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At-home dialysis touted as the next best thing

Florence Tewogbade gets her blood flow checked in hospital. She uses the same type of machine for dialysis at home. ‘Going to hospital three times a week really took a toll on my life,’ the student says.

Ryan Enn Hughes

Patients with life-threatening kidney disease who are treated with home dialysis have survival rates that are comparable to those who receive transplants, new Canadian research shows.

The finding is encouraging news because organ shortages are so dire that the wait for a kidney can stretch out to a decade.

"Kidney transplant is still the gold standard for treatment - it's what everyone wants - but the bottom line here is that nocturnal hemodialysis is as good as a kidney transplant," Christopher Chan, director of the home dialysis unit at Toronto General Hospital and principal author of the study, said in an interview.

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He stressed, however, that the research measured only survival rates and not quality of life.

"Having a machine at home is different than having a new kidney but there are not enough kidneys for everyone," Dr. Chan said.

The study, published in the medical journal Nephrology Dialysis Transplantation, involved 1,239 patients who were followed for more than 12 years on average.

A total of 14.7 per cent of patients on home dialysis died during the study period, compared with 14.3 per cent of those who had received transplants from cadaveric donors and 8.5 per cent of those who received a kidney from a living donor.

Patients who receive dialysis in hospital clinics were not included in the study but, traditionally, they have far worse outcomes. Earlier research showed that patients on home dialysis had better heart function, lower blood pressure, a reduced need for medication and a better quality of life than those on in-hospital dialysis. That is because hospital dialysis is of shorter duration and more intense.

Dr. Chan said the next step is to try to compare the quality of life of home dialysis patients and transplant recipients, and to compare the costs of the procedures.

Dialysis is a procedure used to treat kidney failure. Blood is removed from the body, cleansed of toxic material that would normally be removed by the kidneys, then returned to the body.

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In traditional hemodialysis, patients undergo the procedure at a clinic three times weekly for periods of about four hours at a time. With nocturnal hemodialysis, they are hooked up to a machine six nights a week, for about seven hours a stretch, while they sleep.

Florence Tewogbade, a 27-year-old Toronto student was diagnosed with lupus in 1996 and the autoimmune disease destroyed her kidneys, among other things.

Over the past decade, she has tried both forms of dialysis and said the home version is superior in every way.

"Going to hospital three times a week really took a toll on my life - I didn't have a life," she said.

Home dialysis was a bit daunting at first, Ms. Tewogbade said, but once she got used to the technology, it was a life-changer.

"Now I work dialysis around my schedule, not the other way around, and I do it while I sleep." The home treatment has allowed her to return to school full-time, studying human resources management at George Brown College, and work part-time.

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Just as importantly, she feels much better physically. In conventional hemodialysis, blood is pumped in and out of the body quickly, which can wreak havoc on blood pressure and the heart. In nocturnal dialysis, blood is pumped and cleansed more slowly, and research has shown it is far less damaging to the heart.

Ms. Tewogbade has been on the kidney transplant wait list since 2004 and, because she has rare antibodies, finding a match is difficult, so she will be on home dialysis for the foreseeable future.

"I'm not sure what the future holds for me but this is keeping me healthy enough for a transplant," she said.

There are about 35,000 Canadians living with end-stage kidney disease. Of that number, almost 14,000 have received kidney transplants and the others are being treated with dialysis.

More than 3,000 patients are waiting for a kidney, according to the Canadian Organ Replacement Register.

An unrelated study being published today in the Clinical Journal of the American Society of Nephrology, promises even more dramatic changes for end-stage kidney patients in the years to come.

The research, led by Victor Gura of the David Geffen School of Medicine at the University of California, Los Angeles, outlines work being done on a "wearable artificial kidney."

The device, essentially a miniaturized dialysis machine worn as a belt, weighs about five kilos and is powered by two nine-volt batteries.

Dr. Chan said these portable devices are the "next frontier" and an exciting development but "for the moment, they are not available and the best option we have is nocturnal hemodialysis."

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