WASHINGTON — When Karen Everts wants to go camping, kidney failure no longer slows her down: She simply rolls the first portable hemodialysis machine out of her kitchen and into her motor home, ready to hook up for two hours each morning.
Most of the 400,000 Americans with failed kidneys stay alive by getting their blood cleaned at dialysis centers three times a week. Everts is at the forefront of a movement to get more of them treated at home — not just for convenience, but so they can undergo dialysis every day.
The argument: Healthy people’s kidneys work daily so why provide dialysis less often? Indeed, growing research, albeit preliminary, suggests daily hemodialysis may keep patients healthier. The National Institutes of Health is set to begin a major study this fall to try to settle the issue.
But some frustrated kidney specialists aren’t waiting. They say new technology — including the first hemodialysis machine the size of a suitcase instead of a refrigerator — makes daily at-home dialysis possible for a growing number of patients.
Lower costs, less hospitalization
“Anybody who takes care of dialysis patients isn’t happy with what we do,” says Dr. Michael Kraus, dialysis chief at Indiana University School of Medicine, citing high rates of illness and death with today’s thrice-a-week approach.
So far, he’s converted 20 percent of his patients to home dialysis and says, “Their quality of life is so much better.”
Kaiser Permanente in Southern California just began a new program to spur home dialysis. The mantra: “When you start dialysis, you do it at home,” says kidney chief Dr. Peter Crooks.
Medicare pays for dialysis regardless of patient age, reimbursing the same amount for at-home or dialysis center care. But Crooks cites Kaiser statistics that home dialysis users require less hospitalization, potentially saving $10,000 to $20,000 in annual health care costs per patient.
There are two types of dialysis:
- Peritoneal dialysis — using the lining of the patient’s abdomen to filter out waste — has long offered an at-home option, but drawbacks have limited its use to about 10 percent of patients. Several times a day, patients pour a sugar-based cleansing solution into a tube surgically implanted into their abdomen, and later drain out the waste-filled solution. They perform the procedure several times a day, with the solution in their abdomen for four to six hours at a time, or a machine does it while they sleep.
It’s a good option for select patients, says NIH kidney chief Dr. Josephine Briggs, and Kaiser’s Crooks hopes to double usage, to about 20 percent of his patients.
But abdominal infections are a risk, and infections, abdominal surgery or degree of disease can rule out its use.
- Hemodialysis — where patients’ blood flows through a machine that filters out waste — is getting the new at-home attention.
About 20 percent of hemodialysis patients a year die, and blood pressure problems and other complications are common. Moreover, patients spend four hours a day, three days a week, hooked to a large machine in crowded dialysis centers.
The hope is that more frequent home dialysis could improve all that. The logjam was creating dialysis machines that fit into most homes and use standard water and electrical supplies.
Two machines OK'd for home use
Now the Food and Drug Administration has cleared two machines for daily home use. Illinois-based Aksys Ltd.’s PHD System is still big — 300 pounds — but automatically performs much of the required cleaning. The newest, cleared last month, is NxStage Medical’s portable System One, which weighs just 70 pounds.
Everts, of Fillmore, Ind., once had to leave home at 5 a.m. for dialysis center treatments that left her so fatigued she’d spend the next day in bed. Then Everts, 56, began a study of the NxStage machine last year — and with two hours a day dialyzing at home, she has enough energy to go square dancing and no longer needs blood pressure medicine.
She’s still awaiting a kidney transplant but says, “If I never got the transplant, I could live with this.”
Dialysis’ first hour clears the most toxins, says NIH’s Briggs, so short, frequent dialysis makes sense. But small studies performed so far have included highly motivated patients that may skew results. The NIH’s study will compare two-hour daily dialysis and a slower while-you-sleep version with traditional dialysis, to try to prove benefits.
At-home dialysis isn’t for everyone. A spouse or other helper is required in case of problems, and patients must be able to stick themselves with the needles. Nor is it yet easy to find. Patients should ask if nephrologists are open to home training, says Indiana University’s Kraus.
© 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.