Home or hospital, it makes no difference for survival rates in people who return to dialysis after a kidney transplant failure. But when it comes to cost and convenience, home-based care can’t be beat, according to a new Canadian study.
"There’s a real public-policy implication here. If we can find the right patients for this therapy . . . then we, as a society, stand to have tremendous cost savings," said Dr. Jeffrey Perl, lead researcher and nephrologist – or kidney specialist – at St. Michael’s Hospital in Toronto.
Home-based peritoneal dialysis costs $20,000 to $30,000 less than hemodialysis in a hospital, according to Perl. With the latest available data from 2007 from the Canadian Institute for Health Information showing that approximately 17,200 people underwent hospital-based dialysis, that’s a cost saving of as much as $516 million.
Perl said it is important to note that not all of these patients, some of whom are doing pre-transplant dialysis, would be ideal candidates for home-based therapy.
Home-based treatment, often called peritoneal dialysis, requires patients to inject themselves with cleansing fluids through a catheter tube. These fluids remove toxins from the blood and are then drained several times a day. Hospital-based, or hemodialysis, treatment removes the blood from the body, filters it and then returns it.
There’s also a huge benefit for patients, said Perl, whose study tracked 2,110 Canadian adults patients between 1991 and 2005. The study focused on Canadians who returned to dialysis after a kidney transplant failed. The full results are published in an upcoming issue of the Clinical Journal of the American Society of Nephrology.
"Patients might choose to do dialysis at home because they are used to their own autonomy," he said, adding that home treatment allows patients to travel and hold down full-time jobs.
There was no impact on death rates for patients, which remained at 33 per cent over the life of the study regardless of where dialysis took place.
Still only 18 per cent of patients choose to do home dialysis, and that number is falling.
"To go home takes a lot of resources and a lot of effort up front, a lot of education and comfort, and that takes several months to organize," Perl said.
Francois-Rene Dussault is one of the Canadian patients who actually took on the challenge of home dialysis.
"I really enjoyed it much better because of my lifestyle. I work; I play a bit of sports," said Dussault, who is a lawyer at the federal Department of Justice in Ottawa.
Those are things he had to give up doing while spending between 15 and 17 hours at the hospital a week.
He did peritoneal dialysis until doctors found him a transplant. When that kidney failed two years later, he took an even greater challenge – hemodialysis at home.
Dussault hooks himself up to a machine that cleans his blood while he sleeps. While it took two months of training to learn, it’s a treatment he said was the best option for him.
"You avoid those very strict dietary restrictions. You feel much more energetic. You save time by not going to the hospital," he said.
Dussault received another transplant four years later in 2008.
Detecting kidney disease earlier is the key to getting more people on home dialysis programs, he said.
"People are still in shock. People aren’t sure what’s the best option for them," he said. "A lot of people will start in-centre because it is easy and everything is done for them."
Dussault has a hereditary kidney disease and was diagnosed when he was three. His own kidneys lasted until he was 30, allowing him to be more prepared than most people.
"We have to provide patients an education, and we have to give them an education early," added Perl.
"So they feel more supported when the time comes."
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