Chronic kidney disease is one of the most common chronic illnesses among the elderly population in the United States, with roughly 38 percent of all people over the age of 65 suffering from at least stage one CKD. Because the kidneys are responsible for regulating blood sugar and blood pressure, in addition to filtering out waste, patients with advanced CKD (in stage four or five) are typically placed on dialysis.
Dialysis has been a complicated treatment option for renal failure patients for more than sixty years. The first case of a patient receiving hemodialysis was at the University of Washington in Seattle in 1960, and the technology has rapidly developed since then. The way the treatment works is via an external, artificial kidney (called a dialyzer) hooked up to a patient through an IV or catheter. Once hooked up, the dialyzer cycles the patient’s blood and removes waste and is then reintroduced to the body.
By 1973, 40 percent of all dialysis patients were receiving their treatments at home. However, those numbers have dipped since then: now, only 10 percent of dialysis patients receive their treatments at home. But why?
For starters, cost was a large hurdle. Hemodialysis machines were considered to be bulky, large, difficult to haul around, and ultimately expensive to use at home. Additionally, there was a boom of dialysis locations in major cities that made it easy and convenient for patients to get out of the house, receive treatment, and come back in a quick, safe, and timely fashion.
An advantage of receiving HD at your local dialysis center is that a nurse or technician is present to administer the treatment. This is especially important for new dialysis patients, or those who are uncomfortable administering their own treatment via IV or catheter. They can begin to gain comfort in the dialysis centers, and socialize with staff or other patients to gain more familiarity. As patients travel, they can also take solace in being able to locate dialysis centers in advance of their vacations and coordinate with their schedule to not miss a beat.
However, there are some hurdles associated with receiving treatment at a dialysis center that can be more burdensome than at home: travel and timing. Most patients who are in end stage renal disease are above the age of 65, and not always able to drive to and from a dialysis center. And the cost for patients to be transported to and from their homes or assisted living centers can mount quickly. Finally, patients’ local dialysis centers may not have the most flexible time slots for patients to receive their treatments.
That’s why we’ve seen a bit of a resurgence of home dialysis for ESRD patients; they can receive both hemodialysis or peritoneal at home, don’t have to waste excess time traveling to and from the treatment center, there is not increased exposure to other, potentially sick patients, and they can receive the treatment on their own schedule. In some instances, patients will even receive dialysis overnight (called nocturnal dialysis). The only downside is that patients must feel comfortable enough to deliver their own treatment without additional medical personal supervising.
For patients living in assisted living facilities, at-home dialysis means the best of both worlds. They can still receive either treatment options (HD or PD) on their own schedules and at their leisure, and they can still be under the supervision of health care experts. Residents can still appreciate the comfort of their home environment, without facing the additional hurdles and costs of travel.
While prevention and mitigation should be the first consideration for at-risk kidney disease patients, that’s not always the ideal solution. It’s difficult for patients to alter their lifestyle choices: from diet, to exercise, to consumption of drugs or alcohol. However, once kidney disease advances, there is not always any other choice but to undergo dialysis. So it’s imperative for patients to understand their options.