[Dialysis care in Germany - demand, outpatient care and challenges]

Dialysis is the mostly used renal replacement therapy in patients with end-stage renal disease. The aim of the study was to analyze the present dialysis care system and to scrutinize future changes regarding the need of dialysis as well as the system of care.

The study is based on a structured literature search in Pubmed; selecting relevant studies by predefined criteria. Prevalence of ESRD and the share of nephrologists in outpatient care were modeled until 2020. Guideline-based interviews with experts including a two-round Delphi survey were conducted to identify options for action.

The number of dialysis-dependent patients will increase by one fifth from 83,000 in 2013 to 100,000 in 2020 while the share of nephrologists in outpatient care will decrease by 8% simultaneously. Therefore, young nephrologists and team-building in dialysis care need to be promoted. Home therapy should be used more often to cover the increasing need of dialysis in the future. Besides changes in the structures of care, shared-decision-making needs to be strengthened.

The study offers concrete options to strengthen outpatient care by nephrologists (a) and to use home therapy more often (b) in order to provide adequate and appropriate dialysis care until 2020.