Home dialysis revives lives
SAN MATEO, Calif. — Saia Fassisila, pastor of the United Methodist Church in San Mateo, dreaded his options when his kidneys failed two years ago.
Either he stayed hooked up — three times a week, four hours a session — to a large machine that cleaned his blood, or he'd die. Although he'd taken medication for years to control his high blood pressure, in his case, that wasn't enough to stop the condition from damaging his kidneys.
"I had no choice," Fassisila said. When they sent him from his bed at Stanford Hospital directly to a dialysis clinic to clear his blood of the accumulated metabolic by-products, excess nutrients and water were close to killing him, since his kidneys could no longer eliminate them.
"I was given a second chance in life with dialysis," said Fassisila, 48, who was born and raised in Tonga. "Otherwise, I'm a dead person."
The treatments, however, left him exhausted and frustrated over the toll they took on his productivity. "You're just wiped out the rest of day" after dialysis at the center, he said. "I'd just go home and go to sleep."
But his choices dramatically improved late last year, when he began using a novel dialysis treatment at home, which is not only more cost-effective, but leaves him feeling far more energetic than the standard treatment.
"I feel so much better," he said, with evident relief. "I don't know what else to say. It's so much better."
While less than 10 percent of the estimated 341,000 U.S. patients on dialysis receive home treatment, a burgeoning interest in shifting dialysis from treatment centers to patients' residences will likely start driving that number up, experts predict, particularly if Medicare changes its reimbursement policies to more easily pay for the home hemodialysis.
There are compelling reasons for a shift to home treatment, pointed out Dr. Peter Crooks, medical director of the renal program at Kaiser Permanente Southern California, which has taken a leading role in analyzing home hemodialysis outcomes for the HMO.
"Most nephrologists would like to get their patients on home dialysis," said Crooks. (Nephrologists specialize in treating kidney diseases.) "You have a way to improve patient outcomes, and it's more cost-effective."
Crooks said that not only do patients report feeling significantly better with the regular dialysis home treatment allows, but hospitalizations due to complications from kidney failure, even while on dialysis, were halved for Kaiser patients on the home regimen — from 14 to 7 days of hospitalization a year. Most of these hospitalizations are due to heart conditions linked to or worsened by kidney failure.
Crooks described the overall cost savings of home treatment versus dialysis center care as "substantial."
"All the studies show that the total cost of home dialysis is lower than the cost of treatment in centers," noted Dr. John Moran, medical director of Wellbound, a company with seven Bay Area centers that provides equipment and training for home dialysis.
Numerous studies show more frequent and longer "nocturnal" sessions create the best outcomes for patients, since their blood is cleared more effectively.
"It's almost certainly the best way to go," said Crooks, with Kaiser, of the nighttime treatment.
Crooks said many patients can come off of their high blood pressure medication after starting on home dialysis.
