Home Dialysis Program Research Articles

HOME PERITONEAL DIALYSIS A MAJOR ADVANCE IN PROMOTING HOME DIALYSIS

The institution of a home peritoneal dialysis program has allowed us to increase the number of patients with end-stage renal failure entering our home dialysis program from 42.5% to 67.5% of the total population. This represents a 56.5% increase over the rate achieved by home hemodialysis alone. Twenty-four percent of the home peritoneal dialysis patients could have managed home hemodialysis, but 38 could not and this represents 48% of the total patients who entered our home dialysis program, for the period of the study. These patients would have required institutional dialysis which would not have been practical for 52.6% of them because of the distance they live from Toronto. The results of home peritoneal dialysis have compared favorably with home hemodialysis in the 2 concurrent but unmatched series in respect of training time, failure rate, need for in-hospital back-up and patient survival. A long-term study of matched patients randomized to either treatment group such as that described by Blumenkrantz will finally answer the question as to how valid is our contention that peritoneal dialysis compares favourably to hemodialysis for the treatment of end-stage renal failure.

Intrafamily identity and home dialysis success.

The entire family participates in the success of the home dialysis patient. Isolation and study of discrete quantifiable aspects of behavior within the family may allow identification of patients with a greater risk of failure, thus making it possible to help such patients succeed. A single such factor, 'intrafamily identity', measured in each of 40 diverse families before one family member began a home dialysis program, was found to correlate with success in the program 1 year later. This finding also may contribute to an understanding of systematic patterns of behavior within all families, with special emphasis upon the ability of family members to cope with continuing stress.

Aortic Valve Replacement in the Anephric Patient

A 30-year-old anephric patient on a home dialysis program developed bacterial endocarditis, aortic insufficiency, and severe heart failure. After a period of intensive medical management she underwent aortic valve replacement successfully. One year following operation she continues to do well and is again being managed by home dialysis without further complication.

A club approach to social work treatment within a home dialysis program.

This article discusses one approach to helping patients and their families cope with the stresses of a program where dialysis treatments are performed at home. The "Home Dialysis Club" includes many facets and levels of group work treatment. The need for support is unending for families with this difficult life-style. The club approach offers ongoing services with flexibility to change as needs change.

Experience with essential amino acids in the treatment of patients with chronic uremia.

Nitrogen balance studies in chronic severe uremia have shown that it is possible to convert the negative nitrogen balance on a protein-poor diet to a positive one when the diet is supplemented with the essential amino acids intravenously or orally. It has been possible to make the diet variable and good tasting. This is a great advance as the patients can remain on the diet for a long time. 15N-studies have shown that this nitrogen balance represents true protein synthesis. These studies have also shown that histidine may be an essential amino acid in chronic severe uremia and further improves the nitrogen balance. During long-term treatment with the diet supplemented with essential amino acids including histidine, no signs of progressive neuropathy, bleeding or muscle wasting have been observed. We think that this diet and amino acid regimen is a feasible way to keep chronic severe uremic patients in fairly good general condition and nutritive state until they can have a renal transplantation or a place in a home-dialysis program.

Albumin kinetics and nutritional rehabilitation in the unattended home-dialysis patient.

Forty-six patients with chronic renal failure were trained in a home-dialysis program and followed for six to 42 months. All were given a diet containing 80 g per day of protein. They carried out dialysis three times a week for a total of 24 to 30 hours. After six to 42 months, 41 had gained 1 to 45 per cent of their initial weight, four had no change in weight, and one had lost weight. Mean albumin concentration increased from 3.3 to 4.4 g per 100 ml during the period of observation. Changes from normal as measured by 125l-labeled albumin in eight patients included an increased plasma volume (58 vs. 41 ml per kilogram), increased intravascular albumin (2.6 vs. 1.7 g per kilogram), and a total exchangeable albumin (6.2 vs. 3.7 g per kilogram). The albumin half-life and albumin turnover rates were normal. Thirty-six patients returned to full activity, and 10 resumed part-time activities. nutritional rehabilitation thus was possible with frequent dialysis and a relatively normal protein intake.

Home Dialysis-5 Years' Experience.

Excerpt The first home dialysis program was instituted at the Peter Bent Brigham Hospital, Boston, in December 1963. Since that time our experience has included 55 patients, 5 of whom are in traini...

Learning to Be a Home Dialysis Patient: Trials and Tribulations

For a home dialysis program to be truly successful, it must be patient-oriented and patient-centered. This means the nurse must gear her teaching and nursing along these lines in order to better assist patients through the psychologic crises that are a part of dialysis. Nursing care of the dialysis patient must be comprehensive. This includes not only nursing assessment and subsequent action during his learning phase, but continued follow-up care in the form of routine home visits.

Current status of chronic hemodialysis

Long-term hemodialysis as practiced either at well established hospital centers or in qualified home dialysis programs has been shown capable of restoring useful life in the majority of selected patients with advanced renal failure. Excessive cost and scarcity of trained personnel remain the major deterrents to broadening its application to an estimated 40,000 uremic patients by 1973. Cost reduction through home dialysis, continued technical innovations and more adequate financing mechanisms consistent with current concepts of comprehensive health care offer realistic hope that this valuable prodduct of clinical research will reach its full potential in the benefit of mankind.

HEMODIALYSIS IN THE HOME.

Treatment of the patient with uremia by hemodialysis has evolved from the use of a clumsy, complicated piece of apparatus requiring the constant supervision of a physician to a point where the patient may safely utilize the procedure himself unattended and in his home. Elsewhere in this issue (p 92) Rae and his associates describe their experience with a home-dialysis program based in a community hospital. Their experience is characteristic of the way this procedure can and should be accomplished. The aim of chronic hemodialysis is to rehabilitate the patient. This being so, it follows that the procedure should be done on an ambulatory basis, associated as little as possible with the atmosphere of the acute hospital. This spares the patient the psychologic disadvantage of being treated in an area with severely ill patients, and it allows highly trained medical personnel to concentrate their efforts upon more acute problems. Furthermore,