Health News: Dialysis at home

With Fox News on the television, a large glass of ice coffee on the end table, Mark Stuckwisch settles back in the reclining chair for his regular kidney dialysis treatment and his own commentary on the press and dialysis.

He's in the living room of his apartment, blood flowing from his arm through the dialysis machine and back into his body.

"The press has this misguided notion that people on dialysis are dying," he said. "Dialysis is not the death sentence people make it out to be."

Stuckwisch, 54, has been on dialysis 26 years. For the past four years, he has dialyzed at home on a hemodialysis machine so portable that he's taken it on a church retreat.

"I dialyzed in the middle of the woods in an RV for a week," said Stuckwisch.

And after his regular treatments, he feels good enough to golf 18 holes. That makes him unique among the vast majority of hemodialysis patients, and it makes him a strong critic of standard treatment at dialysis clinics.

Stuckwisch says the conventional regimen at dialysis centers ­­­­-- three days a week, four or five hours a day -- is "barbaric."

Healthy kidneys work continuously, producing urine and filtering wastes, salt and toxins from the body. A variety of conditions can cause kidney failure, including diabetes, hypertension, inherited disorders or long-term use of some medications.

While kidney transplants are the preferred option for treating kidney failure, the wait for donor kidneys can be notoriously long and not everyone is a suitable transplant candidate. Most people with end-stage renal disease or kidney failure rely on standard dialysis, essentially an artificial kidney, to do in 12 to 15 hours a week what the normal kidney does 24 hours a day, 168 hours a week.

Not only can it exhaust the body to remove up to two days of fluid in four or five hours, dialysis requires a strict diet to limit fluid build-up and a strict schedule to follow the thrice-weekly routine.

Dialysis patients have several other options, all of them better health wise and more flexible than the traditional regimen, says Dori Schatell, executive director of Medical Education Institute, a not-for-profit group that publishes www.homedialysiscentral.org.

"But almost 92 percent go to standard, in-center treatment," said Schatell.

Home hemodialysis is growing, she says. However, the numbers of new dialysis patients in conventional centers steadily swamps its growth.

"The biggest reason more people don't do home dialysis is they don't know it's available," said Schatell.

In 2008, new Medicare rules required that kidney patients be informed of all options. Before that, according to Schatell, clinics only had to tell patients about the treatment they provided. This new trend in home dialysis provides shorter two- to three-hour treatments, five or six days a week, or nightly treatments up to seven times a week, either at home or in a clinic.

Stuckwisch recalls asking doctors why he couldn't dialyze at home years ago when he lived in Denver. At the time, home dialysis was no different than dialyzing at a clinic, except installing the 300-pound machine and its supporting equipment required extensive home modifications.

He learned about NxStage System One, one of several brands designed for home hemodialysis, at a local dialysis clinic. Distributed by Affiliated Home Dialysis Centers, the NxStage System weighs about 75 lbs. Unlike earlier home dialysis machines, special water and electrical hook-ups are not necessary.

Stuckwisch's system sits atop another machine, NxStage's PureFlow, which produces the dialysate, the liquid used to clean waste and replace electrolytes in his blood.

"I call it my rock," Stuckwisch says of his combined contraptions.

He went through three weeks of training with Affiliated's staff to learn how to operate the machine, calculate his fluid levels and troubleshoot problems.

While inserting a needle in their arm is an obstacle for some potential home dialysis patients, Stuckwisch isn't squeamish. And, while the creators of NxStage System recommend that users have a trained partner on hand when they dialyze, Affiliated Home Dialysis provides trained technicians to check in on him, since he lives alone.

Stuckwisch dialyzes four hours a day, five days a week, starting at 3 a.m. each day except Wednesdays and Sundays, when he starts in the afternoon. He came upon the schedule by accident, he says, but it suits him because he never goes longer than 30 hours without a treatment.

Since he started home dialysis, his weight doesn't fluctuate as much, he has far fewer problems with swelling, he has more options about what he eats and he no longer takes high blood pressure medications. High blood pressure is the reason he needed dialysis in the first place.

Stuckwisch can't explain the difference between in-home dialysis and dialyzing at a clinic. In-home dialysis makes him feel like he has his own kidneys ­.

"There's no comparison," said Stuckwisch.

At least not right now, according to Schatell.

"There's a lot of competition in the wings," she says. Researchers are working on even smaller, lighter options, such as an implantable artificial kidney. "It's the size of a soup can."

For home dialysis information in general, go to www.homedialysiscentral.org.

Home Dialysis Options

- Conventional home hemodialysis: Three times a week at home

- Daily home hemodialysis: Short two to three hour treatments, five to six days a week

- Nocturnal home hemodialysis: Treatments of six to eight hours at night, three or more days a week

- Continuous cycling peritoneal dialysis (CCPD): Also known as automated peritoneal dialysis (APD). With the help of an automated machine, blood is cleansed inside the body nightly, using the peritoneum, the membrane lining the abdomen, as a filter.

- Continuous ambulatory peritoneal dialysis (CAPD): Also uses the peritoneum as a filter, but blood is cleansed manually four or five times a day.

Home dialysis forums

Affiliated Home Dialysis Centers has about 15 home hemodialysis patients in the Peoria, Ill., area and about 40 throughout Illinois, says Nancy Vanek, director of home dialysis for the Glen Ellyn-based company. She says it is probably the second largest home dialysis provider in the state, behind DaVita Home Hemo Dialysis Centers.

-What: NxStage System One portable home dialysis machine

- When: 4 to 5 p.m. each Thursday in October

- Where: 2500 N. Main St., East Peoria, across from Jonah's Seafood House.

- For more information: On Affiliated Home Dialysis Centers, e-mail v.dick@affiliateddialysis.com.

Pam Adams can be reached at 686-3245 or padams@pjstar.com.