November 11, 2021 admin
Hemodialysis is a process where a kidney patient’s blood is filtered outside of the patient’s body through a dialyzer which acts like an “artificial kidney” to remove unwanted waste, toxins and excess fluids. Hemodialysis uses a solution called dialysate to remove these substances from the blood. Clean, chemically balanced blood is then returned to the patient’s body. It is a form of renal replacement therapy (RRT). Like the name suggests, Home hemodialysis(HHD) is nothing but a provision of performing hemodialysis at home. The only difference is that it is performed with a smaller portable machine which it performs a similar process to in-center dialysis.
Being at home is much more convenient than travelling for in-center dialysis, dealing with rain, traffic, weather and roads. Not having to travel to hospital three times a week gives you more time. In other words, it is easier to fit your treatment around your life, rather than adjusting your life around dialysis sessions. This gives a huge boost to your mental health.
You can be at your home, with your family, perhaps even watching television, reading a book or checking Instagram and Facebook while you go through the process. As soon as you finish the process you can go for a walk or start working on your computer. There is even an option called “nocturnal treatments” for longer, slower dialysis. It also allows you to dialyze more frequently on your schedule. Doctors will work with you to design HHD treatments that suit your needs and make sure that in case of any emergency, medical help is just a phone call away. In a recent survey, many of the patients who have switched to HHD reported increased happiness compared to in-center dialysis. Patients can spend time on their hobbies and leisure and are able to either work more often or return to work. Those who want additional independence, home hemodialysis can be the best option for them. This means, you can take back the control of your own life. Home hemodialysis gives you the flexibility to fit treatment into your lifestyle. In addition to more freedom, hemodialysis also means fewer food and drink restrictions, more energy and more time. (1)
Let’s also look at all the clinical benefits, dialyzing at home can allow you to do so more frequently. In-center patients usually spend 8- 12 hours of hospital hemodialysis every week spread over three or four hourly sessions. A healthy kidney works around the clock, which means that 8-12 hours per week might be adequate for survival but it’s not enough for a healthy life. Home therapies allow for longer and slower dialysis, this can improve kidney function and life expectancy. This leads to reduced reliance on additional medicine. HHD patients rely less on medication overall when compared to in-center hemodialysis. Due to this overall improvement in health, patients on frequent HHD have a higher chance of receiving a kidney transplant. There is less risk from a two-day break imposed by weekend closures of centers.
Dialyzing more frequently also reduces recovery times, from eight hours in-center to one hour after HHD. One study showed a 13% lower risk of death in patients, and a 77% improvement in health.(2) These benefits translate into a much better quality of life.
What do you need for successful home hemodialysis?
• Anywhere from 4 to 6 weeks of training—along with your care partner (a family member or friend), if you need one.
• If you have a care partner, he or she needs to be dependable—to commit to either participating in your home hemodialysis treatments or staying with you to monitor them.
• You or your care partner must be willing to set up for treatments and clean up afterward.
• Before you begin, check with your health insurance provider, so you know whether more frequent at-home hemodialysis treatments will be covered.
• Your water and electrical systems need to be checked in case they need to be upgraded or modified.
• Space that’s set aside in your home to store supplies and equipment. (1)
Home Hemodialysis in India:
Out of all the patients on dialysis in India, less than 10 per cent are on home-based dialysis. But the potential for the growth of HHD is really massive and that is something that needs to be developed. Right now, the dialysis services which are available through the dialysis centers are already operating at the limit of their capacity. The unmet needs of dialysis in India are four to five times of the existing market. As per industry experts, In center dialysis can grow rapidly and the home care dialysis market is estimated around 700 crore in turnover and expected to grow by 25-30 per cent annually. (3)
According to ‘Pradhan Mantri National Dialysis Program’ (PMNDP), throughout India, 2.2 lakh people get affected by ESKD who are started on dialysis or transplant. Diabetes and hypertension are among the most common causes of these kidney diseases in India in both men and women. For patients who are waiting for the transplant dialysis becomes the only option. There is a demand of 3.4 crore dialysis with only 4950 dialysis centers approximately. (4)
Right now, the cost of HDD is significantly higher than in-center dialysis. Hence, a case can be made for creation of a safety net to protect the most vulnerable from such financial consequences. In India, as of now, we do not have cost-effective and portable hemodialysis. Water quality is an important factor when it comes to dialysis. Whenever hemodialysis is conducted at home, it is done by setting up an RO plant which are compact versions of same machines that are there in the hospitals. It is expected that private industry will step in and indigenize the production and servicing of HHD and RO machines. So that it can become affordable and more patients can opt for it. India needs manufacturers which can provide everything from HHD machines, dialysate, water purifiers and can also provide training and support. HHD is not designed to replace in-center hemodialysis, it is designed to complement it so that some load can be taken off of overstretched dialysis centers.
The Recent Trends:
Like every other thing related to healthcare, hemodialysis also had a lasting impact of covid-19. When covid-19 outbreak hit India in march 2020, Kidney failure patients were amongst the worst-hit. Most of them had to step out for dialysis thrice a week, facing an increased risk of contracting Covid-19, and, worse, a higher risk of mortality. The home option, thus seemed safer. When a patient has to be taken to a hospital for dialysis, his/her partner is also exposed to a higher risk of Covid-19.
Over the past few years, the proliferation of innovative healthcare technologies and solutions had a positive impact on the healthcare segment, the impact can be seen in the nephrology segment too. Companies offering products and solutions in the dialysis segment are increasingly focusing on research and development which has resulted in the emergence of newer technologies and lowered the cost of treatment. Home dialysis using compact dialysis machines have become increasingly popular among patients suffering from end-stage kidney disease.
Although hemodialysis can be performed at home with the help of these home-based dialysis machines, people opting for this should still pay special attention to hygiene around the patient. Maintaining hygiene and infection control is a major challenge at home hemodialysis. The patient has to constantly check the area for signs of infection, such as a rash, warmth or redness. When blood flows through the access and the whole mechanism is working well, one can feel a vibration over the area. A patient opting for home hemodialysis needs to ensure minimization of the chances of infection. One has to wash the access with soap and warm water daily and always before dialysis or use other infection control solutions. Which is why training and support being as important as instruments and solutions. HHD in India can truly benefit if companies start providing everything from instruments, solutions, infection control, water purification, as well as training and support under a single roof.
When it comes to cost effectiveness, home-based dialysis machines are probably not the most pocket-friendly option to look at. Innovation and local manufacturing can bring down the cost significantly. Now-a-days, more and more people are opting for it but we still need to work towards making it feasible for the majority.
Busting the myths:
Despite the increasing popularity of home-based dialysis, there are still some myths surrounding it. People often think that assistance in case of emergencies will not be available if you choose home hemodialysis or that the home-based dialysis will not be as effective as in-center dialysis. But this is not true. As a matter of fact, home healthcare supplements the efforts of hospitals and involves working closely with the hospital staff to ensure that the best possible care can be provided to the patient. Another myth is that opting for home hemodialysis will lead to various disorders and infections. Which again is not true, effective infection control is in fact possible at home with training and solutions. During home-based dialysis, help and support is provided to the patient. A doctor is just a phone call away. Patients are fully under the observation of medical experts and the good news is that all this is becoming increasingly affordable.
2.J Am Soc Nephrol. 2012 May; 23(5): 895–904, doi: 10.1681/ASN.2011080761Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients Eric D. Weinhandl Et al