Home hemodialysis

History of home hemodialysis

1960 - A revolutionary breakthrough

Dr. Belding Scribner, a doctor at the University of Washington, was awake late one night agonizing over the death of a patient when he developed the idea that would turn into the Scribner Shunt, which helped make dialysis possible at the time. After watching countless patients succumb to end-stage renal disease (ESRD), he helped herald in a new era of care by spearheading the development of dialysis as a life-saving treatment for millions of patients.

Soon after, Dr. Scribner’s work led to the establishment of the first outpatient dialysis center, the Seattle Artificial Kidney Center (SAKC). Although the facility received funding from several sources, there were too few beds and not enough resources to treat all patients in need of dialysis. Deciding who would receive treatment, and potentially who might live and who might die, became a serious ethical quandary. To ensure a standard of care, a strict screening process was developed and overseen by an anonymous committee.

1964 - At-home hemodialysis is born

The SAKC continued to expand throughout the 1960s, but funds were still limited and demand continued to outpace the necessary resources. Facing difficult ethical decisions, Scribner and his team looked to at home hemodialysis as an answer. At the same time, the scientific community was intrigued by the promise of dialysis and other researchers began looking at ways to bring treatments to patients’ homes. At home hemodialysis soon became a hot topic on three different continents.

Although it was the only way to receive life-sustaining treatments for some patients, at home dialysis in its earliest days appeared to be an inefficient treatment for ESRD patients and the equipment was large and difficult to use. Never deterred, Scribner worked hard to make at home dialysis simple and safe and at home hemodialysis quickly grew in popularity.

At its peak in the early 1970s, nearly 40% of all dialysis patients in the country were on at home hemodialysis.

1973 - Changes prompt a decline in at-home hemodialysis treatment

Despite its initial popularity, at home hemodialysis treatment declined sharply during the following 20 years. There were a variety of reasons for this, including: primitive technology, the introduction and rise in popularity of continuous ambulatory peritoneal dialysis (CAPD) in the late 1970s, an increase in the age and number of end stage renal disease (ESRD) patients suffering from multiple illnesses, and changes in dialysis care funding by Medicare that favored in-center treatment.

Nothing changed for the patients that continued to receive at home hemodialysis, but the explosion of dialysis centers across the nation provided a popular option for patients that preferred to dialyze in the presence of clinicians. Nonetheless, at home dialysis would become a hot topic again.

Late 1970s to the 1980s - The rise of peritoneal dialysis

In 1976, a pair of doctors in Texas submitted an abstract (an academic request to present research) for a new type of dialysis treatment at the annual meeting of the American Society for Artificial Internal Organs. Although the abstract was not accepted, it formed the basis for Continuous Ambulatory Peritoneal Dialysis (CAPD).

Whereas at home hemodialysis requires an external machine to clean blood, peritoneal dialysis filters and cleans blood within the body. In peritoneal dialysis, the patient’s abdomen is filled with a special solution (called dialysate) that absorbs waste and then is drained, taking the waste with it. Offering significant clinical and lifestyle benefits, peritoneal dialysis quickly became a popular form of treatment for patients with kidney failure.

Five years later,two doctors independently devised a new way to automate peritoneal dialysis exchanges -- Continuous Cyclic Peritoneal Dialysis (CCPD). In CCPD, a special machine cycles the dialysate in and out of the abdomen, removing the need for bag exchanges and allowing for nocturnal treatments. Although peritoneal dialysis and at home hemodialysis are different treatments for different patients, the rapid adoption of peritoneal dialysis contributed to the decline of at home hemodialysis treatment in the 1970s and 80s. However, at home hemodialysis would soon make a comeback...

The 1990s - A renewed interest

Within the past fifteen years, there has been a revival of at home hemodialysis in the U.S. The resurgence began in 1994 at the American Society of Nephrology meeting, where it was reported that six patients were successfully treated through at home hemodialysis via nighttime, or nocturnal, treatments. Dr. Robert Uldall reported that nocturnal treatments more effectively cleaned patients' blood compared to in-center treatments.

At the same time, new studies also showed at home hemodialysis to be a potentially safer and more effective alternative to peritoneal dialysis. Momentum has continued to grow with the expanded availability of a variety of safe and effective at home hemodialysis treatment options. New advances in technology help automate the process, making it considerably easier than in the past for patients to manage their at home hemodialysis treatments themselves.

Today - The comeback

Today, physicians continue to study the potential benefits of at home hemodialysis versus other forms of dialysis care. Recent research shows that quality of life may be superior for patients who perform dialysis in their home, especially those who take advantage of their home settings to engage in more frequent or extended dialysis. Benefits reported include: improvements in mental clarity, sexual function, sleep, energy, strength and rehabilitation. At home dialysis also often results in better blood pressure control, as well as reductions in thirst, pruritis, restless leg syndrome, fatigue and depression.

Researchers, physicians, and equipment manufacturers continue to look for ways to improve and expand at home dialysis. New technologies and advances are changing how dialysis patients live, work and spend free time. And with smaller, portable hemodialysis machines becoming available, travel is easier than ever before.

There are more than 300,000 Americans currently receiving hemodialysis treatments and experts predict this number to double by 2010. As the population of patients in need of dialysis grows and demand rises for flexible at home options, constantly improving technology and more readily-available equipment may help more patients discover the lifestyle and clinical benefits of at home dialysis.

External links

• The History of Home Hemodialysis: A View From Seattle

Related articles on DaVita.com

• A brief overview of home hemodialysis