Dialysis comes home

Dialysis comes home
These days, people with kidney failure can take treatments in the living room, far from clinical atmosphere

By Sasha Heller
Staff Writer
(Created: Saturday, January 3, 2009 2:05 AM CST)

DAPHNE, Ala.— Brian McConnell has been dealing with kidney failure since he was 11 years old. He’s received a kidney transplant and years of dialysis treatments.

“I had reflux in my kidneys when I was 11,” McConnell said. “I would have kidney infections and I was on dialysis at 18 or 19.”

McConnell reached out to family members for a kidney transplant; his great aunt stepped up and delivered but his body rejected her kidney after five years.

After three years of outpatient dialysis treatment, McConnell learned of a home process that performs necessary blood-cleaning tasks while allowing people greater personal freedom.

“I do the home hemo(dialysis, the most common method used to treat advanced and permanent kidney failure) at whatever time is good for me,” he said. “I usually do it at night, laying in bed.

“What I’ll do is clean my access site with antiseptic ... two places I stick with two different needles which stay in the access site. One of them will pull the blood out, and one of them will put the blood back in after it cleans and filters.”

The procedure’s flexibility allows McConnell to receive treatments while watching television, for instance, which he said takes his mind off the clinical atmosphere of yore in which he sometimes saw patients’ deaths.

McConnell—who’s taken home treatments for four months—said the convenience allows him to conduct dialysis on his own time, instead of working around the center’s schedule.

Before starting home dialysis, McConnell—who lives in Semmes—would travel 15 minutes to a Mobile treatment center three times a week. He now performs his treatments with the same frequency at home and has monthly follow-up appointments at DaVita, a Daphne home dialysis center.

The difference between outpatient and home dialysis is clear, according to McConnell.

“It (home dialysis) gets your mind off of it; you’re a little more free ... it gives you a little more pep.”

He was able to work part-time at UPS six days a week during the holiday season and he’s led a full-time youth ministry with his wife.

While life has gotten a little easier with the personal treatments, McConnell remembers when his condition limited him from participating in youth athletics.

“I went out for the junior-high football team and my doctor told me it wouldn’t be a good idea if I play,” he said, adding that weight-lifting could have compromised his access point for dialysis.

Faith helped him stay positive while struggling with kidney failure and its affects on athletic dreams and everyday life, he said.

“I’ve been through the ups and downs and God’s been good to me.”

The kidneys

Healthy kidneys purify the blood by removing excess fluid, minerals and wastes; they produce hormones that maintain bone strength and healthy blood.

When kidneys shut down, it can lead to increased blood pressure and anemia, or decreased red blood cell production.

Other symptoms may include: fatigue, joint problems, itching and restless leg syndrome.

“People don’t realize how sick they are or how poorly they feel until they start dialysis and get their blood cleaned,” said Patti Stine, facility administrator at DaVita.

“A lot of the signs are slow to progress,” she said. “One of the biggest ones is anemia; symptoms can be lethargy or having a metallic taste in their mouth.

“It could be itching because waste products are being excreted through their skin,” Stine said. “They can have numbness or a fuzzy-headed feeling.”

Renal osteodystrophy, or bone disease from kidney failure, affects 90 percent of dialysis patients and decreases bone strength, according to the American Kidney Association, which reported that older patients and post-menopausal women are at greater risk for developing renal osteodystrophy.

Hemodialysis allows the blood to flow through a special filter that removes wastes and extra fluids.

“Approximately one unit—about two pints—of blood is removed, purified and then returned to the body,” Stine said.

This process controls blood pressure and regulates the proper balance of essential chemicals like potassium and sodium in the body.

“My blood pressure has gone down (because of treatments) and my heart isn’t having to work so hard,” McConnell said.

The procedure

The dialysis machine—about the size of a dishwasher—has three main functions: pump blood and preserve flow safety; clean wastes from blood; and regulate blood pressure and fluid removal rate.

“You have to clean the site where the two sticks (needles) go into your graft (the point of entry),” McConnell said.

“You hook yourself up to your machine; it’s about a three-, three-and-a-half hour process,” he said.

Before starting home dialysis, patients must complete a training seminar that teaches proper care and maintenance techniques.

Training sessions usually are conducted while the patient receives dialysis at a treatment center.

“(The training process) is like going to school,” Stine said. “It’s usually about three to four weeks, Monday to Friday, for about four hours a day.”

Home treatment usually involves a partner learning the same basic functions.

“We require an assistant of some sort, a family member or a significant other,” Stine said.

“To what degree they’re involved, that’s up to them,” she said. “It’s really for safety, in case something happens.”

Most people learn how to do peritoneal dialysis within two weeks, according to Stine.

Hemodialysis training typically takes three to four weeks.

Peritoneal dialysis involves the insertion of a small, flexible catheter—placed in the abdomen by a surgeon—that cleanses the bloodstream with a sterile solution.

“Peritoneal doesn’t involve a partner,” Stine said. “It’s also noninvasive.

“Instead of pulling blood from the body (as with hemodialysis), it’s putting a sterile solution in,” she said.

Dialysis treatments can be covered by health insurance.

A home dialysis machine can be portable and arrangements can be made through a medical provider to set up home service delivery while traveling.

A medical staff member will provide any follow-up requirements.

Dialysis options

“With either of the modalities, it’s giving them control of their life back,” Stine said.

“With (home dialysis) patients tend to be more in tune with what’s going on during their treatment,” she said.

Options include:

<Traditional home hemodialysis: performed three times per week, typically for about four hours per session.

<Short daily home hemodialysis: performed five times per week for about two and a half hours.

<Nocturnal home hemodialysis: performed while you sleep, three nights a week.

<Peritoneal dialysis: four to five half-hour exchanges per day or nightly blood cleaning cycles.

<In-center self care: dialysis performed by patient in a dialysis center under a nurse’s supervision.

Think you have symptoms of kidney failure?

First, see your doctor.

Also, DaVita—at 27880 N. Main St., Suite A—holds monthly public dialysis education classes at 2 p.m. on the first Tuesday of each month. Call 626-1086 to register.

Free classes cover treatment choices, diet, employment and insurance issues along with home dialysis counseling and evaluations.

For more information about hemodialysis, visit the National Kidney Foundation’s Web site at www.kidney.org.

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