Home Dialysis in Portugal: A Game-Changer for Chronic Kidney Disease (CKD) Care

Empowering kidney health:

Introduction

Portugal’s healthcare system, the Serviço Nacional de Saúde (SNS), is facing significant challenges due to its ageing population and the rising number of Chronic Kidney Disease (CKD) cases. Home dialysis could offer a cost-effective and patient-centered solution for managing End-Stage Renal Disease (ESRD) while alleviating pressure on dialysis centers. This article explores the benefits of home dialysis in Portugal, particularly in Lisbon, where dialysis incidence is among the highest in the country.

The Current State of Dialysis in Portugal

Portugal has one of the highest rates of ESRD and dialysis incidence in Europe. From 2010 to 2016, over 16,000 new dialysis patients were registered in the country. Lisbon, Portugal's capital, stands at the forefront of this crisis, with a dialysis incidence of 386 patients per million people as of 2016, the highest in the nation.

Most of these patients rely on in-center dialysis, typically requiring three treatments per week at public hospitals or private dialysis centers funded by the SNS. While this ensures access to life-saving treatments regardless of financial status, it imposes substantial logistical and emotional burdens on patients and their families. Frequent travel to dialysis centers, time spent undergoing treatment, and reduced work capacity often contribute to social isolation, psychological stress, and financial strain.

Despite these challenges, home dialysis remains underutilized in Portugal. This gap in care points to an opportunity for healthcare reform, particularly as the demand for renal replacement therapies continues to rise.

Home Dialysis: A Patient-Centered Solution

Home dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), offers a more flexible and patient-centered alternative to in-center dialysis. It allows patients to receive care in the comfort of their homes, reducing the need for frequent hospital visits and enabling them to maintain a more normal daily routine. Studies have shown that home dialysis can lead to improved quality of life, increased independence, and better clinical outcomes.

From a healthcare system perspective, home dialysis could help alleviate the burden on public and private dialysis centers, especially in regions like Lisbon, where the demand for dialysis services is particularly high. By shifting a portion of dialysis patients to home-based care, the SNS could reduce both the physical strain on healthcare infrastructure and the financial costs associated with in-center treatments.

Financial Implications of Dialysis in Portugal

Dialysis care is expensive, both for patients and the healthcare system. Each dialysis session costs approximately €150–€200, and with three treatments per week, the annual cost per patient ranges from €20,000 to €30,000. Given that there are around 12,000 dialysis patients in Portugal, the total cost of dialysis care exceeds €300 million per year.

In Lisbon, where the prevalence of dialysis patients is particularly high (2,055 patients per million people), the financial burden on the SNS is significant. Furthermore, private dialysis centers, which play a crucial role in meeting the demand for renal replacement therapies, add to the cost, as the government must reimburse these facilities for the care provided.

In addition to direct treatment costs, the SNS incurs other expenses related to transportation for patients who require in-center dialysis, as well as costs associated with managing complications of ESRD. As the number of CKD patients continues to rise, these financial pressures will only intensify, raising concerns about the sustainability of the current model of care.

The Case for Expanding Home Dialysis

Expanding home dialysis could offer a more sustainable approach to managing CKD in Portugal. Home dialysis is generally more cost-effective than in-center dialysis, and it allows for more personalized care. However, to successfully implement a shift towards home-based care, investments are needed in patient education, training programs, and technological infrastructure.

The benefits of home dialysis extend beyond cost savings. Patients who undergo home dialysis typically report higher satisfaction levels, greater flexibility in their treatment schedules, and improved mental health. For healthcare providers, home dialysis could reduce the strain on hospital resources, allowing them to focus on more complex cases that require specialized care.

Conclusion

As Portugal continues to grapple with rising rates of CKD and an aging population, the expansion of home dialysis could play a critical role in addressing these challenges. By providing a more patient-centered and cost-effective solution, home dialysis has the potential to improve the quality of life for thousands of patients while also reducing the financial burden on the SNS.

Moving forward, healthcare policymakers must consider strategies to promote home dialysis as part of a broader effort to optimize CKD management. With the right investments and support, Portugal could lead the way in innovative renal care, ensuring better outcomes for patients and a more sustainable healthcare system for the future.