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By Stephen Z. Fadem, M.D., F.A.C.P., F.A.S.N.
With specially designed machines on the market today, patients once limited in their modalities to in-center hemodialysis or home peritoneal dialysis may now receive their hemodialysis treatments at home. The newer machines are much simpler to use and are safe. Patients who are interested in home training can go through an intensive training program and are only allowed to manage their own care when they are considered qualified to do so.
The major advantage to home hemodialysis is that patients can dialyze every day. This is more natural and has distinct advantages, especially with respect to quality of life, reduction of symptoms and better management of fluids and diet. Home care gives patients more authority and responsibility toward their own care - it empowers them to do well. Empowerment is the best way to improve adherence. Home dialysis therapy offers flexibility with one's work and lifestyle schedule. Much time is wasted in travel and meeting a tight schedule when dialyzing in a center. This is avoided as patients create their own schedules and dialyze in the comfort of their own homes.
Home dialysis is not new. In fact, it preceded in-center hemodialysis and was once the major option in the 1960s and early 1970s. The concept began in London and spread to the Northwest United States and Canada. In the 1970s, as Medicare guaranteed coverage of in-center dialysis, it became less prominent in the United States, but gained in popularity in the past few years. Word soon spread that patients on home therapy had a very high quality of life, and the dialysis industry began listening to them, developing machines, techniques and programs especially for home treatments.
The current home dialysis machines are easy to set up and use. They were designed for the home patient, using pre-packaged disposable cartridges. The new models sit atop their own self-contained water purification system. Thus, there is no requirement for a large, cumbersome machine in the home, nor the need for expensive plumbing modifications. Since the new machines are smaller, patients can travel with them.
The buttonhole method of arteriovenous (AV) fistula cannulation makes it easy and safe for patients to insert needles into their own access sites. In contrast to the conventional method of using a sharp needle and finding a new place to insert the needles with each treatment, the patients use a dull needle that creates a tract much like a pierced earring does. This method is less painful, easily done by patients and allows the fistula to last a very long time. Its drawback is a risk of infection, and thus patients must be very vigilant with skin hygiene.
Home training programs such as DaVita at HomeSM are giving patients and their partners (required) the opportunity to train with highly qualified nurses. Patients learn the basics of dialysis, safety and hygiene, how to insert their needles and how to operate the dialysis equipment. They must keep meticulous records. After demonstrating that they are fully capable of dialyzing at home, they are released to home therapy, but must still follow up closely with their teammates.
Patients are heavily promoting home hemodialysis to one another because they feel better and are enjoying better outcomes. Home patients on average dialyze two hours, six days a week.
Patients who are interested in home dialysis can learn more about it by asking the teammates in their dialysis center or speaking with their doctor.
Stephen Z. Fadem, M.D., F.A.C.P., F.A.S.N., is the Medical Director of the Houston Kidney Center and the DaVita Integrated Service Network. He is also a Clinical Professor of Medicine at Baylor College of Medicine and Chief Medical Officer of Kidney Associates, PLLC.
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