Home dialysis sets patients free

[okarol]

Home dialysis sets patients free

May 07, 2010
Steven Pecar

Special to the Star

Free to do what they please

For 70 kidney patients at Humber River Regional Hospital, there really is no place like home.

The patients, all in various stages of kidney failure, are living healthier and more active lives than those on traditional forms of dialysis because their blood is being cleaned every night while they sleep.

Fatima Benjamin-Wong, clinical co-ordinator of the hospital's Home Dialysis and Kidney Care Clinic, sees the positive results first hand on a regular basis.

“It changes their life,” she says. “They can hold full-time jobs, spend more time with their family. When they come in, you can't really tell they are kidney patients. The benefits are amazing.”

It is these benefits, both the physical as well as the emotional ones, that have made the nurses in the Home Dialysis Unit (HDU) an integral part of the lives they care for.

From the early stages when it is determined that dialysis is necessary, the HDU nurses are there.

The process begins during a lengthy consultation period. Although a kidney transplant can free patients from dialysis, that option is not always available due to the health of the patient and the availability of suitable donor.

“Many people just don't want to go through that,” explains Benjamin-Wong, who assesses all patients.

Unlike dialysis care — where patients must go to a hospital clinic three times a week for sessions of four to six hours each — those who elect to be treated at home are trained to be self-reliant. Although there are some costs involved, the home dialysis machine and program is fully funded by OHIP and arranged through the hospital.

Paul Doherty, 58, of Innisfil, has been on dialysis for more than 14 years. He underwent a kidney transplant 10 years ago, but it failed. However, since he has been on home dialysis, he has faced very few restrictions in his life.

“I do everything I want to do, really,” says Doherty. While acknowledging that other health issues do not allow him to take part in some strenuous activities, he says his lifestyle is much improved since he started home dialysis.

Doherty also believes the relationship he and other patients have with the HDU staff makes a big difference.

“You can tell that is more than just a job for these nurses,” he says. “They really do spend a lot of time with us, they get to know us, they can tell when something's not right.”

During one of his regular checkups, Doherty says a curious nurse spotted an infection that otherwise would have gone unnoticed. He believes the resulting operation saved his life.

“I don't think I would be here if it weren't for their care and encouragement,” he says.

Mulu Demisashi, a nurse clinician at Humber River, says the biggest barrier most people face is learning how to take care of themselves. Six to eight weeks is needed for training and, most often, family members or other caregivers are involved.

Demisashi says the process might first seem daunting— and he admits that it does take some work — but he adds anyone can learn and most do. Some of the work involves applying a needle into your own body, cleaning filters, monitoring the operation of the machine and learning what to do if complications arise.

“Once they start to realize that they can do it, their outlook changes,” Demisashi says. “But along the way, they learn that it is important for them to look after themselves, that it is important for their health.”

Benjamin-Wong stresses that nurses and technicians are available around the clock and patients continually stay in touch with their case worker to overcome problems.

A registered nurse for 25 years, Benjamin-Wong believes those who work with kidney patients get the most job satisfaction because results can be measured.

“When you actually see people feeling better and getting better you know that you are really helping.”

— Steven Pecar

Perry Brooks works out at the gym five times a week. At the age of 70, it's not a big deal.

Kirk Kelly, 57, plays a round of golf at least twice a week. He is even coaching hockey again. He gets out on the ice now and again during practice, too.

Both are kidney patients and receive their dialysis treatment at home. Not too much stands in their way.

“I feel great,” says Brooks from his Toronto home. “I'm not tied down, I can do what I please.”

For kidney patients on home dialysis, it's the freedom to move around that made their decision for the type of treatment they receive an easy one.

For Kelly, aside from the sports, he said the time with his family has been the most valuable. A dialysis patient for 20 years, Kelly said the time he spent in the hospital receiving treatment three times a week care meant time away from his Mount Albert home.

That changed 11 years ago when he switched to having a dialysis machine at home.

“I got to be with my daughter all this time,” he says. “That's time I couldn't replace.”

Another positive benefit is there are no restrictions on what you can eat. Food intake for those on traditional dialysis must be strictly monitored and many favourites have to be eliminated. Not so for those on home dialysis who receive treatment more often and for longer periods of time.

And as for the physical activity, just consider Brooks.

A dialysis patient for six years, he says he has cut out racquet sports, but his fitness routine makes him feel the best he has in a long time.

http://www.healthzone.ca/health/newsfeatures/article/805900--home-dialysis-sets-patients-free

[MooseMom]

We all know that CKD and ESRD is on the rise, and I do believe that this fact will bring a lot of attention to home dialysis.  I think there is a LOT of money to be made in the home dialysis market, and there will be new technologies on the horizon.  I think NxStage, for instance, will soon be even better, and home nocturnal HD will be more commonplace.  Put all of these new patients in clinic, and the system will be overwhelmed.  One reason I want to do home D is so that a chair will be freed up in clinic for someone else who can't do D at home.

[monrein]

This hospital is in my hometown of Toronto, Ontario, Canada.  We don't have Nxstage here in Canada but since we have a single payer not-for-profit system home dialysis is encouraged and supported as it saves us all money.  Same thing with transplantation and also paying for the transplant drugs...cheaper than D and both supported by taxpayer dollars.  Better dialysis resulting in better health also saves money with less hospitalizations and trips to the ER.  We also have the option of self-care clinics (my choice before my second transplant) and I went to 5 times a week within about a week of requesting this option so I could feel better. 

An issue for the Canadian system is often the fact that there can be quite a difference between larger urban centres and smaller places where smaller populations can restrict the available options but saving money while optimizing health benefits seems to me to be a no-brainer.

[okarol]

Let's all move to Canada!