Dialysis by night saves the day

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From the YakimaHerald.com Online News.
Published on Friday, December 7, 2007    

Dialysis by night saves the day

By LEAH BETH WARD
YAKIMA HERALD-REPUBLIC

UNION GAP -- Toting her son's Harry Potter blanket and the movie "Hairspray," Lisa Marie Cozad prepared for bed recently in a strange new setting: a kidney dialysis center.

Cozad, 33, is one of a handful of Yakima Valley patients with kidney disease who has been invited to try having her blood cleaned while she sleeps three nights a week at a clinic operated by DaVita Inc., a national chain of dialysis centers based in California.

Cozad, who has been on daytime dialysis for 11 years, is hopeful that the relatively new technique will give her more time and energy during the daytime with her two sons, ages 11 and 13.

"I really hope this will allow me to stay home during the days," she said before getting hooked up to an artificial kidney that will cleanse her blood over eight hours.

Nocturnal dialysis debuted in the United States 10 years ago, according to Tom Gill, vice president of nocturnal dialysis at DaVita. But it wasn't until the last year that the company began to pursue it more aggressively as an alternative. With eight beds, the Union Gap center is the first in the state to offer nocturnal dialysis, according to DaVita, which operates another dialysis center in Sunnyside and will open a third in Ellensburg later this month.

Dr. Hamilton Licht, a longtime area nephrologist and medical director of the DaVita centers, said he decided to start nighttime dialysis after determining he had enough patients who could benefit from longer, slower cleansing.

Conventional daytime hemodialysis, he explained, can be tough on the body. The shorter three-to-five hour treatments remove fluid at a faster rate, which can cause cramping and lower blood pressure, leaving the patient feeling washed out and often in need of a nap afterward.

Research has shown that some medium and larger-sized toxic molecules that build up in the blood aren't cleaned out as effectively during the shorter treatments. When the kidneys can no longer eliminate all the toxins, the patient suffers a series of symptoms ranging from the mild, such as fatigue, to the serious, including fluid buildup in the lungs and heart failure.

"We've known this for a long time, but dialysis units have been structured to treat the largest number of people in the shortest period of time," Licht said.

The first major clinical findings around nocturnal dialysis came in 2003 from France, where patients on the longer treatments had higher survival rates. Deaths from cardiovascular disease were nearly cut in half.

More recently, a study published this fall in the Journal of the American Medical Association found that patients on the nocturnal schedule experienced a sizable reduction in the thickness of the heart muscle. That reduction increases the survival rate and allows patients to cut back on their medication for high blood pressure.

"The total number of pills is often reduced dramatically," Licht said. "Many patients take from six to 10 tablets with each meal and that is just drudgery for them."

Nocturnal dialysis isn't for everyone with chronic or end-stage kidney disease, he said, because some people simply can't sleep well in a setting that resembles a hospital ward. There are no private rooms, and a nurse technician must take a blood pressure reading every hour, which can wake the patient. Patients aren't exactly mobile, as they are hooked up to the machine either through a catheter in the chest or intravenously. But they can shift from side to side with assistance.

Leonard, who preferred that his last name not be used, was the first and only patient when the program started last week.

"It was a little strange. I kept watching the clock," he recalled.

But the upside seemed readily apparent to him the next day.

"I had more energy and felt more ambitious," he said.

The staff at DaVita prepared for the new program by having their own slumber party at the center a week before the launch date.

"We wanted to go through what our patients would be going through, to the extent possible," said Maureen Ritter, a nurse and administrator at the center.

DaVita, which also operates dialysis centers in Sunnyside and Ellensburg, figured out that at least eight nocturnal patients would be needed for the additional costs of the longer treatment to be offset by the benefits of reduced medications and healthier patients. The patients have to represent a mix of private-insured and Medicare, Gill said.

"If it's all Medicare, it's pretty cost-prohibitive," he said.

Unfortunately, the rising incidence of diabetes and high blood pressure is damaging more kidneys every year, Licht said. Currently, 113 patients in Yakima County are on dialysis.

So far, 12 patients have expressed an interest in trying the nocturnal treatments. The center will add a patient or two each week until there is a shift of eight full beds. To help induce sleep, the center has equipped each bed with a television with ear phones and individual reading lights.

"We won't know exactly how many we'll have until we put them in there and see if we are good hosts and they are comfortable sleeping away from home," Licht said.

* Leah Beth Ward can be reached at 577-7626 or lward@yakimaherald.com.

http://www.yakimaherald.com/page/dis/290464940851294

Photos by KRIS HOLLAND/Yakima Herald-Republic
Lisa Marie Cozad rolls up her Harry Potter blanket before turning in for the night to undergo nocturnal dialysis at the DaVita dialysis center in Union Gap last month. The Union Gap clinic is the first in the state to offer its patients the overnight treatment.