Toronto Rehab and UHN Open New Dialysis Service – a Toronto First

When people need lifesaving dialysis because of kidney failure, it is always considered their number-one medical priority. For patients of the new Toronto Rehab and University Health Network Dialysis Service, dialysis is also a means to another end: rehabilitation and better quality of life.

This spring, the two hospitals jointly opened Toronto’s first specialty service to provide geriatric rehabilitation and hemodialysis to inpatients. The Dialysis Service also provides treatment for complex continuing care patients who currently face long waits for service in the Toronto area.

Hemodialysis involves passing a person’s blood through an artificial kidney machine to remove wastes and excess water from the body-work that is normally done by healthy kidneys.

“We’re trying to maximize the effects of rehabilitation knowing that these patients can’t survive without dialysis,” explains Dr. Vanita Jassal, a nephrologist (kidney specialist) and Medical Director of the Dialysis Service. The service, operated by University Health Network dialysis experts and located at Toronto Rehab’s University Centre, includes six machines that provide hemodialysis for up to 12 patients admitted to Toronto Rehab’s Geriatric Rehabilitation Program and 12 patients from the hospital’s Complex Continuing Care Program.

Ena Harrison, a University Health Network registered nurse, gives Francis Sequeira a hemodialysis treatment

Patients are admitted to the Geriatric Rehabilitation Program because of physical, mental and social conditions that affect their ability to live independently in the community, explains Dr. Barry Goldlist, Medical Director of the program. “These frail, elderly people have a functional decline for a multitude of reasons. They often have muscle weakness because of inactivity that is usually sparked by an illness, and nutritional issues can be a major factor in that functional decline.”

By providing two hours of dialysis, six days a week-instead of the usual schedule of four hours of dialysis, three days a week-it is anticipated that patients will have more energy and be better able to participate fully in daily rehabilitation. “We’re confident that we will be able to prove that this combination of services makes a big difference to patients’ lives,” says Dr. Goldlist.

Patients with kidney failure who are admitted to Toronto Rehab’s Complex Continuing Care Program are people who need hemodialysis, and medical and nursing care that exceeds the capabilities of community services or long-term care facilities. “They also need the social, spiritual and psychological support that we can give to them, so that in between dialysis treatments they can live as normal a life as possible,” explains Dr. James Edney, Medical Director of the Complex Continuing Care Program. Many of these patients have been in acute care hospitals for months because there was nowhere else to go.

Complex Continuing Care patients are transported from the Queen Elizabeth Centre to University Centre three times a week for four-hour dialysis treatments. On the other days, “they can enjoy a different environment that is more socially focused, while still having the medical, nursing and therapeutic care they require,” Dr. Edney adds.

The dialysis population is growing by 10 per cent a year due to the aging of the population, and because health care and dialysis care continue to improve. “The other population we’re seeing more of is diabetics,” says Dr. Jassal. “Diabetes is one of the major causes of renal disease, particularly among older people.”

For Francis Sequeira, 64, the opening of the new Dialysis Service allowed him to be transferred out of acute care, where he spent five months. Francis has been on hemodialysis since 1995, and he went for outpatient treatments until health complications began last year. Following a stroke in April 2001, he spent 10 days on life support. In the fall, he had another stroke. Soon after one leg was amputated due to complications from diabetes. In April 2002, Francis was admitted to Toronto Rehab’s Complex Continuing Care Program and became one of the first patients to receive hemodialysis at the new Dialysis Service.

“It’s very comfortable. It’s good service and they pay a lot of attention,” Francis says. Francis is also settling into life at Queen Elizabeth Centre in southwest Toronto, where the Complex Continuing Care Program is located.

“It’s much better here,” says Mary Sequeira, who prefers the homelike atmosphere and is pleased that her husband does not spend the days between dialysis treatments in a hospital bed. Another bonus for the Sequeiras is that Queen Elizabeth Centre is only a short distance from their home. “I wanted Francis to come here because it allows me to visit every day,” adds Mary.

For a couple that will celebrate their 30th wedding anniversary this fall, that means everything.