Columbia Nephrologist Launches
Home Dialysis Initiative
The stunning view of the Hudson River from the 20-foot floor-to-ceiling windows is the first thing people notice when visiting the dialysis center at Columbia University Medical Center.
Professor Dean Preddie
Although this is a vista few people in New York get to see regularly, most of the patients who come here would gladly give it up if they could.
“The patients who must stare out of these windows three days a week, for up to five hours a day, would certainly say they would rather be home,” says Dr. Dean Preddie, the center’s medical director for home hemodialysis.
In a few months, some may get to do just that. Under Preddie’s supervision, the dialysis center will soon begin training patients to perform kidney dialysis at home. The endeavor is part of a growing movement toward home hemodialysis, not only to make dialysis more convenient for patients, but also to improve health.
“Having dialysis only three days a week is not necessarily optimum,” says Dr. Donald Landry, chief of the nephrology division. “If dialysis can be done at home, it can be done more often, which is better for the patient because it more closely matches the natural function of the kidneys.”
A Burgeoning Problem
As Preddie makes his way around the 24-station center, another reason why home dialysis is so desperately needed becomes clear. The room is packed, and there are no empty stations. The center runs through three shifts a day, six days a week and is considering adding a fourth.
“Even with the added shift, we will soon run out of units to accommodate everyone,” Preddie says. Diabetes and kidney disease are on the rise and New York State is projecting thousands of new stations will be needed within the next four years.
With more frequent dialysis possible at home, Preddie says, the number of medications a patient must take to reduce high blood pressure decreases drastically, resulting in less stress on the heart. In addition, less calcium is leached from bones, and it is easier to manage the anemia that often results from kidney disease.
And new dialysis machine designs also mean patients no longer need to be wealthy to afford home dialysis. Today’s machines are portable and simpler to operate, so patients do not need full-time nurses. Some new machines do not require extensive plumbing renovations, which can reach as high as $20,000.
The first Columbia patient began the four- to six-week training program last month. Once dialysis starts at home, a nurse will visit periodically. Preddie expects the program to train two to three patients a month initially.
Though Preddie thinks home dialysis has the potential to greatly improve health and quality of life, he says it is not for everyone. Such patients must be highly motivated, have good hand-eye coordination and have the help of a trained family member or friend.
Despite the challenges, Preddie says, “Home hemodialysis is probably the next best thing to a kidney transplant for a person with kidney failure. It’s far and away the wave of the future.”
Reprinted with permission from the December 2007 issue of In Vivo, the newsletter of Columbia University Medical Center