Monday, April 25, 2016
It Gives Me Freedom
By: Harold E. Giles, M.D. with Nephrology Associates, P.C.
“It gives me freedom.”
“I tell people I'm a dialysis patient and they don't believe it.”
“It's like I'm living a normal life.”
These are quotes from my patients who do dialysis at home. Their sentiments are common amongst those who visit us every month for a checkup.
Home dialysis is in a resurgence right now. This move is a combination of two strong trends in medicine. Patients want and deserve more autonomy over their healthcare and dialysis done in a traditional center is incredibly expensive. Most of our dialysis patients are on Medicare and while they make up just one percent of Medicare enrollees they take up eight percent of the budget. Home therapy is a win for the patient and the overall community.
Right now there are two paths to doing dialysis in the home. Patients can choose to do peritoneal dialysis (PD) which involves the placement of a soft catheter in the abdomen. Most of our patients can do most, if not all, of their dialysis overnight with a cycling machine the size of a printer in one’s office. If you see a PD patient in the grocery store or at church you would never know they have their catheter coiled up and hidden under their blouse or shirt.
Do patients do hemodialysis at home? Absolutely they do. And recent outcomes data shows that these patients do as well as those who have received a kidney transplant from a deceased donor. If you have ever seen the small machines in the ICU that are used for continuous dialysis then you have an idea of the small platform that is deployed in a patient’s home for hemodialysis. Most of our patients do this four to five times a week. The increased frequency makes it easier on the patient and reduces the “wiped out” feeling that in center dialysis patients often report.
Our home patients, need to get labs drawn once a month and see our team shortly after that. Our team consists of a nephrologist, their RN, a dietician and a social worker. We work together and this approach offers deep resources for patient care. This stands in contrast to an average of thirteen in center treatments at a local dialysis unit. I think much of the satisfaction for patients lies in both ownership of their health and in a less burdensome interaction with the delivery of healthcare.
If you run across a patient, a friend or a family member who might be facing dialysis, rest assured that an opportunity for home therapy is strongly supported by the literature. And most importantly, it is a wonderful chance at preserving more of the normalcy of daily life that we all treasure even when faced with a chronic illness.