Providing health services in the community offers benefits to patients and can be more efficient for health systems. This was true long before any of us had heard of COVID-19, but the pandemic has highlighted the need to provide safe and effective community and home care for vulnerable patients, like those suffering from chronic kidney disease (CKD) and needing kidney replacement therapy (KRT).
By 2030, if no action is taken, the number of CKD patients could reach 14.5 million . This imposes a heavy burden on patients and their families, but also translates into significant costs for health systems: treatment for CKD accounts for 2% of many countries’ healthcare budgets.
While investing in preventative measures and research for kidney disease is important, we also need to provide all treatment options as part of the continuum of care to allow patients to live well with CKD. Our goal should be to embrace a shared decision-making approach and take advantage of the new opportunities provided by digital solutions for remote treatment and patient support, particularly in the context of COVID-19. This concept is reflected in the theme of this year’s World Kidney Day: Health for Everyone Everywhere: Living Well with Kidney Disease.
COVID-19 risk factors
Research shows that CKD is one of the most prevalent risk factors for severe COVID-19 . In light of this, the European Kidney Health Alliance has issued a Call to Action supported by the European Commissioner for Health, Stella Kyriakides, and endorsed by 20 Members of the European Parliament and 69 scientific & patient organisations from across Europe. It demands better access to home therapies, transplantation and the uptake of digital tools, as well as better prevention, research, collection and sharing of CKD data.
The European Commission’s Expert Panel on Resilient Health & Social Care Following the COVID-19 Pandemic has argued that community care and home care can ensure the continuity and quality of treatments of CKD patients during the pandemic. The recent OECD Health at a Glance also highlighted the benefits of greater access to home/community care and telemedicine in enabling access and continued care to chronic patients.
By taking chronic disease management – notably dialysis – out of the clinics and into patients’ homes, we believe patients can have the opportunity to benefit from improved clinical outcomes and increased autonomy. Simultaneously, health systems can relieve some of the pressure on clinical infrastructure, budgets and health professionals.
It is important that we share and learn from examples of best practice. Take the UK, for instance, where virtual clinics help to avoid one third of face-to-face appointments while reducing waiting times for advice and preventing or delaying progression to end-stage renal disease. Models like this help to make efficient use of healthcare resources and provide greater convenience to patients which often leads to better outcomes.
COVID-19 has accelerated the deployment of home dialysis, supported by remote care, for many patients. In some regions of Italy, nephrology societies and regional authorities were able to expedite patients in switching to home dialysis. We believe this could become the norm rather than a temporary response to a moment of crisis.
The medical technology sector is committed to playing its part in supporting kidney patients in living well by offering home dialysis and digital solutions as a sustainable treatment option for suitable patients alongside delivering care in clinics.
Dialysis patients should, where possible and on the basis of a shared decision-making together with their healthcare professionals and care persons, have the best possible choice in where they receive care.
The direction of travel is clear – home dialysis will be a key feature of CKD care across Europe. For our part, we remain committed to supporting patients, policymakers, payers and scientific societies, in this paradigm shift.
1.Himmelfarb et al., “The current and future landscape of dialysis“, Nature Reviews Nephrology, 2020,
2.ERA-EDTA survey data
3.EKHA Call to Action to improve CKD prevention, treatment and care in the aftermath of COVID-19 http://ekha.eu/blog/ekha-launches-a-call-to-action-to-improve-ckd-prevention-treatment-and-care-in-the-aftermath-of-covid-19/