Improving patients’ quality of life with at-home dialysis

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Hemodialysis machines look complicated, but Flynn Ramirez has no trouble hooking one up.

With the skill that comes from constant repetition, he attaches a fresh pack of saline solution, along with the numerous tubes used to transfer blood through the system – a life-saving process that cleans blood for patients whose kidneys aren’t working well enough to do the job themselves.

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He adjusts the roughly four-foot-tall machine’s settings and double checks all the bags and tubes to ensure they’ll properly pump blood through the dialyzer.

Then, he lifts his shirt up and gets ready to attach the tubes on the machine to the tubes coming out of his chest.

Flynn isn’t a nurse or a doctor. He’s a patient, dialyzing in the comfort of his bedroom, thanks to a program dubbed “Homeward Bound” at St. Joseph’s Health Centre.

“It’s really easy now,” the 56-year-old Etobicoke resident says of his at-home dialysis, which he started doing back in March 2013.

Ramirez dialyzes every other day, and works the 6-hour treatment around his schedule – sometimes dialyzing while he sleeps, other times while friends pop by for a visit.

This comfortable routine is a far cry from the overwhelming diagnosis Ramirez first received from his doctor: high blood pressure that had affected his kidneys, leaving both at a 13 per cent functioning level.

“My wife and I were devastated… I could not accept it right away,” Ramirez recalls.

The diagnosis meant he had to do hemodialysis regularly at St. Joe’s Community Renal Centre, which provides hemodialysis stations and a renal management clinic for patients like Ramirez who are suffering from renal failure.

“When renal failure occurs, it means (the kidneys) aren’t performing properly – and so you end up with waste products building up in your blood,” explains Jacqui Cooper, patient care manager for the Renal Therapy program at St. Joe’s.

In hemodialysis, the patient’s blood is pumped through a machine, where it passes through a membrane and is then returned, in a clean state, back into their body.

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It’s a rescue therapy, according to Cooper. “Patients have to have dialysis if they want to continue living,” she says. “It is that serious.”

Serious, but inconvenient. The trek to a clinic for dialysis can take a toll on patients’ day-to-day lives, notes Renal Centre nurse Janice Brown-Martin.

Some patients travel an hour to get to the Islington Avenue site, she says, then it takes them half an hour to get connected to the machine – meaning they may spend 5 to 6 hours for a three and a half hour treatment. It can be quite a cumbersome process, and sometimes makes holding down a job impossible.

With these concerns in mind, St. Joe’s began the Homeward Bound program in October 2011 to help patients dialyze at home, instead of a clinic.

“Being on a home therapy allows them to go back to work and normalizes their life again,” says Cooper. It’s also a better quality of dialysis, she adds, because it can be done for longer periods of time at home, rather than the condensed variation found in a clinic setting due to shared machines and high demand.

If patients are interested in doing dialysis at home, staff at the Renal Centre conduct an in-depth interview to figure out how to make it happen, by determining the patient’s knowledge of their disease and their support network at home. Once they’ve been deemed capable of doing at-home dialysis, staff start on the training.

“On average, it takes patients six weeks to learn (at-home dialysis),” says Brown-Martin.

Patients aren’t sent home until they can do the entire process without assistance. There is also on-call support 24 hours a day, seven days a week, and a built-in alarm system on the machine that goes off if there is even a drop of blood spilled.

Ramirez takes comfort in the at-home dialysis system he’s now mastered. His wife has gotten used to the machine, he says, and he only needs to check in with his doctor once every two months.

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“If there are no problems, you just relax at home,” he says with a laugh.

Yet many patients still choose the clinic route, rather than dialysis at home, despite what Ramirez and St. Joe’s staff see as obvious benefits.

“I just wish more patients would actually consider it as an option,” says Brown-Martin. “A lot of people are scared.”

Ramirez was one of those scared patients – at first.

But dialyzing at home “is really a lot easier,” he says, crediting St. Joe’s team with making it happen. Now, he can stay healthy without constantly trekking out to a clinic.

“Thanks to them – to the doctor, to the nurses, to this facility – I’m okay.”