For chronic kidney disease patients like Alex Harvey, home dialysis is an option that has reaped some great health benefits including lifting dietary restrictions, increasing energy and allowing more flexibility on when he performs his renal therapy treatment.
With the right training and education from his renal therapy team at St. Joseph’s Health Centre in Toronto, Harvey said this treatment option works for him.
Previously, Harvey was doing onsite haemodialysis six times a week for a total of 12 hours weekly at St. Joseph’s satellite renal therapy site in Toronto known as the Community Renal Centre (CRC) located northwest of the hospital.
Recently, Harvey was trained by a St. Joseph’s home dialysis nurse to do haemodialysis at home and he gets on call support and in person monthly checkups to monitor his progress. Now he does this treatment at home, overnight for eight hours, five days a week for a total of 40 hours. He uses a haemodialysis machine and a catheter is connected to a major vein, usually in the arm, to filter his blood and remove waste and toxins and then the cleaned blood is returned into his bloodstream.
“The big benefit is to my health,” explains Harvey. “I have more energy. I feel better. I take less medication than before. I can eat anything I want. I hadn’t had an orange in seven years. Now I eat an orange daily.”
“It’s very straightforward. I get a good night’s sleep,” adds Harvey. “I would certainly suggest it to anyone who is interested, for people who have the discipline and are organized and are willing to take responsibility.”
“The only downside compared with peritoneal dialysis is the haemodialysis machine is not portable. You can’t put it in the trunk of your car,” says Harvey, who used to do peritoneal dialysis, which is another home treatment.
With peritoneal dialysis, dialysis fluid flows through a catheter inserted into the peritoneal cavity (abdomen). The dialysis fluid is left in the peritoneal cavity for a predetermined amount of time to allow for toxins and excess fluid to be removed from the body. It is then drained out through the catheter and discarded.
St. Joseph’s patient Ishbel Thomson has been on peritoneal dialysis since December 2004. Thomson was trained at St. Joseph’s CRC on how to do home peritoneal dialysis. In her case, she does this for nine hours, every night.
“You have the freedom as the machine is portable,” says Thomson. “I am sick but it (peritoneal dialysis) doesn’t remind me I am sick. I can get on with my life. It gives me the freedom to do what I want. I have travelled with it.”
Before requiring dialysis, a patient’s treatment is prescribed and monitored in the Renal Management Clinic located at St. Joe’s CRC. They are seen by an interprofessional team of nephrologists, nurses, dietitians, pharmacists and social workers who help the patients and families manage and adjust to their chronic disease and coach them in their renal replacement options. It is during this time that the decision of in centre or home dialysis is reached.
The majority of St. Joseph’s renal therapy patients do onsite dialysis either in the Haemodialysis Unit or at the satellite CRC site in west Toronto. St. Joseph’s performs about 33,000 haemodialysis dialysis treatments (visits) annually. The hospital also has four home haemodialysis and 58 peritoneal dialysis patients engaging in self care at home.
The Ontario Renal Network (ORN) has a goal of increasing the number of dialysis patients doing treatment at home, explains Jacqui Cooper, Patient Care Manager of Renal Therapy at St. Joseph’s.
“We are at around 23-24 per cent home dialysis. The provincial average is 18 percent. We still have a long way to go to reach the ORN’s goal of 40-50 percent of patients on dialysis at home. We strive for more home dialysis as it has greater benefits for patients who can do it,” says Cooper.
“Although home dialysis does not suit all patients, it does give patients the opportunity to fit dialysis into their busy lives,” explains Pat Pollard, Home Dialysis Coordinator at St. Joseph’s. “Home dialysis allows a patient to perform the treatment in the comfort of their home with their family and pets. The time of treatment is flexible and can be fit into one’s life,” she adds.
Lisa Ben is a St. Joseph’s social worker who works with renal therapy home dialysis patients. She said while the goal is to offer home dialysis as an option to patients, it has to be a good fit for their goals and lifestyle.
“Ultimately our philosophy is it’s the patient’s choice. The goal of any (dialysis) therapy is to have quality of life and to sustain life. If we persuade someone to do home dialysis and to do so increases their stress every day then that is at cross purposes of our goal for patients to have the best quality of life medically, socially and emotionally,” says Ben.
“For some patients, the end goal is a kidney transplant, but what about the in between time? We want to ensure people are having as great a quality of life in the here and now,” adds Ben. “Home dialysis will allow more freedom, but by doing it at home you are taking on more responsibility for managing (your) care and that’s a big plus for some as they are more in control.”