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Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.
Even if you're not a history buff, you may want to take a look at how the development of home hemodialysis (HHD) impacted the lives of many people living with end stage renal disease (ESRD). It may help you understand this treatment option a little better and help you decide if it’s the right treatment choice for you or your loved one.
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 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.
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, Dr. Scribner and his team looked to HHD 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, 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, Dr. Scribner worked hard to make home dialysis simple and safe and it quickly grew in popularity.
At its peak in the early 1970s, nearly 40 percent of all dialysis patients in the United States were on HHD.
Despite its initial popularity, HHD treatment declined sharply during the next 20 years. There were a variety of reasons for this, including primitive technology, the introduction and rise in popularity of peritoneal dialysis (PD) in the late 1970s, an increase in the age and number of ESRD patients with multiple illnesses, and changes in dialysis care funding by Medicare.
Nothing changed for the patients who continued to receive home hemodialysis, but the explosion of dialysis centers across the nation provided a popular option for patients who preferred to dialyze in the presence of clinicians. Nonetheless, at home dialysis would become a hot topic again.
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 home hemodialysis requires an external machine to clean blood, PD filters and cleans blood within the body. In PD, the patient’s abdomen is filled with a special solution (called dialysate) that absorbs waste and extra fluid and then is drained, taking the waste and fluid 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 cycling peritoneal dialysis (CCPD). In CCPD, a 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 home hemodialysis are different treatments, the rapid adoption of PD contributed to the decline of HHD treatments in the 1970s and 1980s. However, HHD would soon make a comeback.
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 helped automate the process, making it considerably easier than in the past for patients to manage their at home hemodialysis treatments themselves.
Today, physicians continue to study the potential benefits of at home hemodialysis versus other forms of dialysis care.
New technologies 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.
Constantly improving technology and more readily-available equipment may help more patients discover the lifestyle and clinical benefits of home dialysis.
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