Home, sweet home dialysis

When her kidneys failed a decade ago, Madeleine Therrien, 63, of Merrimack, N.H., tried a home dialysis system to remove the poisons building up in her body. Several times a day, she flushed her abdomen with fluids. But, as sometimes happens with this kind of treatment, known as peritoneal dialysis, she wound up in the hospital with a painful abdominal infection.

So she switched to a different kind of dialysis -- hemodialysis -- three times a week at a clinic, which was safe and more effective, but meant sitting for four hours each time hooked up to a machine that cleansed her blood. Last year, she had a kidney transplant, but her body rejected the donor organ within days, and she ended up back in the hemodialysis clinic.

Since then, Therrien has discovered a new generation of hemodialysis treatments that can be done at home, and she says she is the healthiest she's been in years. By day, she runs a roadside stand where she and her husband, Skip, sell the vegetables he grows on their four-acre farm. Six evenings a week, he hooks her up to a machine for two hours and 20 minutes, while they watch TV or play cards.

Recent, vast improvements in home hemodialysis machines are beginning to revolutionize the treatment of people like Therrien. Until now, nearly all of the nation's 300,000 kidney-failure patients have had to get treatment in a dialysis clinic, in part because old-style home hemodialysis meant learning to program a complicated, refrigerator-sized machine and re-plumbing and re-wiring the house to assure pure water and sufficient electricity.

But the advent of these ''dramatically improved machines designed to be extremely user-friendly" means as many as 40 percent of patients could safely dialyze at home, said Dr. Allen Nissenson, director of the dialysis program at the David Geffen School of Medicine at UCLA, which receives funding from a major dialysis machine manufacturer.

This will become increasingly important in years to come. By 2030, due to the aging of Baby Boomers and the continuing epidemic of diabetes, a leading cause of kidney failure, more than 2 million Americans are projected to be on dialysis or will have had a kidney transplant, according to the US Renal Data System, a government-funded national database.

In addition to the convenience factor, there's also hope -- though not yet solid proof -- that home hemodialysis will save lives, by cleansing the blood more frequently. Preliminary data suggest that dialysis more than three days a week, which more closely reflects the kidney's normal 24/7 job, can protect heart function, help reduce anemia, and prevent some of the bone loss that often accompanies kidney failure. It may save money as well because patients may need fewer hospitalizations for complications, and labor costs are cheaper.

So far, it is working quite well for about 400 patients nationwide -- including Therrien. Her blood pressure is down; her weight is, too, because she's not bloating up with fluid; her lab test results are better; and most important, she said, she never has ''that lousy feeling of being full of toxins."

To see whether this regimen is effective for others, as well, the National Institutes of Health is starting a three-year, multi-center study. The data are considered crucial to persuade Medicare, which usually pays for hemodialysis only three times a week, to pay for the six-day-a-week treatments.

Thrice-weekly hemodialysis costs $60,000 a year per patient, including hospitalizations for complications. Medicare paid $14.4 billion for kidney dialysis patients in 2003, the latest year for which figures are available.

Kaiser Permanente, California's giant health-care system, believes that frequent, home hemodialysis can not only improve patient outcomes but could save $10,000 a year per patient, said Dr. Peter Crooks, director of the renal program for Kaiser Permanente Southern California.

Even if the government does decide to spring for more frequent hemodialysis and the home machines that make it feasible, home hemodialysis won't eliminate the need for some center-based treatment.

Patients with other medical conditions or who live alone may not be able to insert the two needles (one for blood coming out of the body, one for blood going back in) needed to hook them up to the machine. And some actually like the social value of chatting with other patients in a center.

But at least those who, like Therrien, want another option will have one.

Judy Foreman is a freelance columnist who can be contacted at foreman@globe.com.