Summer 05

Healthier & Free

A new portable device being tested at Indiana University Hospital is making life easier and more enjoyable for kidney dialysis patients.

Neither snow, nor rain, nor heat, nor gloom of night will stay Angela Bunch from the swift completion of her appointed rounds as an employee with the U.S. Postal Service. Nor will kidney dialysis.

That’s because Bunch now controls her own treatment with a suitcase-size device being tested at Indiana University Hospital and eight other sites nationally by researchers who began evaluating the NxStage System One about a year ago. The unit allows patients to conduct dialysis in the clinic, at home or on the road.

Nationwide, about 100 patients with kidney failure are testing the System One, a third of which are treated at IU Hospital, a member of Clarian Health Partners. The focus of the current study is to determine how well it works for home use, and the preliminary results are promising, says the study’s principal investigator.

“We usually see the health benefits within a week of a patient beginning this therapy,” says nephrologist Michael A. Kraus, MD, associate professor and medical director of the IU Continuous Ambulatory Peritoneal Dialysis and Acute Dialysis Units.

“On the whole, patients have reduced or completely stopped using medications to control their blood pressure, their anemia rates have declined and their appetites have increased.”

The new technology potentially could give a new lease on life to many of the 400,000 Americans who receive dialysis – but it is not intended to be a replacement for kidney transplants. There are two kinds of dialysis available to patients with kidney failure. . Less common is peritoneal dialysis, where the patient’s abdominal membrane filters out waste, a process usually performed at home.

Most common, however, is hemodialysis, which separates toxins and excess water from the patient’s blood. This therapy usually is takes place in clinics or hospitals, though some units have been adapted for home use. Patients usually undergo four-hour treatments three times a week tethered to massive units which require vast amounts of electricity and water. While effective, sessions leave patients physically exhausted and emotionally drained.

Government health programs cover about half of the costs for the six-times-weekly portable dialysis. Clarian Health pays the balance between the government rate and any additional costs incurred.

“Before I started using this device, I would leave work in the morning, come to the clinic for conventional treatment, go home and rest, then crawl into work that night,” says Bunch, an Indianapolis resident, who has been on dialysis since 2001. “No pep or get-up-and-go to me whatsoever. Now my energy level is higher.”

Clinical Clique

It’s an early Tuesday morning in IU Hospital’s dialysis outpatient clinic, and Keely Beckner reclines in the padded chair and flips through a magazine. The humming of the System One machines is muffled by the staccato one-liners she is trading with her dialysis buddies and the staff nurse. Dr. Kraus pokes his head in the door to say “hello” and immediately becomes the new target for patients’ good-hearted wisecracks.

“The patients encourage one another and that’s important,” says Connie Summitt, a Clarian nurse who has worked with dialysis patients since 1972. “You walk into this clinic and you immediately sense these patients have bonded with one another and us with them.” There’s plenty of evidence to attest to this; a wall is decorated with Polaroid snapshots of patients and their families posing with staff, thank-you notes and cards.

Some of those receiving System One care chose to do so in an outpatient clinic at IU Hospital and are trained to do the procedure. The clinic can accommodate up to four patients at a time, but there are plans to double the size of the facility. Flexible clinic hours accommodate patients who must visit six days a week for dialysis sessions lasting about two hours.

“Our kidneys work round the clock seven days a week,” Dr. Kraus says. “In my opinion skipping days as you do with conventional dialysis makes a big difference because more toxins can build up in the blood.”

Luther Mitchell’s three-year-old transplanted kidney quit working in 2004 and he was forced to return to the standard thrice-weekly dialysis at IU. He underwent the rigorous traditional dialysis for several months before he was offered an opportunity to test the NxStage System One earlier this year.

“This technology is giving me my life back,” says the Indiana Army National Guard veteran, who was medically discharged when he was diagnosed with kidney failure in 1992. “It’s the next best thing to having a normal kidney in there doing what nature intended for it to do.”

Don’t Leave Home Without It

Rick Skiles and his wife took a cruise last Christmas. When they returned to land, they traveled to Virginia to visit with family. Not so unusual for most folks, but when you’re on kidney dialysis, any kind of extended travel is at best a logistical labyrinth of scheduling treatments in unfamiliar areas and clinics months in advance. For many, a lengthy journey is impossible.

Skiles is among 20 IU patients who use the portable dialysis unit at home and wherever the road might take them. In fact, one patient and her husband make frequent trips in the RV around the country. Whatever health benefits it affords them, the technology means freedom – and freedom translates into a better quality of life.

“We have had mothers who didn’t have the energy to take care of their kids, people who had resigned that they would never be able to work or have a career or travel anywhere – but now their situations have reversed and they now have control over their lives,” says Dr. Kraus.

The determining factor in using the machine at home depends on the patient’s desire and discipline to take responsibility for his care. Users, who cannot weigh more than 230 pounds, typically train for one-to-three weeks on how to set up, operate and clean the machinery. They also must have a clean home and a companion who is trained and willing to assist with the device.

Studies evaluating the health benefits of more frequent dialysis and home use are next. But for Skiles and other renal failure patients there is no choice whether using a portable device or being tethered to a larger blood-cleansing unit.

“If you don’t do dialysis, you die,” Skiles says. For him and many others, they would rather do it on their schedule – at home and away.