Last fall, the Nephrology Program at William Osler Health Centre began offering a new service to patients with kidney disease – home peritoneal dialysis (PD). Patients performing PD are able to manage their dialysis care at home after completing a training process. Among its many benefits, PD gives patients flexibility to manage family, work or other responsibilities. The sense of increased freedom and independence is the key benefit of PD according to Sharon Fairclough, Home Dialysis Coordinator. “It gives patients back some of the control they lose when they become ill. They can decide how and when they are going to do their treatment. They can manage their own care.”
Osler provides a regional service for patients with chronic kidney disease through its Kidney Care Clinic and Hemodialysis Unit. People who need dialysis usually have to come to the hemodialysis clinic at Brampton Civic Hospital three times a week to undergo treatment, which can take four hours on average. With the inception of Osler’s PD program, the hospital can now offer a regional program that provides full support to meet the needs of patients within the community. Patients in the Brampton area no longer have to travel to another community to have access to this treatment.
Dialysis is a therapy used to clean blood of waste and fluids when the kidneys can no longer perform these functions. While hemodialysis occurs outside of the body, cleaning the blood of waste products and removing excess fluid, peritoneal dialysis works inside the body doing the same thing. Peritoneal dialysis is able to complete this process using the patient’s own peritoneal membrane as a natural filter. It involves surgical insertion of a soft, flexible tube called a peritoneal dialysis catheter, through the abdominal wall into the peritoneal cavity. Once placed into the peritoneal cavity, the catheter is used to allow the flow of specialized solution into the peritoneal cavity where it sits for 4-6 hours until is drained out. While in the peritoneal cavity, waste products and excess fluid pass from the blood into the peritoneal cavity. The process starts again by filling the cavity with fresh solution.
The PD process must be done four to five times a day when using the manual version of the procedure. There is also an automated version in which the catheter can be connected to a machine that performs the same exchange of fluid and waste products overnight. The most amazing feature is that it can be done by patients in the comfort of their own homes.
The training process involves one on one teaching sessions with the patient and a nurse over the course of just a few days. Once trained, the patient can complete this relatively easy procedure at home.
Being part of the PD program involves an assessment to determine if the patient is a candidate for the therapy. Most patients are candidates unless they have had previous major abdominal surgery causing scarring or have severe breathing difficulties. The majority of patients who choose PD want to maintain their independence, are able to manage their own care, and want to regain control of their life by being able to work and travel.
Catheter insertions can be done on a day surgery basis at either Osler’s Etobicoke General or Brampton Civic site. Following this, patients receive several days of training at the Home Peritoneal Dialysis Clinic at Brampton Civic Hospital. Once they are confident, they can perform the therapy at home, each patient has access to 24-hour support from the nurses in the dialysis clinic and come into the hospital monthly for scheduled clinic visits with the entire nephrology team – a nephrologist, social worker, pharmacist and dietitian as well as the home dialysis coordinator in the Home Peritoneal Dialysis Clinic.
Howard Rodgers was the first patient to graduate from Osler’s Home Peritoneal Dialysis Program and is now performing the procedure on his own. “It gives me a lot more freedom,” he says. “I was able to go back to work, and it also allows me to travel a bit. The training was super.”