Back in the swing of things

He works 12-hour shifts at his full time job as a systems analyst. He plays at least one round of golf a week. He and his wife show their five Rhodesian Ridgebacks at dog show competitions across Canada and the United States. He does everything his friends do except, when night falls, Malcolm Kennedy does something very different from most of his 51- year-old peers.

Every second night, Malcolm hooks up to a machine that dialyzes or ‘washes’ his blood the way his kidneys would if they were working properly. Malcolm is one of two million Canadians who is either diagnosed with chronic kidney disease or is at risk for developing kidney disease.

Dialysis is a treatment for people whose kidneys no longer function to properly clear their blood of toxins and waste. There are two types of dialysis. Hemodialysis passes the blood through an artificial kidney machine to clean it. A similar filtration system is used for peritoneal dialysis; the exception is that the blood is cleaned inside your body rather than outside through a machine.

When Malcolm was diagnosed with renal failure in June 2004, he worried that the disease would have an impact on his lifestyle due to the restrictions and demands of regular dialysis treatment. Fortunately, Malcolm was one of the lucky patients able to benefit from the flexibility that the peritoneal form of dialysis lent to his very active lifestyle.

Peritoneal dialysis allows patients to go about their regular activities for the most part. Malcolm needed thirty-minutes to complete the replacement of dialysis fluid containing waste with fresh dialysis fluid. The replacement fluid remained in the peritoneal cavity for four hours until his next fluid exchange. For Malcolm’s needs, this procedure had to be completed four times per day.

After three years, Malcolm was no longer getting optimal outcomes in terms of the clearance of toxins from his blood using peritoneal dialysis. His medical needs had changed requiring the more conventional and more restrictive form of hemodialysis offered in a renal care centre. Malcolm started hemodialysis treatment for four hours three times per week at Credit Valley’s satellite renal care centre.

After six months, Malcolm decided the impact of in-centre treatment on his lifestyle was a significant one – one that he was not willing to accept if there was an alternative. The Credit Valley Hospital’s renal care centres, not unlike other renal care centres, offer little flexibility since patients are booked into one of the three shifts – early morning, mid day and evening treatment sessions offered three times per week. The morning treatment sessions offered Monday Wednesday and Friday are more desirable since the schedule doesn’t infringe on Saturday’s weekend plans and the timing allows patients to complete their treatment and get on with their day. “My life was dictated by my dialysis schedule,” says Malcolm.

“I still work full time. I play golf and my wife and I travel to show our dogs – I have a very active lifestyle. I was losing half a day each treatment. My treatment schedule had a huge impact on our lifestyle. I needed something that would be more flexible,” he explains.

That’s when Malcolm met Terri Chanda RN, a home hemodialysis training nurse at Credit Valley’s renal care centre. During intensive training Malcolm learned techniques for needle insertion, monitoring blood pressure, ordering supplies and equipment operation and cleaning. He was also trained to recognize medical complications and emergencies and to contact the centre’s 24-hour support staff or to seek more immediate medical assistance if necessary. By the end of the eight-week training session, he was ready for his first home hemodialysis treatment.“Prior to starting home hemodialysis, I was taking seven blood pressure medications and all my levels were elevated,” says Malcolm. “After my first treatment, all my levels showed an improvement. The best part was that my clearance – a measure of blood toxicity – was at 85 per cent, well above the 60 per cent I was achieving in conventional in-centre treatments,” says Malcolm.

To say that he was satisfied with the results from a medical standpoint is an understatement. Terri Chanda agrees, “Malcolm enthusiastically embraced the opportunity to participate in the home hemodialysis program primarily because of the lifestyle benefits but he was thrilled when he realized the medical benefits this form of dialysis has for patients,” says Terri.

Home hemodialysis is not suited to every patient. However, for those who meet the criteria, the benefits of the program are significant. “We monitor the patient’s progress when they return to the clinic every six weeks to see their nephrologist, dialysis nurse and dietitian. Blood work and exams determine whether there are any problems such as anemia or high potassium levels that need to be addressed,” says Terri.

The benefits of home hemodialysis far outweigh the risks associated with the treatment.

Patients may opt to do conventional dialysis during the day three to four times per week for three to five hours or longer. Alternatively, they may opt for the eight-hour overnight treatments while they sleep three to four nights per week. As a result, they have less fluid and toxin buildup per treatment session than their in-centre counterparts. As well, the long nightly treatment at home is not only more convenient since it frees the patient for their daily activities, the slower blood flow rate is a gentler treatment which is easier on the patient’s access point and their heart. Also, since the process is a longer one, it removes more phosphorus and other wastes than shorter treatments can achieve. In many cases, patients who do home hemodialysis overnight often require less medication for high blood pressure as a result.

“I only take blood pressure medication as needed since I started home hemodialysis. I dictate when I do dialysis. I work my treatments around my career and my activities. I may decide to partake of extra fluids including a beer at an upcoming golf tournament, but since I have to be careful about my fluid intake, I’ll prepare for it. I’ll dialyze the night before and then again the night of the tournament to remove the excess fluid,” he explains. “I feel like I’m normal again! I highly recommend home hemodialysis to everyone who fits the criteria,” says Malcolm. When he learned about Amgen Canada’s recent $1.5 million dollar donation supporting the renal care department’s optimal care program, Malcolm said he was “grateful for the donation because it provides patients with a better quality of life.”

In the meantime, he and his wife have a full calendar of events coming up. He’s looking forward to improving his golf game and he’s hoping to bring home a few more ribbons from his upcoming dog shows.