A

NEW METHODS: HOME DIALYSIS

Hospital Dialysis

Kidney failure is devastating because the kidneys cease to cleanse the body of poisons that come from the digestion of food and the normal breakdown of proteins in the body. Without treatment a person with kidney failure will live for about three weeks before dying of uremia (named for a poison that builds up in the blood). Dialysis involves taking blood from the patient with kidney failure and removing the poisons by passing the blood over a membrane which has fluid on its other side. The fluid contains water, salts, sugars, and other small molecules found in normal blood. The dialysis process was designed to be used with an artificial kidney. The patient went to the hospital twice a week for four to six hours at a time. The equipment was expensive, and the medical personnel who ran it required special training. By 1964 there were one hundred patients in the United States routinely being dialyzed twice a week at a cost of about $10,000 a year each.

A Solution

Patients who required hospitalization two days a week found it difficult to keep a job so that they could pay the cost of dialysis, or at least qualify for group health insurance that paid for it. The answer was home dialysis, a refined procedure that significantly reduced the cost and the time required.

How It Works

Home-dialysis patients had two tubes placed permanently in their arms, one in a vein, the other in an artery. The tubes were normally connected so that the blood from the artery went back into the vein. During dialysis the two tubes were connected to a machine, a large stainless steel tank containing a chemical-cleansing mixture. The tubes were plugged into a membranous tube which was primed with one and a half pints of the person's blood from the last dialysis. A physician and nurse could evaluate the patient at home and connect him or her to the device.

More Comfortable and Convenient

Once the machine was started, the patient could read or sleep during the dialysis. The physician and nurse did not have to stay for the whole process as long as they could be contacted by phone in case of difficulty. The few original home-dialysis patients had spouses who monitored the process and unhooked the machine after dialysis. An alarm on the machine rang if any leaks occurred. A seven-page checklist was also provided for safety.

Cost

The initial cost for the home-dialysis machine was $2000. Supplies totaled about $170 per week. The overall cost (after purchasing the machine) was about half the price of hospital visits twice a week. Patients could often continue working during the day and sleep through the dialysis at night.