education and align patient care with home-first initiation.