This blog is part of the Early Diagnosis campaign #BeFirst
Early diagnosis and care can prevent illness from developing and slow disease progression. Lab tests, genetic tests, tests for chronic diseases and modern lab diagnostics can help facilitate earlier intervention and improves outcomes for patients and are increasingly valuable in informing treatment choice.
Read the other blogs here: A smarter way to fight colorectal cancer, Why should we prevent cervical cancer? Because we can, Diagnosing severe hearing loss and deafness, Can screening decrease lung cancer mortality rates? and Kidney Disease: catch it early to save lives and money.
To me, modern healthcare should be about improving patient outcomes and offering patients as much choice as possible. All of us are patients at certain times in our lives. Shouldn’t we have greater input into how and where we are treated?
When it comes to kidney disease, not all patients have time to consider their options and prepare for treatment. To understand why this is, let me explain a little about the condition.
Kidney disease is a major and growing burden in Europe. One in ten Europeans has some form of kidney disease but most don’t know it.
However, kidney failure is a ‘silent disease’, often diagnosed in the late stages. This significantly narrows the treatment options available to patients, often leading to worse outcomes.
For some, late diagnosis denies them the opportunity to learn about and to discuss home dialysis with their doctors. Clinical guidelines – such as the NICE clinical guidance on peritoneal dialysis –recommend that stage 5 chronic kidney disease patients should be informed of all treatment options so that they can choose the one that best fits their lifestyle.
Time to explore treatment options
The best treatment for kidney failure is transplantation with a new kidney. However, waiting lists are long and some patients are unsuitable for surgery due to their poor health or other limiting factors. For them, dialysis is the only option.
Dialysis can be done in a clinic or at home. Patients medically suitable for home dialysis must undergo training and have a catheter inserted at least two weeks before beginning home treatment. The most common home-based dialysis modality is peritoneal dialysis.
Some patients with renal failure present so late that dialysis must be started urgently. These patients usually end up using hospital-based dialysis.
Not only are they likely to be denied the time to choose which kind of dialysis they would prefer, their prospects of availing of home dialysis are severely restricted.
What do patients want?
People diagnosed early have time to research their options, receive pre-dialysis education programs, and discuss these with dialysis nurses and nephrologists. For example, they may opt to have dialysis at home at night time – sparing themselves frequent and lengthy hospital visits.
Of course, patients are not in sole charge of managing their condition. Modern home dialysis machines can connect remotely with hospital healthcare teams, allowing them to monitor therapy sessions.
A European study showed that 54% of patients surveyed would choose peritoneal dialysis (PD) over haemodialysis in a clinic1, yet according to the European Kidney Health Alliance (EKHA) 89% of European patients are treated in hospital2. Treatment at home is a more cost-effective option for society but, for some patients, a lack of pre-dialysis education programs and counterproductive financial incentives for healthcare providing institutions means some hospitals are more likely to favour in-clinic dialysis.
I would strongly endorse the EKHA’s call for fair access and distribution of care options across Europe. The Association’s paper, published in Nature Reviews Nephrology2 identifies key barriers to delivering what patients want.
Education is key: we need to make sure newly diagnosed patients who are suitable for home dialysis are informed about the benefits of this option to their overall quality of life. From a policy and patient advocacy perspective, by rethinking reimbursement and incentives to allow patients to choose the best suitable option to them and their lifestyle and involving patients in decision-making, we can significantly improve patient satisfaction and outcomes and even reduce healthcare expenditure.
Senior Vice President & President, Baxter EMEA
1 Peritoneal Dialysis International, Vol. 33, pp. 367–371, doi: 10.3747/pdi.2011.00255 Perit Dial Int. 2013;33:367-371.
2 Nature Reviews Nephrology volume 13, pages 393–409 (2017) doi:10.1038/nrneph.2017.63