More patients get dialysis at home

[okarol]

January 22, 2009

More patients get dialysis at home

By Peggy O’Farrell
pofarrell@enquirer.com

Kevin and Susan Reynolds’ Florence family room is a busy place.

Their 9-year-old daughter and her friends play there.

The family watch movies and eats dinner there.

And five nights a week, it’s where Kevin Reynolds, 47, undergoes dialysis treatment. He’s one of about 3,400 people in the U.S. who undergo treatment in their homes instead of making the trip to an outpatient center.

Reynolds gets the service through DaVita, a national provider of treatment that operates several patient centers in Greater Cincinnati and Northern Kentucky. The company estimates it has about 1,500 home dialysis patients nationally, including 34 in Greater Cincinnati and Northern Kentucky. The home service has grown by about a third in the last four years.

Nationally, more than 340,000 Americans received treatment at home or in outpatient centers in 2006, according to the National Institutes of Health.

Complications from diabetes and high blood pressure were the leading reasons for the treatment.

The home-based treatment costs about the same, and is covered at about the same level by insurance, as center-based treatment.

Reynolds lost both kidneys to cancer in 2007. Dialysis takes over the kidneys’ role of removing toxins from his blood and excess fluid from his body.

For many patients, home treatment is much more convenient than visiting a center. Home patients can schedule their treatments around their work or school schedules, instead of trying to arrange their jobs around treatment.

Most dialysis centers are open during the day, which is when most people work.
Once a patient reserves a particular slot for treatment, it’s hard to change that schedule to accommodate work or school activities.

But Reynolds can come home from work at 5, set up the machine that rests on a coffee table next to the family room couch, and undergo treatment while watching a movie and having dinner with his wife and daughter. And he can choose the five days in the week that work best that particular week.

Home dialysis treatment involves two small machines. Blood is taken through a tube connected to Reynolds’ arm and run through a machine about the size of a desktop scanner to be cleaned and detoxified. That machine also removes excess fluid from his body. While the blood is coming out, a saline solution is running into the body.

All of the toxins and excess fluid drain out of the machine through a tube that runs from the basement family room to the sewer drain.

The second machine, about the size of a computer CPU tower, houses the medication used to filter Reynolds’ blood.

Home treatment does take planning, and it takes up a big chunk of the day.
Susan Reynolds estimated it takes about half an hour to set up the treatment, plus another four hours for the treatment itself, then 45 minutes to disconnect everything once the treatment is finished.

It’s also taken a lot of training.

The Reynoldses have had to learn how to insert and remove the lines from Scott Reynolds’ veins, how to monitor his blood pressure and how to set up the machine itself.

“I can take the needles out of my arm, but I can’t stick them in,” Reynolds said. “That’s Susan’s job.”

Susan Reynolds said it isn’t her favorite job, “but when they said I had to do it to keep him alive, I took a deep breath and did it.”

If the power goes out, everything has to be disconnected and cleaned. On the plus side, the treatment only takes about a third of a pint of blood out of Reynolds’ body at any given time, so risks are minimal.

Home dialysis patients work with nurses and social workers to monitor their progress, said Carolyn Reiff, a nurse with DaVita. Patients also visit the dialysis clinic monthly for ongoing testing and assessment.

In addition to the convenience factor, home patients undergo the treatment five days a week. Outpatient center clients only go three days a week, so more fluid and toxins have built up when they get to the center.

If Reynolds remains cancer-free through 2012, he’ll be a candidate for a kidney transplant, which will end the need for dialysis.

“I tell myself that while I’m waiting, the doctors will get better at the transplant surgery and the medications will get better,” he said. “That’s what I have to tell myself, so I don’t think I just have to sit here and wait.”

http://news.cincinnati.com/article/20090122/NEWS01/301220046