Home dialysis revives patients' lives while saving substantial costs

Saturday, March 1, 2008 9:20 AM CST

Home dialysis revives patients' lives while saving substantial costs

By Susanne Bohan/San Mateo County Times (MCT)

SAN MATEO, Calif. -- Saia Fassisila, pastor of the United Methodist Church in San Mateo, dreaded his options when his kidneys failed two years ago.

Either he stayed hooked up -- three times a week, four hours a session -- to a large machine that cleaned his blood, or he'd die. Although he'd taken medication for years to control his high blood pressure, in his case, that wasn't enough to stop the condition from damaging his kidneys.

"I had no choice," Fassisila said. When they sent him from his bed at Stanford Hospital directly to a dialysis clinic to clear his blood of the accumulated metabolic by-products, excess nutrients and water were close to killing him, since his kidneys could no longer eliminate them.

"I was given a second chance in life with dialysis," said Fassisila, 48, who was born and raised in Tonga. "Otherwise, I'm a dead person."

The treatments, however, left him exhausted and frustrated over the toll they took on his productivity. "You're just wiped out the rest of day" after dialysis at the center, he said. "I'd just go home and go to sleep."

But his choices dramatically improved late last year, when he began using a novel dialysis treatment at home, which is not only more cost-effective, but leaves him feeling far more energetic than the standard treatment.

"I feel so much better," he said, with evident relief. "I don't know what else to say. It's so much better."

While less than 10 percent of the estimated 341,000 U.S. patients on dialysis receive home treatment, a burgeoning interest in shifting dialysis from treatment centers to patients' residences will likely start driving that number up, experts predict, particularly if Medicare changes its reimbursement policies to more easily pay for the home hemodialysis.

There are compelling reasons for a shift to home treatment, pointed out Dr. Peter Crooks, medical director of the renal program at Kaiser Permanente Southern California, which has taken a leading role in analyzing home hemodialysis outcomes for the HMO.

"Most nephrologists would like to get their patients on home dialysis," said Crooks. (Nephrologists specialize in treating kidney diseases.) "You have a way to improve patient outcomes, and it's more cost-effective."

Crooks said that not only do patients report feeling significantly better with the regular dialysis home treatment allows, but hospitalizations due to complications from kidney failure, even while on dialysis, were halved for Kaiser patients on the home regimen _ from 14 to 7 days of hospitalization a year. Most of these hospitalizations are due to heart conditions linked to or worsened by kidney failure.

Crooks described the overall cost savings of home treatment versus dialysis center care as "substantial."

"All the studies show that the total cost of home dialysis is lower than the cost of treatment in centers," noted Dr. John Moran, medical director of Wellbound, a company with seven Bay Area centers that provides equipment and training for home dialysis.

Everett Reed, 43, is a champion of the home treatment, after 22 years receiving dialysis at a center, mostly recently one that was about a 15-minute drive from his Pittsburg home. Reed now lives in Brentwood.

Following standard protocol, he visited three times a week, where for about four hours he was tethered to tubes that funneled his blood through a filter and then back into his body. The treatment also typically removes a few quarts of excess fluid. Each time, the procedure left him so spent that he would rest in his car for nearly an hour before driving home.

"When he got off from it, he felt so sick," recalled his 63-year-old mother, who lives with him.

Reed's kidneys failed when he was an athletic, 17-year-old high school student in Oakland. His mother and his doctor thought he had the flu when he fell ill that year, but his symptoms only worsened. Another doctor found that undetected high blood pressure in the otherwise fit young man had destroyed his kidneys. Like Fassisila, he was near death when his condition was discovered.

He had two kidney transplants, but his body rejected the first one, after Reed, then in his early 20s, didn't keep up with the strict regimen of taking 30 to 40 pills a day to prevent organ rejection.

"It was my fault," he said, noting that "I tried to make up for all those years I lost" as a teen and a young man by abandoning his medical treatment. "But it was a learning process," he added.

And his second kidney transplant failed after an infection developed.

Reed, who's worked in an administrative position for Contra Costa County, several years ago heard of a home treatment for dialysis, and called around until he was referred to a company called NxStage, based in Massachusetts. In 2005, the Food and Drug Administration gave the company's compact dialysis machine approval as a portable hemodialysis device.

Currently, it's the only portable hemodialysis machine on the market, and is capturing most of the small but rapidly growing market for this type of dialysis.

Reed signed up four years ago to participate in a clinical trial on home hemodialysis using the NxStage machine, and would never go back to "in-center" treatment, he said.

"With NxStage, it's more like normal kidney function," Reed said.

He now undergoes dialysis six times a week, while he's sleeping at night. So he's getting far longer sessions, and without taking up hours during the day.

Numerous studies show more frequent and longer "nocturnal" sessions create the best outcomes for patients, since their blood is cleared more effectively.

"It's almost certainly the best way to go," said Crooks, with Kaiser, of the nighttime treatment.

Crooks said many patients can come off of their high blood pressure medication after starting on home dialysis. Reed used to take four blood pressure medications daily, and one other medicine. Since he started home dialysis, he no longer needs the pills, which cost nearly $1,700 a month.

Reed is back playing basketball at a nearby recreation center a couple of days a week, and is planning to return to school later this year to learn the business skills to open his own clothing store for men and women, carrying "urban style" clothing.

"It's been a dream of mine for years," Reed said. "Now that I'm feeling better, I can pursue it."

http://lakeexpo.com/articles/2008/03/01/top_news/10.txt