|
Doctor to Doctor |
|
This newsletter made possible by a grant from the Gilbert & Martha Hitchcock Foundation |
|
Provided as a service for Nebraska H by the Nebraska Kidney Association 11725 Arbor St., Ste 210, Omaha, NE 68144 402.932.7200 NE Toll Free: 800.642.1255 e-mail: develop@kidneyne.org www.kidneyne.org |
|
Home Hemodialysis: Old Becomes New
Les Spry, MD, FACP, FASN Director, Lincoln Nephrology and Hypertension |
|
The first home hemodialysis program was started by Dr. Joe Eschbach in Seattle, Washington in 1964. Dr. Eschbach would subsequently come to prominence by doing the original research on and introducing to the medical world, the biological drug, erythropoietin. In that time, home programs were necessary because dialysis was expensive and Medicare did not pay for dialysis until 1972. Dialyzing at home was the only cost effective alternative. Home hemodialysis began to die out in the late 1970’s and early 80’s with the advent of peritoneal dialysis techniques and more in-center hemodialysis venues. In the early 2000’s, home dialysis was much less than 0.5% of the dialysis population. However, we are seeing a renaissance of home hemodialysis over the past decade as newer technologies emerge to make it easier to train and keep patients at home with their own dialysis machines. Today, home hemodialysis programs are again on the increase, with the number of home patients more than doubling in the past 5 years. Our program in Lincoln, started in 2003, boasts one the largest home hemo dialysis populations in the country with more than 50 patients at home doing hemodialysis. This represents almost 15% of our total hemodialysis population, with patients coming from all corners of the state as well as surrounding states. Traditional home hemodialysis involved installing an expensive water treatment system in the home and training for 3 to 4 months so that you could go home with the same machine that we use for in-center dialysis. This resulted in greater convenience, as it was done at the patient’s schedule rather than a dictated schedule, but was still done three times weekly or occasionally every other day (seven times in two weeks). Today’s new home hemodialysis systems employ a short daily technique, whereby the patient uses a small hemodialysis machine that is portable and about the size of a small TV. It uses a dialysate generator that is about the size of a coffee table and requires no specific plumbing. The machine can also run with sterile bags of dialysate which can be delivered regularly to the home, or delivered to a vacation destination. This allows greater ability to travel on dialysis. Rather than running 4 hours three times weekly, the short daily technique runs 2 or 2.5 hours six days per week. There are also techniques where 5 days per week can be used and a nocturnal technique can also allow a patient to run 6 to 8 hours while sleeping at night, five or six nights per week. Training for these techniques can generally be accomplished in 2 or 3 weeks. Advantages to home hemodialysis that have been reported include better blood pressure control with most patients being able to dramatically cut back on the number and dosage of blood pressure medications. Patients report feeling better, have a better quality of life, have more energy, and report that they no longer have the prolonged recovery times associated with in-center hemodialysis. It has been reported that recovery times after in-center dialysis can be as long as 8 to 24 hours. With short daily technique, the recovery time after dialysis has generally been in the range of 30 to 60 minutes. Sleep patterns and sleep apnea have been improved with home hemodialysis techniques and there have been reports of improvement and reversal of left ventricular hypertrophy. Most patients would never return to the in-center program after being at home. Most have returned to full time activity. Candidates for home hemodialysis must have someone to assist them at home and who can train with them at the training center. They must have adequate hemo dialysis access. The best access is a primary AV fistula that can be used for “button hole” access. Patients must learn how to properly care for and be able to successfully cannulate their access at home. Patients and their helpers must be ready and willing to learn. Helpers must be willing to accept the burden of care over the long term. We require monthly visits with our home dialysis staff. We encourage patients of all ages to consider home hemodialysis along with home peritoneal dialysis as the treatments of choice for all patients wishing greater independence and improved well being on dialysis. Note - Please send us your email address so that in the future you may receive these electronically. Send your email address with your name to: Sherri Petersen -develop@kidneyne.org
FOR MORE INFORMATION Contact Dr. Spry at 402. 484.5600 or via e-mail at lspryguy@aol.com
|
|
Les Spry, MD, FACP, FASN
Dr. Spry is a partner in Lincoln Nephrology and Hypertension, Medical Director for Dialysis Centers of Lincoln and with his partners are co-owners with the Dialysis Center of Lincoln of Home Dialysis of Lincoln.
Dr. Spry is also active as:
ˇ Chair of the Public Policy Committee for the NKF ˇ Chair of KDOQI Learning System for the NKF ˇ Immediate Past President of the Nebraska Medical Association ˇ Nebraska Delegate to the American Medical Association ˇ Member of the Medical and Scientific Advisory Committee for the Nebraska Kidney Association
|
|
Nebraska Kidney Association |
|
|
