Home dialysis winning support both for quality of care and lower cost

For hundreds of thousands of Americans with failed kidneys, the days and weeks revolve around dialysis.

In most patients, the process of removing waste such as phosphate and urea from the blood means spending three to five hours on a machine at a hemodialysis center at least three days a week.

Less frequently, renal-failure patients are able to use peritoneal dialysis, which requires regular, several-times-a-day injections of fluid into the abdomen and relies on blood vessels in its wall to act as a kidney substitute.

The only real, more or less permanent, alternative to dialysis is a kidney transplant, from a deceased or living donor.

But with more than 80,000 candidates on waiting lists and only about 15,000 transplants performed in the United States each year - about a third from living donors - thousands don't survive to receive a new kidney. And tens of thousands more never make the list at all, ruled out as transplant candidates due to other medical conditions or poor outlook for surviving a transplant, among other factors.

So, researchers are constantly looking for ways to improve not only the quality but the cost of caring for kidney-disease patients - more than $60,000 a year for each patient on hemodialysis.

One technique that's been the subject of two favorable reports this year is to have patients undergo dialysis overnight, either at a clinic or at home. A study by British researchers who followed 146 patients for up to 10 years found that overnight sessions in a clinic three times a week for six hours or more were well-tolerated and kept patients at least as healthy as those who received dialysis for slightly less time during three daytime appointments.

Only a third of the patients dropped out of the overnight sessions, with most citing lifestyle, rather than medical reasons, for the choice.

A second study, carried out over 12 years, was reported last month by Canadian researchers who compared the survival of patients who got nightly dialysis treatments at home with those who received a kidney transplant from a deceased or living donor.

The home-dialysis patients, who underwent treatment for six to eight hours a night for up to seven nights a week, were matched with transplant patients of similar age, race, diabetic status and duration of conventional dialysis before entering the trial.

Over 12 years, 14.7 percent of the home-dialysis patients died, compared with 14.3 percent of those who received a kidney from a deceased donor. The death rate for those with a live donor was 8.5 percent.

"This study allows me to actually answer what my patients have been asking me for over a decade: 'What does night home dialysis mean for my life span?'" said Dr. Christopher Chan, the medical director for home hemodialysis at Toronto General Hospital and leader of the study. "Now, I can tell them that this specific dialysis option is as good as getting a transplant from a deceased donor."

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