Dialysis at Home: A Better Treatment

Hemodialysis has evolved over the last 50 years as a life-saving treatment for people with renal failure. It involves the removal of blood from the arm, passage through a filter that removes fluid and protein metabolites, and return of the cleansed blood back to the body. Prior to the advent of dialysis, chronic renal failure was invariably fatal. Kidney transplantation removes the need for dialysis, but the supply of donor kidneys is limited.

There are now about 400,000 people in the United States on dialysis therapy. Most of them are older adults. In 70% of them, the cause of kidney failure is high blood pressure or diabetes.

Traditional dialysis is performed three times a week for four hours each time. For many older people it is difficult to tolerate. The rapid removal of fluids, required for treatment to be effective, causes muscle cramps and fluctuating blood pressure, often accompanied by nausea, vomiting and weakness. Many patients must rest for hours after each treatment, because they are too weak to resume normal activities. The quality of life for many dialysis patients is poor. Beyond this, the death rate is a dismal 25% per year.

Now there is a new treatment, though it is not really new: home hemodialysis. It was available 30 years ago, but fell into disfavor and withered. In a different form, it is being used by a 78 year-old patient of mine. He is treated by his wife at home, for two hours, six days a week. The briefer, more frequent treatments are much better tolerated. He has no vomiting, no fatigue, and gains much less weight between treatments because of the shorter time interval before the next treatment. I am very impressed with how good he looks.

The dialysis apparatus is called NxStage System One^TM. It is portable, and can be moved from room to room, and can be taken on trips. A trained assistant is required to be present for every treatment session, in this case the patient’s spouse.

I don’t know the cost of therapy, but figure it must be cheaper than treatment performed in a dialysis facility, with all its associated cost of space and personnel. It is certainly less stressful for the patient. There is no requirement to travel for therapy, arrive according to schedule, or tightly restrict fluid intake because of the duration between treatments.

I strongly recommend that all dialysis patients investigate this treatment option. It will improve their quality of life, and their ability to tolerate an otherwise arduous experience.

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