At-home dialysis

Wilbert Worley has a newfound freedom. The 35-year-old Northeast resident is no longer bound to his local dialysis clinic for treatments. For the past three months, he has used home hemodialysis equipment at his deceased mother’s home in Upper Marlboro.

“I have always been trying to go ahead and do the next thing,” Mr. Worley says. “I continue to live life as normal, whatever normal may be.”

Dialysis is a cleaning of the blood, which takes out toxins for people with kidney failure. Home dialysis units allow patients to dialyze daily for shorter periods of time so that they have more independence and control of their lives. Most patients using the devices report less fatigue, improved sleep and appetite, increased strength and healthier blood pressure.

The National Kidney Foundation (www.kidney.org) reports that 20 million Americans — one in nine American adults — has Chronic Kidney Disease (CKD). Another 20 million Americans are at increased risk of contracting CKD in their lives, and the National Kidney Foundation says those at most risk include blacks, Hispanics, Pacific Islanders, American Indians and seniors. The organization also offers an Internet link with details about home dialysis (www.homedialysis.org).

After being hit by a car at age 2, Mr. Worley has spent most of his life in a wheelchair. He frequently held his urine when it was inconvenient to use a public restroom, which eventually damaged his kidneys. Eight years ago, Mr. Worley experienced renal failure.

With the at-home device at his fingertips, Mr. Worley is able to do more convenient dialysis therapy, which he says improves his health. His sister, Wilma Zanganeh of Northeast, helps him perform the procedure five times a week, instead of the standard three treatments done in clinics.

After receiving proper training for at least two to three weeks, patients are fully capable of performing their own treatments, including sticking themselves with a needle, says Dr. Cosette Jamieson, medical director of Ultimate Renal Care, a dialysis center in Hyattsville.

She also works as a nephrologist at Washington Hospital Center in Northwest. Mr. Worley is her patient.

Plumbing and electrical modifications might be required in a home before the dialysis devices can be installed, she says.

Until the past year in the metropolitan area, peritoneal dialysis, an indirect way of cleaning blood using the abdominal peritoneal cavity for the exchange of fluids, has been the only option for home treatment. In contrast, with advancements in technology, at-home hemodialysis, directly cleanses the blood like machines at dialysis clinics, she says. The devices are generally between the size of a microwave and a small washer.

Although Dr. Jamieson only started offering training for the at-home procedures six months ago, she says that she sees good results in the patients who are able to do the therapy at home. Since they are able to perform the treatments on a more regular basis, they have less change in their fluid weight gain between sessions. The therapy usually takes 2 hours, compared to 3- to 4-hour clinic visits.

“When you have the fluid removed three times a week, that means whatever you eat for two days piles up in your body; you come in with five to 10 pounds of weight gain,” Dr. Jamieson says. “Your heart has to take the weight. Your blood pressure goes up.”

At-home dialysis is generally covered by insurance companies at the same rate as in-center therapy, says Dr. John E. Anderson, assistant professor at Johns Hopkins University School of Medicine and staff nephrologist at Johns Hopkins Bayview Medical Center in Baltimore.

Aksys, Ltd., in Lincolnshire, Ill., NxStage Medical Inc. in Lawrence, Mass., and Fresenius Medical Care North America in Lexington, Mass., are the common manufacturers of the equipment.

Many medical professionals are enthusiastic about the therapy because there is a nursing shortage, he says. Otherwise, people in need of the care might have to go without treatment.

“It doesn’t take a degree in anything to learn how to do it,” Dr. Anderson says. “The machines have been designed to be user friendly. It does take someone who is diligent, learns how to do things well and consistently well, who is really willing to take responsibility for their own care.”

Lamont Thomas, 35 of Baltimore, is currently having his plumbing and electric updated in order to install a system at his home. He is undergoing training for the equipment at Bayview Medical Center. He is a patient of Dr. Anderson’s.

In 1989, Mr. Thomas started in-center dialysis, due to focal segmental glomerulosclerosis, a type of glomerular disease that affects kidney function. He has had to schedule his work around his clinic appointments. He runs his own sedan service called Where To.

“With the three-day-a-week system, regardless of how I felt, I would push myself to do what I had to do, as far as work,” Mr. Thomas said. “Flexibility is the saving grace with this system. I determine when I get on the machine.”

Despite other benefits, research is still being done to see if mortality rates decrease due to the at-home systems, says Dr. Todd Gehr, chairman of the nephrology department at Virginia Commonwealth University in Richmond.

Patients routinely report better appetites, lack of anemia and fewer hospital stays, he says.

“Like with anything else, compliance is a very important part,” Dr. Gehr says. “We had a patient that was noncompliant and got sick.”

Other patients, like Linda Baker of Midlothian, Va., do better with the therapy. Six afternoons a week Ms. Baker, 52, undergoes at-home treatment. She has been giving herself the therapy since September. After a heart transplant in 1999, the medication interfered with her kidney function. She is a patient of Dr. Gehr’s.

“I feel much, much better,” Ms. Baker says. “It’s made a world of difference in my life.”

While many people have benefited from daily at-home hemodialysis, nocturnal home hemodialysis is another option, says Dr. Robert Lockridge, nephrologist and medical director of the University of Virginia Lynchburg Dialysis in Lynchburg, Va.

He has trained more than 60 people on this method with the Fresenius 2008H machine, primarily used in dialysis clinics. Other machines specifically for nighttime use are being developed.

Longer therapy sessions with better results is the advantage of the overnight procedures, lasting eight to 10 hours, he says. However, patients have to be willing to sleep attached to the equipment.

“My kidneys work at 100 percent,” Dr. Lockridge says. “When you start dialysis, they function at 10 percent. When you dialyze three times a week, you’re only maintaining 10 percent. When you do short daily dialysis, you increase it to 20 percent. With nocturnal dialysis, you increase it to 30 to 40 percent.”