Perceptions

Haemodialysis Options – There are more options than you might think!

by Paul Bloor, Home HD Patient

Going onto dialysis is a traumatic experience and for many people simply involves a choice between Peritoneal Dialysis (PD) or Haemodialysis (HD). In my case, as a patient with very large Polycystic Kidneys, there was no choice. I had to go onto HD because there was insufficient space inside my abdomen to accommodate the fluid needed for the exchanges involved in PD. So once I had a functioning fistula I spent twelve months at a dialysis unit receiving the standard HD dose of 4 hours three times a week. However, times have changed significantly with respect to HD and the tide is definitely flowing towards more and more patients delivering their own treatment away from dialysis units.

As I said before, my first year of HD was based in a unit and followed what is widely referred to as “maintenance HD” or if you like, just enough to keep you alive! Nowadays renal consultants are realising that maintenance HD is simply not good enough if patients are to feel well and live relatively normal lives. More and more patients are now being offered home based HD treatments and taking back control of their conditions and lives as a result. At the start of my time on HD my consultant offered me the prospect of converting to home treatment as soon as I was stable on HD and had a reliable vascular access. Of course, the funding also needs to be available to supply the training and equipment to make home treatment possible; which in turn depends on the renal teams convincing the health care trusts of the long term economic benefits of home treatment.

After a full year on unit dialysis and following around 6 weeks of training I commenced my home HD treatments. My house had a garage conversion downstairs, which made a perfect space for placing the machinery, chair and most of the renal supplies. It took around 3 days for the necessary plumbing and electrical work to be completed and then I had my first delivery from Fresenius, half of which came into the house and the rest into the back of my garage. I started at home on an alternate-day regime, doing 4 hours at a time, so gaining an extra session compared to being at the unit. I was visited a few times by the home care team of nurses to check I was following the correct protocols and getting the needles in without too many problems. For most home HD patients it is the needling that presents the biggest obstacle, but with practice and plenty of Emla cream to numb the area it starts to become routine.

I had been on alternate-day HD for nearly 4 months when the opportunity arose to train for Nocturnal dialysis. This is still a relatively new form of HD and involves the patient using a single needle/double pump set up on the machine with the pump speeds reduced and the time period extended to 8 hours. It is more gentle on the patient than conventional HD because of the lower pump speeds and it clears many more of the toxins from the blood because of the number of hours involved. Usually nocturnal HD is carried out for 6 nights a week, so the patient is getting up to 4 times as many hours on the machine and blood chemistry is so improved that medicines can be reduced or even stopped altogether (eg. Phosphate binders). I trained over a 5 day period at the hospital for my nocturnal HD and then managed 3 weeks at home before I had to quit. I had an underlying condition which made lying still for 8 hours very uncomfortable, so I was not sleeping during my treatment and could not enjoy its benefits during the daytime.

Well what next then? I did not want to go back to alternate-days and I certainly did not want to go back to the unit! After a discussion with my renal consultant it was decided that I should try short-daily HD as this would give me a halfway point between nocturnal and alternate-days. So this is where I am now, dialysing 6 times a week for between 2.5 and 3 hours at a time. The pump speed is back up but the time is down compared to where I started. I get up to 18 hours dialysis a week, so that is like going to the unit four and a half times and my blood chemistry is well within normal limits. I have been able to relax my diet and fluid restrictions to a reasonable enough extent and still get a fair number of hours left in the day after my treatment to get out and do things.

So when you come to start HD, or of you are already doing it, give some thought to whether you are getting the right type to give you the best choices and quality of life. Open a two-way dialogue with your renal doctor and explore what is, or could be on offer for your treatment.

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