Kidney Care Partners (KCP) – the nation’s leading kidney care multi-stakeholder coalition representing patient advocates, physician organizations, health professional groups, dialysis providers, researchers and manufacturers – today expressed concern over the most recent home dialysis recommendations issued by the National Quality Forum (NQF).

Though home dialysis corresponds with improved health outcomes and patient quality of life, home modalities are used at substantially lower rates in the U.S. than other developed nations, hovering at only around 15%. As such, the Centers for Medicare and Medicaid Services (CMS) has identified increasing the use of home dialysis as a major objective within the new ESRD Treatment Choices (ETC) Payment Model. In alignment with this objective, the Kidney Care Quality Alliance (KCQA) Technical Expert Home Dialysis Workgroup and Steering Committee developed Home Dialysis Measures to promote steady, deliberate performance improvement over time and protect patient choice by addressing both home dialysis uptake and retention to counterbalance unopposed financial incentivization of home prescription.

However, despite overwhelmingly passing the National Quality Forum (NQF) Renal Standing Committee’s preliminary evidence review finding the measure set to be valid and reliable, the Committee ultimately recommended against the endorsement of KCQA’s home dialysis measures, acquiescing to one member’s concern over the lack of randomized controlled trials (RCTs) that definitively support patient selection of home dialysis. In particular, the member arguing against endorsement concluded that the data did not support home dialysis as improving patient quality of life or outcomes.  These conclusions are out-of-sync with clinical and patient consensus about the adoption of home dialysis. 

“We note that NQF’s own Evidence Algorithm does not require RCTs for a measure to pass the Evidence Criterion; the application of such academic, controlled studies is often simply not feasible—or ethical—in real-world clinical settings,” KCP wrote in its comment letter.  

“We’re extremely disappointed in the Committee’s failure to endorse the Home Dialysis Measure Set, which was developed specifically to provide CMS the rigorously vetted and empirically tested measures it needs for the ESRD Treatment Choices (ETC) Payment Model,” said John Butler, Chair of KCP. “In reversing its initial support of the measure and implementing an unprecedented, infeasible randomized control trial (RCT) standard, the Committee has deprived the kidney community of the tools desperately needed to expand the benefits of home dialysis.”