Home Hemodialysis: A Personal Experience
Guest post by Robert E. Kaprove, M.D.
In 1996, I received a kidney transplant. It worked well for more than 19 years. However, by fall 2019 I had reached end stage renal disease (ESRD). I needed to make a decision about management of kidney failure.
My options: another transplant, dialysis or nothing. Transplantation is the best option, with the best results. Given my age and many medical problems, I was not a candidate for another transplant. Doing nothing would be fatal within a short time. I was not ready for that.
"I am grateful that home hemodialysis (HHD) was offered to me. Surprisingly few people know about it. With its many advantages, I want to increase awareness of HHD." - Robert E. Kaprove, M.D.That left dialysis, which replaces normal kidney function in people whose kidneys no longer work, removing the body’s toxic wastes and maintaining fluid balance. The outcome is better quality of life and longer life.
Peritoneal dialysis (PD), which has been the preferred dialysis option, involves placing a catheter in the abdominal cavity and filling the abdomen with dialysis fluid. After several hours that fluid along with the body’s toxins and excess water that have moved into the abdominal cavity from the bloodstream are removed, thus cleansing the body.
In hemodialysis (HD), two tubes connect a patient’s blood vessels to a dialysis machine. One tube takes blood from the patient to the machine, where the blood is separated by a thin membrane from dialysis fluid flowing through the machine. The other tube returns blood to the body. Most of the time, HD is done at a dialysis center (HD-C). HD-C occurs three days weekly for 3-4 hours, by appointment.
Due to abdominal scar tissue from previous surgeries, I was not a candidate for PD. In 2019, I became aware of hemodialysis done at home (HHD). HHD was first reported in 1962, but its use had fallen to almost nothing. Over the past few years there has been increased interest in and usage of HHD. Despite my being a physician, I did not know about HHD until I became a candidate for it. A survey of several physicians revealed widespread ignorance of it. Recent analysis has shown that HHD is more cost effective than either PD or HD-C. HHD results in more energy, less tiredness during and after dialysis, better sleep pattern, better quality of life, fewer and shorter hospitalizations and longer life span than PD or HD-C.
HHD is not for everyone. Both the patient and a necessary health care partner must be willing to accept responsibility for care, and must be willing to take and pass a course in doing HHD and learning how to respond to problems. The home needs to be clean, and must be modified to meet the needs of dialysis. Some dialysis centers have a nurse dedicated to supporting patients on HHD. HHD is given 5-6 times weekly for 2-3 hours. A nurse is available by phone for troubleshooting, as is the technical support team of the dialysis machine manufacturer. HHD can be performed on a flexible schedule.
In November 2019, I needed to start dialysis. I chose HHD. My wife and I spent four days weekly for four weeks in “HHD school,” no easy feat for septuagenarians. Our nurse educators were wonderful, devoting 5-6 hours daily to teaching us how to do dialysis. Our teachers provided clear written instructions. After four weeks we “graduated.” Since then we have been doing HHD independently with good result. I was pleasantly surprised to feel as well as I do. The flexibility of choosing our dialysis time has allowed us to fit dialysis into our schedules.
Then came coronavirus. Quickly we realized an unanticipated benefit of HHD. I can continue social distancing while doing dialysis.
I am grateful that HHD was offered to me. Surprisingly few people know about it. With its many advantages, I want to increase awareness of HHD. I encourage those with ESRD and those with chronic kidney disease that may progress to ESRD to consult their nephrologists (doctors specializing in kidney disease) to learn more about it.
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Robert E. Kaprove, M.D. is a retired physician who has been on dialysis for one and one half years.