UPDATED SEPT. 17

Northwest Kidney Centers patient Jim Smith, who is on a national road trip to educate the public about home dialysis, parked right outside the entrance to the West Seattle Kidney Center, 4045 Delridge Way Sept. 14 & 15 in his motorhome to invite the public and health care professionals to join him while he dialyzed himself in the comfort of the RV.

Home hemodialysis allows patients to decide when and where to dialyze, and also allows them to dialyze more often during the week, which is better for their long-term health compared to patients scheduled for three, four hour visits per week in dialysis centers.

At home, they use the machine about six days a week for about three hours per day. But they save time avoiding the commute to the clinic, and, according to doctors and patients, they feel strong after their home dialysis sessions.

PATIENT JIM SMITH

Smith, who lives in Indianola, has worked closely over the years with Northwest Kidney Centers to optimize his health. He has been taking his motor home to the parking lots of dialysis centers around the area to promote a home hemodialysis unit from NxStage. While other companies are developing this type of apparatus, this is the principal company currently in the game.

Northwest Kidney Centers opened its West Seattle dialysis center Sept., 1998. It is now one of 14 in King and Clallam counties. The West Seattle clinic currently serves 75 patients who come three times a week for dialysis therapy to replace their kidney function, totaling 11,700 treatments per year.

Smith explained that kidney centers are not adversarial with patients on home hemodialysis.

"They sponsor this program," he said. "They are very happy to encourage this. Kidney disease is increasing every year 7 to 10 percent. They get more and more kidney patients and only have so many seats and people to care for patients. If you want your freedom on dialysis you have to get out of the center.

"The people who work in the center are wonder, fabulous people, but the advantage of doing this at home means it's my schedule, when I want and how I want to do it. Also, there are massive health advantages because I do this five days a week vs. three days a week at the center. You build up fluid in your body and can't get rid of it if your kidneys haven't been working so it is dangerous to not be in center two or three days. Your risk of heart attack increases."

To clarify, there is another home treatment for patients, peritoneal dialysis (PD) which uses the patient's peritoneum (the serous membrane lining the cavity of the abdomen) as a membrane across which fluids and dissolved substances are exchanged from the blood. But the membrane eventually wears out and other options are then chosen.

The machine weighs 75 pounds. It's a closed, sterile system which addresses concerns about HIV or pet contamination. The machine is covered by the kidney center. They purchase or lease it and give it to the patient with supplies. It is covered the exact same way as things are covered in the center, with no additional financial impact. The training program takes about three weeks to learn the machine, and a second person to assist is helpful but not always necessary.

"When I am done, I stand up walk away go on with the rest of my life," he said. "Most patients coming out of the kidney center feel like hell. They are tired when they go home, and often go to sleep for hours. The difference is night and day how you feel. Dialysis is not a death sentence. It's a life sentence. With this portable unit, you can travel, make your own schedule, and live your life the way you want."

DR. ROBERT WINROW, NEPHROLOGIST, NW Kidney Centers, Minor & James Medical clinic

"My personal view is that home dialysis is best," Nephrologist Dr. Robert Winrow, Smith's doctor, told the West Seattle Herald, referring to home hemodialysis, also called "HD".

"It gives patients more interaction in their own health care, and get's them feeling better," he added. "It allows them to adjust based on their scheduling, not as rigid as going to a center.

"When I meet patients I talk to them about home (dialysis)," he said. "Home hemodialyis is probably the best you can feel without having a transplant. If someone is dialyzing in a center I will talk to them periodically about home hem. It's an ongoing discussion between me and my patient. People who go to school, if their class schedules change, instead of rearranging their schedule at the center, home hem gives you more control. I want to minimize impact on their life as much as I can. There is a negative connotation in the world that you feel crummy with dialysis, and I can get my home patients to feel quite well and not worn out.

"Across the country only one-percent of patients are on home therapies," he said. "For my patients I have about 33-percent at home. In Seattle the percentage (over-all) is higher. Seattle is the birthplace of dialysis. The kidney center is coming up on its 50th anniversary next year. We're very focused on home therapies and they have been an integral part of the kidney center throughout those times. I think there is more of an awareness here."

He feels that some are resistant to home dialysis because they "don't want to bring their disease home with them" and feel that once they leave the center it is no longer part of their life until they return.

"My view is that dialysis does interact in the patient's entire life both in a center and at home, and dialysis in the center segregates their disease away," Dr. Winrow said. "I think that is not always the best overall. It's part of your life and you need to adjust."