Program allows patients to perform dialysis without leaving the house

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Article published Jul 29, 2007

Program allows patients to perform dialysis without leaving the house

By Hattie Bernstein
Telegraph Staff

For 2½ years, John Magrath traveled from his home in Londonderry to the DaVita Center, on the campus of Southern New Hampshire Medical Center in Nashua, where he underwent dialysis treatments three times a week.

His routine was demanding: Wake up at 4:30 a.m., be at the center by 6:15 a.m., get onto the dialysis machine by 7 a.m., and finish around 10:30 a.m. or 11 a.m.

“I’d drive home and take a nap. I was washed out for the rest of the day,” said the 43-year-old father of three.

Two weeks ago that changed, after Magrath and his wife, Anne, completed training with Mary Abelleira, the registered nurse at DaVita who runs the newly created home dialysis program.

Anne Magrath, a director of finance at Northeastern University in Boston, took five weeks off from work to attend the training sessions where she learned how to be her husband’s “care partner.”

Abelleira instructed the couple in how to set up and use the home equipment, available through the Nashua center since mid-June.

“It does require a big commitment from the partner,” Magrath said. “She has to learn it, first of all. It’s time involved daily.”

The program had to be licensed through the state, said Abelleira, who trained in April to teach qualified patients and their partners. It is the first home program offered by the local center, and so far two patients and their partners have completed the training, Abelleira said.Patients learn to use the equipment, which is provided by prescription. The center buys the machine after a medical specialist approves the home treatment, and the patient and care partner train at the center.

The machine goes home with the pair after training is completed.

Because the home treatments are done more frequently, they are performed for shorter periods, leaving patients less fatigued, Magrath said.

He said he had known since he was 15 that eventually he would need dialysis, a result of digestive surgery he had as an infant.

He has undergone three failed kidney transplants, including one donated by his wife. The last transplant lasted for nine years, failing in 2005.

“The doctors tell me it would be better if I have a living donor,” he said during an interview in his living room, sitting by his home dialysis machine.

According to Abelleira, the training nurse, the home treatment has several advantages for Magrath: He can choose when to take the treatment; he can travel with the equipment, which is portable; and by taking, shorter, more frequent treatments, there will be less strain on his heart.

The treatments also allow for more family time. While he sits in his leather easy chair that faces a large plasma TV, his wife in the kitchen fixing dinner, and his 10-year-old and 12-year-old playing nearby, he receives his dialysis.

“It’s convenient for us. Before we were on opposite shifts,” Anne Magrath said.

Hemodialysis is treatment that replaces the work of a person’s kidneys, clearing wastes and extra fluid from the blood. It is done using a filter called a dializer or artificial kidney.

Blood travels through plastic tubing to the dialyzer, where it is cleaned and returned. The process depends on the insertion of two needles, connected to the tubing that carries blood to the dialyzer.

To qualify for home dialysis, Magrath and his wife had to be willing to insert the access needles. They also had to agree to take about five weeks of training with Abelleira.

“He was willing to put the needles in his arm,” Anne Magrath said while her husband extended his arm to display the access point, a surgically relocated blood vessel in his left arm, enlarged to handle the task.

In addition to operating the home dialysis machine, Magrath and his wife were also trained to draw blood samples, package them, and send them out through FedEx to a laboratory in Florida that contracts with DaVita.

Abelleira said she receives the lab results in 48 to 72 hours.

“This is the best home therapy being offered for its ability to mimic normal kidney function and have people feel their best,” the nurse said during a home visit to the Magraths. “The first week, he noticed he was feeling better.”

The nurse said the home program is particularly beneficial for younger patients.

“The clinic environment is not a positive experience,” she said, evoking images of critically ill, elderly patients, typically those with complicating medical conditions.

Magrath said so far he and his wife have fared well in doing the treatments at home. They can call Abelleira for advice during business hours, and they also have several other phone numbers, including 24-hour technical support.

“It’s definitely exciting,” Magrath said. “My first experience with dialysis was in 1990, and I’d never have predicted this then.”

© 2006, Telegraph Publishing Company, Nashua, New Hampshire

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