In 1972, Congress passed legislation to fund the ESRD Program. The result was a shift in how and where dialysis was performed. With a guaranteed payment backed by the federal government, nephrologists joined with investors in opening freestanding clinics across the United States and created the three-times-a-week in-center dialysis model. According to Medicare.gov, there were 6,871 dialysis facilities in the United States at the end of 2016, the most current data available.
Interest in home dialysis, both peritoneal dialysis (PD) and home hemodialysis (HHD), has made a comeback, however, partly fueled by the same government agencies that unintentionally almost killed it with the creation of the ESRD Program.
“We don’t know what the limits are [on how many patients can do home dialysis therapy],” Jeffrey Hymes, MD, chief medical officer for Fresenius Kidney Care and senior vice president of clinical and scientific affairs for Fresenius Medical Care North America, told Nephrology News & Issues. “I think we need to put all our efforts into making home dialysis and transplant more available to patients. We want to take advantage of this moment in time where everyone seems to be pointed in the same direction.”