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Overcoming psychosocial barriers for long-term success on home dialysis

Overcoming psychosocial barriers for long-term success on home dialysis

Just 13 percent of people who currently dialyze in the U.S. utilize a home treatment option. For many, fear plays a strong defense against the possibilities of treatment at home.

Home dialysis is widely encouraged due to the potential for patient autonomy, clinical and lifestyle benefits. Treatments at home also enable more flexible and personalized care, which positively impacts patient outcomes and symptom burden. 

While growing home dialysis programs and encouraging more eligible patients to choose home modalities is crucial to the work I do, my ultimate mission is clear—I aim to optimize the home experience for patients in a way that ensures their care plan is successful over the long term, and for their dialysis treatments to coincide with their life goals. A crucial aspect of that mission is being able to identify and breakdown psychosocial barriers to successful treatments at home. Some of these barriers include maintaining control of supplies, family member burden, lack of a support system and difficulty managing treatment schedules. Each year we estimate 50% of home patients are unable to continue dialyzing at home, and about 35% stop due to what the nephrology community considers “controllable risk factors.”

I believe the barriers patients and care partners are confronted with include internal and personal obstacles that stem from our beliefs, attitudes, and inhibitions as individuals. This can often lead to feelings of apprehension and anxiety about their ability to successfully treat at home. Additional barriers include fears of self-cannulation, maintenance complications and social isolation. 

It’s no secret that home modalities are complex, but as utilization continues to grow each year it’s paramount our work focuses on breaking down such barriers to encourage more patients to experience the benefits. This type of work includes education and providing support and resources for patients, care partners, community leaders, clinicians and health care systems.

From 2009 to 2019, utilization of home dialysis increased from 6.8% to 12.6% among patients receiving dialysis for the first time. The percentage of patients on home dialysis one year after initiation jumped from 10.5% to 18.2% during the same time period. 

At DaVita, we believe the path to breaking down psychosocial barriers and enabling more patients to experience home treatment begins with three key points: striving for patient flexibility and autonomy; celebrating employment alongside treatment schedules; and, shifting mindsets and decreasing fear. 

Since 2002, DaVita has helped approximately 445,000 patients treat at home—more than any other kidney care provider. In 2021, more than 30,000 DaVita patients received home dialysis; the first year more than 15% of DaVita patients with end stage kidney disease (ESKD) treated at home.

I’m energized by the conversations I’m having with members of the nephrology community and leaders in the home dialysis space, and believe by continuing to place emphasis on the continuum of care, we can create better opportunities for patients to stay on their modality of choice. By working together to more accurately identify patients best suited for home dialysis, and to pinpoint effective strategies to keep them on their treatment of choice, I believe the nephrology community can achieve long-term success in the home dialysis space. 

Rather than dialysis dictating how they need to live, I believe it’s possible to create a world where patients gain full autonomy over how dialysis fits into their lives. 

For more information on DaVita Home Dialysis Programs, visit

Service provider and modality selection are choices made exclusively between the patient and nephrologist.


2. DaVita Home Modalities Internal Loss Data