Dialysis debate continues

Dialysis debate continues

By Greg Amos

Pioneer Staff

A push towards home-based peritoneal dialysis is at the heart of the mid-January decision to close Invermere’s community hemodialysis unit and relocate its equipment to Sparwood.

“Peritoneal dialysis is the preferred treatment; it means independence, but often people don’t look at that as an option because of the change it involves,” explained Interior Health director of renal services Paula James. “Research shows that the more involved a person is with their care, the better the results they can expect.”

Invermere’s dialysis unit served the renal population for the Upper Columbia Valley including Golden, and was initially an income generator for Interior Health due to the premiums paid by out-of-province users of the facility. As usership declined, that ceased to be the case about six years ago, said Ms. James. Those numbers were not a factor in the decision to close the unit, she added.

“You don’t start a community dialysis unit to deal with the one-offs coming into an area for vacations,” she noted.

With just one full-time hemodialysis patient requiring the services of the two-chair dialysis unit in Invermere’s hospital, the facility’s reverse osmosis equipment will soon be moved to a six-chair dialysis unit in Sparwood, where it’s expected to see more use.

“The equipment has to be used; there’s a risk of damaging the membranes in the equipment if it sits stagnant,” said Ms. James, who noted peritoneal dialysis — which involves a permanent tube in a patient’s abdomen — is usually carried out at night while the patient sleeps, allowing them to dialyze for longer, said Ms. James.
Appointments with a regional renal doctor are easy to accommodate via teleconference, she added.

But peritoneal dialysis also means home renovation costs around installing a high-voltage connection and a water supply in the bedroom, while going without the reassurance that a nurse can provide, explained one valley resident.

“It should be your choice; they try to push home dialysis, but I don’t think it’s right for senior citizens,” said Cathy DeGuise, a 30-year resident of Fairmont Hot Springs whose father, Bill Chalus, was a diabetic who required dialysis at Invermere’s unit before he passed away last June at age 81. “My dad thought about it hard and almost went that route, but then thought, ‘What if I have complications?’”.

“Peritoneal dialysis wouldn’t have worked for my father, with all the complications he had,” she said, noting machines in the Invermere were able to document his potassium and iron levels as well as red and white blood cell counts. “My father had so many infections, and the nurse could spot them before the blood work.”

The human touch was also an important factor, she added.

“At the Invermere unit, there was passion, there was heart and soul; I didn’t see the same care in the Cranbrook unit,” she noted.

There are seven patients currently requiring hemodialysis in Sparwood, and all could potentially move to peritoneal dialysis, Ms. James said.

For hemodialysis patients in the valley with acute care needs, the nearest treatment option is now in Trail, where there’s an in-centre renal doctor and a full intensive care unit.

Upgrades are now being considered to make Cranbrook meet that standard, said Ms. James.

The B.C. Renal Association normally requires a regional population of 85,000 people in order to justify creating a standard six-chair dialysis unit capable of serving 24 patients each week, said Ms. James, who allowed that dialysis units can exist in smaller communities for historical reasons in some cases.

http://www.columbiavalleypioneer.com/?p=8372