Kidney Care in Rural Communities

Updated on September 19, 2023
Kidney Care in Rural Communities

End-stage renal disease is a particularly difficult burden for people living in rural communities. Momentum is building as rural-based home hemodialysis programs give patients back their autonomy and provide a better quality of life, but more needs to be done.

Today, America faces an under-recognized public health crisis. The lives of more than half a million people with end-stage renal disease (ESRD) are tied to life-preserving dialysis to clean their blood three or more times each week. Often, they have lower health-related quality of life, which is strongly associated with increased hospitalizations and higher mortality. And the trajectory we’re on is startling, with the ESRD population projected to grow more than 30% in the next decade.   

In remote communities, the struggle is even more dire as ESRD is growing at a concerning rate, and patients can face unique hurdles impacting their health and quality of life. 

The reality for many rural patients is a lack of access to primary and specialized nephrology care, and time-consuming or otherwise difficult commutes to and from dialysis centers and doctor visits, impacting their ability to maintain employment. In many remote areas, the lack of reliable transportation is cited as the key obstacle for those with ESRD. 

There is a solution that can help alleviate many of the significant issues facing these patients, their families and providers: home hemodialysis (HHD). 

HHD can give patients back their autonomy, agency and control, and provide significant medical and lifestyle advantages. Benefits include a five-fold higher likelihood of maintaining employment compared to in-center dialysis, lower mortality compared to in-center, and improved sleep, physical and emotional well-being and depressive symptom burden, among others. 

Living in a rural setting doesn’t have to mean living with suboptimal ESRD care. Patient-centered providers are taking action and engaging with patients to address their unique needs. Much-needed HHD programs are making a difference, thanks in large part to innovative new technology. Meet two dedicated providers and a resilient patient.

Nephrologist Maria Story, MD, FACP, CHS, and her team at Southeastern Renal Dialysis in southeastern Iowa have launched and grown a successful patient-centered HHD program featuring the Tablo® Hemodialysis System. Terry is one of their patients. Last year, they were driving 80 miles roundtrip three times a week for his in-center dialysis. After starting on Tablo at home, the couple are enjoying the convenience of managing his treatments around their schedule. Terry says what he likes most is the freedom. “My dialysis works around what we want to do, and we don’t have to drive to a center anymore,” he says.

St. Peter’s Health in Helena, Montana is the only hospital-based HHD program in its state. More than 50% of its patients are now managing their dialysis at home, compared to the national average of about 12.6%. Says Medical Director Robert LaClair, MD, “Tablo has given us total control over the dialysis we can provide to our community … that kind of flexible decision-making is exactly what you want to be able to offer.”

With innovative technology, it is easier for patients to manage their dialysis at home than ever before. Rural health-focused legislation, government funding and patient advocacy efforts are also shining a spotlight on this vulnerable population, and exciting momentum for change is growing. 

It’s essential that the nephrology community learns from these efforts and takes action to reduce health disparities. The unequivocal message is clear: dialysis at home must become the standard for all, no matter your zip code.

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Michael Aragon, MD
Chief Medical Officer at Outset Medical

As Chief Medical Officer at Outset Medical, Michael Aragon, MD, a board-certified internist and nephrologist, has the unique opportunity to support innovation to revolutionize dialysis treatment, such as with the Tablo Hemodialysis System as an all-in-one solution for treatment. Before joining Outset, Dr. Aragon spent 14 years in clinical practice as a founding partner and president of North Texas Kidney Consultants – DFW. His clinical research focus has been on the expansion and improvement of home dialysis options for patients with renal disease. Dr. Aragon received his undergraduate degree from Texas A&M University, and his medical degree from The University of Texas Medical School. For more information, visit