Janani Rangaswami, MD: The Benefits of Increasing Weekly Dialysis Treatments

Dialysis frequency was a hot topic during the annual Heart Failure Society of America (HFSA) 2019 Scientific Sessions in Philadelphia, according to Janani Rangaswami, MD, a nephrologist with the Einstein Medical Center Philadelphia.

Rangaswami explained in an interview with MD Magazine® after presenting new data at the HFSA meeting that increasing the frequency of dialysis and transition the treatment to more home-based therapies would be a positive for patients with end stage kidney disease.

MD Mag: Would you suggest increasing the amount of weekly dialysis treatments for patients with end stage kidney disease?

Rangaswami: When you compare quality of life between those that get these typical 3 times a week, shorter dialysis treatments versus those that get more frequent and prolonged treatments like he discussed and like we know and is recorded in literature, recovery time from dialysis is much less.

So, I think as clinicians both problems tend to emphasize a lot and we rightfully should you know the hard clinical end points, but you also have to realize that there's a large part of this is also patient driven needs. Most dialysis patients have extremely poor quality of life, their tolerability for dialysis is limited and when you have heart failure compounding the picture it is even worse.

MD Mag: Why do you think more frequent dialysis treatment has not been implemented on a widescale?

Rangaswami: That's a very good question and it's also coming at a good time. The non-nephrologists in our audience may not be aware that there has been a recent executive order signed by this administration to be implemented in 2020 where there is a lot of push being given to utilizing home base dialysis therapies. They want us to achieve a target of up to 80% about dialysis patients starting dialysis to not start in the 3 times a week regimen but in the home therapies patients. For many reasons that is an excellent goal, it’s lofty, it's hard to achieve and to touch upon what are some of the barriers.

The ability to do home dialysis requires patient participation to a large extent. Patients are in charge of their dialysis. They get support, they can have partners helping them but ultimately they are responsible in carrying it out in a safe and effective way. So if you have a patient that doesn’t engage in the process, it becomes difficult to implement it even if they’re a medically sound practice.

There is also a culture of fear of patients when you tell them you are going to dialyzing yourself, you really have to overcome a lot of fear to do that. And once patients realize it’s doable and it is much easier than they thought it was but that initial perception is usually negative when he tried to explain that to a patient.