New home dialysis machine giving patients more freedom

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New home dialysis machine giving patients more freedom

By MARK ANDERSEN / Lincoln Journal Star
Monday, May 14, 2007 - 12:26:32 am CDT

Mike Pepper, 58, suffered the annoyance of dialysis three times weekly for 10 of 24 years since a virus killed his kidneys.

He underwent three kidney transplants to avoid the hassles. The middle transplant lasted 10 years. His body rejected the others.

Then, 18 months ago, a new device made the chore more bearable.

Until then, Pepper did what’s been the standard procedure for the vast majority of the 472,000 people in the United States with end stage renal failure. He went to a dialysis center three times a week.

“Sitting somewhere for 4-4½ hours exhausts you,” Pepper said. “It’s like fall asleep city.”

His life went like this: Do dialysis. Go home tired. Go to bed. Feel good the next day. Feel lethargic the next. Return to the dialysis center that afternoon. Repeat cycle.

Today, Pepper is among a small but growing group of patients at Dialysis Centers of Lincoln who clear their fluid toxins at home, six days a week, 2½ hours at a time. He uses a NxStage System One, a portable 70-pound machine, the size of a square metal file cabinet.

“Doing it at home is not as big a pain in the butt as doing it in the center,” Pepper said.

Plus, he’s not tied in to a center’s schedule. “Now, I can do something every day.”

Lincoln’s non-profit Dialysis Centers has one of the country’s largest home programs. It may be setting a trend in the $20 billion per year kidney treatment industry.

Dr. Tim Govaerts, a Lincoln nephrologist, hopes that’s true.

Studies performed in the 1970s showed frequent dialysis improved patient health, Govaerts said. Nutritional parameters, quality of life, blood pressures, all were significantly better, he said.

It isn’t for everybody. People have to stick themselves with needles. They have to bring dialysis into their homes. They do it more often.

“Some don’t want to deal with it,” Govaerts said. “They’d much rather go into a center and have somebody else do it.”

Still, he expects home dialysis will double from 15 percent of the center’s patients currently to 30 percent in the next few years.

New dialysis options will be increasingly important for the country’s aging population of overeaters, prone to diabetes, high blood pressure and then kidney failure.

But upon this roadmap to more frequent dialysis at home stands Medicare, the major payer for dialysis treatments. It’s awaiting proof of the benefits of frequent dialysis from a larger National Institutes of Health study.

As the manufacturer of NxStage said in its annual report: “The adoption of our System One for more frequent therapy for (end stage renal disease) could be slowed if Medicare is reluctant or refuses to pay for these additional treatments.”

Hemodialysis, which cleans toxins directly from the blood, mostly occurs at centers due to the hassle of the machines, setting them up and shutting them down, Govaerts said.

The first hemodialysis machine designed for home use arrived a few years ago. Aksys, made by a company which folded in January at a loss to investors of several millions, sterilized itself with heat. It was heavy, weighing 300 pounds.

The NxStage system uses disposable cartridges and sets up and  down in about a half hour. Even at six times per week, total time for dialysis per week is less if the center is more than 15 minutes away.

The problem with thrice weekly treatments, Govaerts said, is that it leads to greater accumulations of fluid, and then a sudden decrease.

It’s like this. People with end stage renal failure can’t urinate.

Over a weekend, patients may accumulate 12 pounds of water and toxins. Treatment takes them from bloated to drained.

“They feel like they’ve been put through the wringer,” Govaerts said. The fluid extremes have implications for blood pressure, appetite and ability to exercise.

The average length of survival for patients visiting inpatient centers is about three years, Govaerts said. For those doing it more often, it’s double.

But the government remains unconvinced. Studies proving these health benefits have involved small numbers. Most were observational studies — which produce debatable conclusions.

A 2006 study published in Hemodialysis International involved roughly 100 patients using Aksys more often at home. It showed a 61 percent improvement in survival, but that study, while contributing to a growing body of evidence, was less than definitive.

Increasingly, Medicare bases payment decisions on science-based medicine, on proven results.

The NIH study  relies on random selection. It began in January. Completion is expected in March 2009.

From the standpoint of reimbursement to dialysis centers, Govaerts said, home dialysis isn’t a moneymaker. Centers make up for lost income by needing fewer personnel.

Pepper, meanwhile, has moved on to the next stage of NxStage, which hooks up to tap water to produce its own sterile flush fluids from concentrate, simplifying storage.

As for his personal health, his laboratory results haven’t changed, he said. “They say it will help eventually,” he added.

The biggest hurdle was in learning to put needles into his own arm.

“I tell people it doesn’t hurt,” he said. He knows several people who would like to try at-home dialysis but who can’t imagine sticking themselves.

“And it’s nothing,” he said.

Overall, he feels better, he said.

“Every once in a while I might feel a little weak, but it’s not at all the same (as thrice weekly).”

You won’t find him at home most days. “Golf is my main passion now,” he said.

Reach Mark Andersen at 473-7238 or mandersen@journalstar.com.

http://www.journalstar.com/articles/2007/05/14/news/local/doc4647a17c368a5646195149.txt

PHOTO: Mike Pepper reads the paper while undergoing a dialysis treatment in his home Wednesday morning. He receives the treatment each day for two hours. (Jill Peitzmeier)