Home dialysis changes lives of kidney patients
Nine years ago, Marie Eve-Chainey’s world as she knew it came crashing down.
The then-18-year-old from Ontario—an elite high school athlete in track and field —went on the trip of a lifetime: a visit to Spain to study Spanish. One month after her arrival, she had bruises on her cheeks. By the end of November, the once-lean teenager had gained weight, was out of breath, became dizzy after too much exertion and had stomach pains. By January 2002 she had entered a Spanish hospital, 50 pounds heavier with water weight, totaling 180 pounds. Her parents flew to Spain to be with her.
“My dad didn’t recognize me because I was swollen and had three double chins,” she says. “I lost my kidney function in Spain.”
Fast forward to 2010, and 27-year-old Eve-Chainey is in a better place. She’s now on nocturnal hemodialysis, a form of dialysis patients can take in their home while they sleep. She’s a personal fitness trainer, with a weight of about 120 pounds. She’s competing in national track and field competitions. And she’s attending nursing school at the University of Ottawa, with a plan to graduate as a registered nurse in 2012.
“Nocturnal [hemodialysis] gave me my life back,” she says. “When I got sick, I lost my identity.”
Eve-Chainey is just one of thousands of patients worldwide who use home dialysis, a form of dialysis that allows patients with chronic kidney disease to do it at home instead of in a clinic several times a week.
Only about 13 percent of kidney disease patients use home dialysis today in the United States, says Dr. Leslie Spry, a spokesperson for the National Kidney Foundation and a nephrologist and medical director of the Dialysis Center of Lincoln in Nebraska. He hopes that percentage will increase over time.
“[Home dialysis] patients have control over their own therapy and take much better care of themselves,” he says.
In the United States alone, the numbers of Americans with chronic kidney disease are staggering. According to the foundation, more than 26 million Americans older than age 20, or 13 percent of the adult population, have the disease, and millions more are at risk for developing it, particularly people with diabetes or high blood pressure. More than 526,000 Americans are receiving treatment for kidney failure, and every month the number of Americans waiting for kidney transplants rises.
Patients can choose from various types of home dialysis if they prefer not to receive it at a dialysis center.
Home hemodialysis replaces the work of a person’s kidneys to clear wastes and extra fluid from the blood by using a special filter called a dialyzer or artificial kidney, the foundation reports. Patients can opt for conventional home hemodialysis, administered three times a week for three to four hours or longer; short daily home hemodialysis, typically done five to seven times a week using a machine designed for shorter treatments; or nocturnal home hemodialysis, which entails long, slow treatments done at night while a person sleeps. Most home hemodialysis programs work best with a care partner who can help with the treatments.
Patients can also choose peritoneal dialysis (PD), which replaces some of a person’s kidney function by using the lining of the abdomen to filter wastes and fluid out of the blood. With PD, patients have a soft plastic tube surgically placed in the abdomen. PD can also be done at night, when a person is sleeping.
All forms of home dialysis come with pros and cons, and require several weeks of training, often conducted by nurses.
Kanda Wurm, a dialysis nurse in Lincoln, says that when given the option, most patients prefer home hemodialysis to in-center treatments. “What we’ve noticed and what research has shown is people tend to feel better and have more energy, their appetite is better and the recovery time after the treatment is significantly shorter,” she says.
Dr. Tom Hostetter, a nephrologist at the Albert Einstein College of Medicine in the Bronx, N.Y., says nurses are critical to the process and act as educators and clinicians in home therapy. “A home patient will be seen by a doctor or nurse practitioner once a month,” he says, “[But] they may be talking to the nurse a lot more frequently.”
Eve-Chainey tried every form of dialysis offered in Canada: conventional hemodialysis, PD, short daily hemodialysis and finally nocturnal. One of the hardest things she had to overcome with her current form of dialysis was her fear of needles, as poking oneself is part of the process. Nocturnal dialysis is also difficult to obtain outside of one’s home, so travelling can be difficult. But none of this seems to faze Eve-Chainey, who is simply happy to be alive and exercising and competing, something she loves to do.
“I can consider myself a sporty girl again,” she says. “I have my energy and my personality back.”
