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This fall marks the 40th anniversary of kidney dialysis at the Indiana University School of Medicine. It’s also an exciting time for many patients seeking more mobility and fewer side effects from their hemodialysis treatments.
After leading a nationwide clinical trial of the first portable hemodialysis unit, IU is now expanding a program that enables kidney patients to perform their dialysis at home. It’s welcome news for the 3,000 kidney dialysis patients in the Indianapolis metropolitan area and nearly 6,000 dialysis patients in the state.
Using suitcase-sized, portable hemodialysis units, patients perform their therapy in comparatively short daily sessions at home instead of the three-days-weekly routine used by patients at dialysis centers. Patients have the freedom to schedule dialysis around their professional and personal commitments.
The result for many are improved health, less fatigue, and significantly improved quality of life, says Michael A. Kraus, MD, professor of clinical medicine and medical director of IU’s Continuous Ambulatory Peritoneal Dialysis and Acute Dialysis Unit in Indiana University Hospital, a Clarian Health hospital.
Dr. Kraus was the principal investigator of the new units in the NxStage System One study. The equipment received approval from the U.S. Food and Drug Administration in June 2005 and is currently the only device cleared by the FDA for home hemodialysis. While standard hemodialysis equipment can be used in the home, it requires electrical and plumbing modifications to the home.
IU currently has more patients using the NxStage system than any other treatment facility in the country. This fall IU’s home dialysis program will expand and Dr. Kraus hopes to accommodate six to 10 new patients each month. Currently seven percent of all dialysis patients are on a home therapy. In the Indianapolis area, the number is even lower. However, almost 25 percent of patients in the IU program are on a home therapy. "We think the number should be 35 to 40 percent," says Dr. Kraus. "That means there a lot of people in central Indiana being treated in a dialysis center who could be at home."
The primary requirement for a patient to dialyze at home is the availability of a dialysis partner to be present in case of emergency and to assist with setup and maintenance of the system. Patients do not incur any additional charges for using the therapy.
Vicki Hurley was born with a neurogenic bladder, a condition in which the bladder does not empty properly. Eventually, her kidneys failed due to chronic reflux and she began traditional hemodialysis in 1987, followed by a kidney transplant the following year. When that kidney failed 10 years later, she again did traditional dialysis before receiving a second transplant. Unfortunately, a diagnosis of rectal cancer in 2006 led to chemotherapy and radiation treatment, causing the second transplant to fail. Hurley is now back on dialysis, but this time everything is different.
“I’ve been in end stage renal failure for 20 years, and being able to dialyze at home is the best advance that’s happened,” says Hurley, a nurse for an employee benefits company. “The mobility and freedom it gives me is huge. It’s given me my life and career back.” She will make her first trip with the portable system this fall when she travels to Kansas City on business.
Hurley is one of about 400,000 Americans who suffer from kidney failure, leading to the eventual need for dialysis or transplantation. Patients who cannot receive a transplanted kidney must undergo dialysis to remove toxins from the blood. While some patients employ peritoneal dialysis, where the patient’s abdominal membrane filters out waste, usually at home, most undergo hemodialysis in clinics or hospitals to detoxify their blood.
Traditionally, patients undergo four hours of “cleansing” three days a week. While effective, the process often leaves patients physically exhausted and unable to resume normal activities. The NxStage system requires daily, but shorter, treatments of up to 2 ½ hours. The system also allows many users to travel without the difficulty of researching out-of-town dialysis clinics and reserving a spot. The portable system allows them to perform their dialysis in hotel rooms or other locations away from home.
For William Doherty, a 65-year-old retired mechanical engineer from Lebanon, Ind., the travel benefit is key. “In my mind, travel wasn’t a practical thing before,” says Doherty, “but now we can travel at will.” Doherty and his wife took a six-week road trip in their RV last year and have taken several smaller trips since he started using NxStage therapy.
Both Doherty and Hurley agree that the shorter, daily dialysis sessions leave them having more energy and feeling better than the fewer, but longer sessions they once did in traditional dialysis clinics.
“I had to build in rest periods each morning as I showered and dressed for work because I felt so drained from traditional dialysis,” recalls Hurley.
Doherty says, “I used to feel wiped out, suffered headaches and lost my appetite because food didn’t taste the same. Within two weeks of switching over to daily in-home dialysis, I had more energy, no headaches, and an improved appetite.”
Patients feel better with daily dialysis, explains Dr. Kraus, because there’s less time between dialysis sessions for toxins to build-up in the system. “These two patients demonstrate the true benefits of daily dialysis. Besides feeling better, patients return to a more normal lifestyle. The ability to maintain employment or return to work and to travel freely has been absent in traditional renal replacement therapies,” states Dr. Kraus.
Doherty is so satisfied with his current therapy, he took himself off the transplant list. He explains if he were still on traditional therapy, he would have remained on the list. “But now,” he says, “being on dialysis is hardly an inconvenience.”
“I simply feel better, feel healthier,” says Doherty, who has started to rebuild lost muscle tone now that he’s more active. “The psychological benefit is important, too. I don’t feel tethered to a dialysis clinic. I tell people I feel normal.”
