# Novel Methods to Inform Health Care Policy in Home Dialysis

> **NIH NIH F32** · MASSACHUSETTS GENERAL HOSPITAL · 2020 · $63,900

## Abstract

Project Summary:
The prevalence and cost of end-stage kidney disease (ESKD) continue to rise in the US. As of 2016, >726,000
patients have ESKD and >$35 billion annually is spent through Medicare. Peritoneal dialysis (PD) is a form of
home dialysis that can provide better quality of life and slower loss of residual renal function with no difference
in mortality compared to hemodialysis (HD). On average, PD also costs $15,000 less per person per year for
Medicare compared to HD, according to the 2018 United States Renal Data System report. Despite clinical and
economic advantages, while up to 78% of ESKD patients meet eligibility criteria for PD, only 9.7% started PD
in 2016. In 2019, the US Department of Health and Human Services announced the Advancing American
Kidney Health Initiative (AAKH). The primary goal of AAKH is to have 80% of new ESKD patients initiate home
dialysis (PD or home HD) or receive a kidney transplant by the end of 2025. Achieving this goal would result in
a paradigm shift in care delivery that dramatically improves patient outcomes. However, several stakeholders,
including patient advocacy groups, the American Society of Nephrology and dialysis organizations have raised
concerns about the achievability of this 80% target. Research is needed to help inform the clinical outcomes
associated with choosing a more achievable target (such as 20%, 40% or 60%), as well as to identify cost-
effective ways to achieve this target. Assisted PD (a modality of PD where trained staff assist with PD at home)
could be a cost-effective way to improve home dialysis utilization in line with the AAKH initiative. We propose a
modeling-based approach to i) examine the clinical and economic impact of the AAKH initiative and alternative
targets and ii) evaluate the clinical and budgetary impact of implementing assisted PD to improve home
dialysis in the US alongside the AAKH initiative. This relates to the mission of NIDDK. ESKD is a debilitating
and costly chronic disease, and we seek to understand and inform novel ways to improve the outcomes of
patients with ESKD in a cost-effective manner. To achieve my goals, I will pursue didactic training through
formal coursework focused on 1) developing a Markov model with Monte Carlo simulation, 2) calibration and
validation of models, 3) cost-effectiveness and budgetary impact analysis and 4) modeling uncertainty through
sensitivity analysis. As a clinical research fellow in the Renal Division at Brigham and Women's Hospital and
the Medical Practice Evaluation Center at Massachusetts General Hospital, I am in an innovative collaborative
environment. My mentors are Drs. Rochelle Walensky, an expert in cost-effectiveness analysis around chronic
disease care; Krishna Reddy, an expert in policy-oriented modeling research; and Mallika Mendu, an expert in
PD and population health management. Through the support of my mentors, my institution and the training
supported by this award, I will be closer to my ultima...

## Key facts

- **NIH application ID:** 10067675
- **Project number:** 1F32DK126345-01
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Yuvaram Nellore Vilambi Reddy
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $63,900
- **Award type:** 1
- **Project period:** 2020-12-01 → 2021-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10067675

## Citation

> US National Institutes of Health, RePORTER application 10067675, Novel Methods to Inform Health Care Policy in Home Dialysis (1F32DK126345-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10067675. Licensed CC0.

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