Home dialysis plea to give kidney patients more normal lives

Most patients with kidney failure have to go to hospital three times a week for dialysis – where the blood is removed from the body and cleaned of toxins, the job normally done by the kidneys.

But a form of home dialysis, peritoneal dialysis (PD), is suitable for many patients.

The most recent figures show that, out of 2,146 patients receiving dialysis in Scotland, only 406 had PD.

The National Kidney Federation (NKF) said it would expect up to 1,000 patients in Scotland to receive the home treatment, which can allow them to lead much more normal lives.

But the charity said that many renal units were not giving patients the option of PD.

Doctors in Scotland said they would like more patients to receive home dialysis, but an ageing population meant many were not suitable.

Tim Statham, chief executive of the NKF, said 40,000 patients in the UK had end-stage kidney failure, and having the option of home dialysis could help improve their quality of life.

"Dialysis is a very aggressive treatment," he said. "You are taking all the blood out of the body and pumping it back three times a week. The day before dialysis, your blood is full of poisons and you don't feel well."

He went on: "PD makes it easier for people to go about their daily business, stay at home, see friends and go on holiday.

"Usually after five years, they have to go back on hospital dialysis, but that means that they can have five years out of hospital to get on with their lives."

Mr Statham said as many as 3,000 patients stopped dialysis each year across the UK, because they were too ill to continue or could not bear to carry on. Their symptoms are controlled and most die in a week or two. In Scotland, 272 patients have stopped dialysis in the past ten years, according to the Scottish Renal Registry, either through choice or because their condition had deteriorated.

Mr Statham admitted not all patients would be suitable for PD. But if it was offered to those who were suitable, it could improve their lives while they were still well and even encourage them to continue dialysis when, otherwise, they might consider stopping. "We think patients should at least be offered that chance, but they are frequently not," he said.

"It tends to be that the consultant decides on your treatment and they prefer to have you in hospital and under their wing."

Dr David Jenkins, a consultant renal physician at Queen Margaret Hospital in Dunfermline, said: "

We would love to put more patients on PD, but we don't because it is not always a good treatment for them."

Alison Blezard, secretary of the Scottish Kidney Federation, said she would encourage patients to consider PD if they were suitable for it.

A Scottish Government spokeswoman: "We would expect patients on dialysis in discussion with their clinicians to establish the best form of treatment to meet their needs."

Shock gives way to hope as Stuart gets new lease of life

FOR Stuart Middleton, the news that he was suffering kidney failure came as a complete shock. The active 32-year-old, who enjoys mountain biking and snow-boarding, started kidney dialysis in December.

But his experience has been very different to that of many patients who have to go to hospital for lengthy periods each week. Mr Middleton, from Dunbar, has been using peritoneal dialysis (PD) at home and at work, allowing him to carry on his life as normally as possible.

He is now preparing for a kidney transplant with his mother as the donor this week.

Mr Middleton was diagnosed with the condition IgA nephropathy, which causes progressive kidney damage.

To start with, his condition was managed with drugs and a special restrictive diet as he waited for a kidney transplant.

But by December a transplant still seemed some way off and it was decided he needed to start dialysis.

"My doctor strongly suggested that PD would be the best way forward. I was given the option to go on haemodialysis. But I can't see why anyone would want to have to go into hospital every day."

Mr Middleton has to carry out the PD four times a day, each time taking about 30 minutes. It has meant he has been able to carry on with his life, working as an energy trader at firm Intergen in Edinburgh and even continuing his mountain biking.

"I have been told that the reason many people don't want to do PD is because if you go to the hospital they do everything for you. But I have to make sure that everything is clean, fit everything together myself and am responsible for my treatment.

"I can see why for some people it may not be such a great thing, but I would certainly urge people to consider it."

VITAL MEANS TO SAVE LIFE

PERITONEAL Dialysis (PD) works by using a natural membrane in the abdominal lining to do the job of the kidneys.

The blood never leaves the body. Instead, dialysis fluid flows into the peritoneal cavity through a catheter inserted in the abdomen.

Fluid and waste cross the peritoneal membrane into the dialysis fluid, which is drained from the abdomen, and exchanged with fresh fluid.