Home dialysis offers patients better health

For Monique Ratelle, it's something of an accomplishment every time she celebrates a birthday.

The Sudbury woman, who will turn 50 in September, was diagnosed with Lupus at the age of 13. The condition damaged her kidneys, and she had to go on dialysis by the time she was 21.

Although she's had two kidney transplants over the years, she's spent 27 of the last 31 years on dialysis.

Her body rejected the first organ after three years. The second organ caused her to contract a virus which damaged the blood vessels in her legs, requiring her to receive an above-the-knee amputation.

“When I was 18 years old, I was told by a physician I would not live another 10 years,” Ratelle, who recently spoke to reporters about her experiences on World Kidney Day, celebrated March 8, said.

“When I reached 30, it was a big accomplishment. When I reached my 40th birthday, we had a big party, because never in a million years did I think I'd reach 40. Now here I am, close to 50. Life works in mysterious ways, obviously.”

Things started looking up for Ratelle about a year ago, when Health Sciences North introduced its home dialysis program. She booked two months off of work to learn how to run a dialysis machine in her own home.

“When you're at home and it's 2 a.m., you don't have that nurse running to help you,” Ratelle said.

“You have to know every detail of that machine, in and out. If that alarm goes off, you have to know what to do ... Not everybody can do it. You have to be a little bit mechanically inclined, I guess.”

She opted for nocturnal dialysis, which is performed while the patient sleeps. It is usually done five to seven times a week. The advantage of nocturnal dialysis is it avoids a disruption in the patient's daily life.

Home dialysis patients can also opt for short daily dialysis, which is performed five to seven times a week, with each session lasting two to three hours. The sessions are shorter in duration, meaning less time spent on a machine at one time.

Ratelle, a part-time lab worker at Health Sciences North, said her life used to be centred around dialysis. She received treatments three times a week at the hospital.

“Basically my life was dialysis and work,” she said. “Those were the two things I had in my life. I had no energy for anything else. I had no social life. I was so tired from my week, that the weekends, for me, were just sleeping and catching up on my rest.”

But now that she's on nocturnal home dialysis, things are looking up.

Because she receives dialysis every day instead of only three times a week, she's feeling much better. Ratelle jokes that she's almost become “addicted” to her treatments.

“You feel good all the time,” she said. “Because I'm doing this type of dialysis, I want more of it. I'd be crazy to skip my treatment.”

Ratelle was recently able to go on a vacation to St. Lucia.

Although she had to arrange to receive dialysis at a local hospital, she said she's excited to have travelled at all.

She hadn't travelled in 20 years because she didn't have enough energy.

While on holiday, she got engaged to her boyfriend, Michel Babin. Babin and Ratelle met while they were both still on dialysis.

“For me, personally, I see how much more energy and independence she has,” Babin, who received a kidney transplant in 2004, said.

“When on nocturnal dialysis, you can eat healthier foods, drink more fluids. She's a healthier person, more outgoing, and has more confidence.”

When people receive dialysis more often, there are “true medical benefits,” according to Dr. Richard Goluch, service head of Health Sciences North's nephrology program.

“When you think about it, your own kidney works every second of the day, seven days a week,” he said.

“As great as the technology is, to expect a machine to do the same in four hours, three times a week is wishful thinking. The more dialysis you have, the better it is.”

Those with kidney failure end up with too much phosphorus in their blood and too much liquid in their body, he said. Too much liquid, especially, can be dangerous because it increases blood pressure, Goluch said.

Because of these issues, kidney failure patients are forced to follow liquid intake restrictions and phosphorus-restricted diets, something which is a “great hardship,” he said. These restrictions are lifted for those on daily dialysis.

Adrienne Barrett, a modality independent dialysis nurse at Health Sciences North, was one of the people who helped to set up the home dialysis program.

She said the hospital is currently funded to provide up to 14 patients with short daily or nocturnal dialysis. Five patients are currently using these forms of dialysis, with six more expected to start training this year.

Anyone from northeastern Ontario is eligible to participate in the program, with a team of nurses and health-care workers available to travel to the patient's community to provide them with support.

Hotel costs for out-of-town patients coming to Health Sciences North for training are paid by the province.

Barrett said those learning to perform their own dialysis at home are a bit anxious at first, but by the time they're done their training, they're confident.

“We focus on problem solving — what are the alarms, why do they happen and how do you fix them?” she said. “We always tell them the worst that can happen is they can just take themselves off the machine.”

She said there's a “metamorphosis” in patients who go on home dialysis because there's such an improvement in their general health.

The treatment gives them “the energy to do some of the things they want to do,” such as go back to work or spend more time with their families, Barrett said.

Posted by Arron Pickard