ARTICLE SUMMARY:
With a novel remote patient monitoring device and a cloud-based care platform, CloudCath is eliminating the barriers to home-based peritoneal dialysis to allow more people needing renal replacement therapy to enjoy treatment in the comfort of their own home.
For many patients with end-stage renal disease (ESRD) who require renal replacement therapy, peritoneal dialysis (PD) is a preferred alternative to in-center hemodialysis. In-center therapy is inconvenient and even prohibitive for a patient with a nine-to-five job, requiring them to spend three or four days in the clinic every week. It’s also harsh—in-center hemodialysis rapidly pulls toxins and excess fluid out during a four- to five-hour treatment session, and the aggressive pace of filtration tires patients. Recently, several home hemodialysis companies have entered the market with systems that ameliorate some of the drawbacks of the brick-and-mortar service model, but they have only acquired a small share of the home dialysis market due to cost concerns and challenges with self-cannulation and other ease of use issues.
Peritoneal dialysis is an attractive, in-home option for renal disease patients because they can perform it themselves daily in the home in longer, gentler sessions, even while they sleep. It’s not only less disruptive, it’s also more physiological as it filters the blood in a frequent, slower, and steadier manner. PD is also much less expensive than in-center hemodialysis with its staffing and infrastructure requirements. PD involves a cycler that allows the infusion of a bag of dialysate into the peritoneal cavity via a catheter port in the belly. The dialysate draws the extra fluid, chemicals, and toxins through the peritoneal membrane, which acts as a filter for the blood. The dialysate fluid is then removed from the body through drainage tubes.
Despite these clinical and quality-of-life advantages, and even though CMS, the major payor for this population, is working toward incentives for home-based therapy with value-based models like Kidney Care Choices (KCC), PD is underutilized. Penetration rates vary across global geographies, but the US has one of the lowest. Only about 14% of ESRD patients receive home-based renal replacement therapy. That number is up from 10.8% in 2017, but there is a long way to go to meet the 80% penetration rate set by CMS going forward, as part of its Advancing Kidney Health Executive Order in 2019 (according to an article by D. Weiner et al., published in Kidney Medicine in March 2020).
