Dialysis at home offers patients greater freedom

For the past 30 years, the Richard Bright Renal Unit at Southmead Hospital has been at the forefront of offering its patients the option of receiving their dialysis treatment at home.

The Trust installs the equipment – including the plumbing – and offers full training for the patient and their carer on how to use the machine. 24/7 technical and nursing support is also provided.

Due to the relatively high transplant rates at Southmead, there are, on average, about 30 patients receiving home dialysis at any one time.

Once a patient has received their new kidney and no longer requires dialysis, the equipment is removed from their home, re-conditioned and installed in another patient’s home.

Dr Chris Dudley, Clinical Director for the Renal Department, said: “We believe that home haemodialysis provides a number of excellent benefits to patients and their families.

“Patients have improved health and quality of life outcomes and it enables them to participate more fully in family life. It also allows them to take control of their treatment.

“The whole healthcare community also benefits as it is financially more cost-effective releasing hospital and satellite unit dialysis capacity for new and sicker patients and reduces transport costs as well as being greener.

“This is all about giving our patients an option that’s best for them.”

David Morris is a Bristol City Councillor from Windmill Hill and has been receiving home dialysis from the department at Southmead for almost six years.

He is unable to have a transplant due to problems with his arteries, leaving ongoing dialysis as his only option.

Cllr Morris said: “Having home dialysis has made a tremendous difference to my life and without it I can honestly say that I wouldn’t be able to carry on as a councillor.

“When I first needed dialysis, I had to attend Southmead three times a week for four hour sessions. All-in-all, taking into account journey times, that was about eight hours out of my day.

“With home haemodialysis I have much greater freedom with my treatment schedule, I can be more flexible and my regular pattern of dialysis is to use the machine six times a week for two hours at a time. This means that I can work around council meetings and I am not as restricted as I would be by having to go to hospital.”

Fact File

Dialysis is a type of treatment that replicates many of the functions of the kidneys. It is often used to treat cases of kidney failure, which is also known as end-stage renal disease. This is where the kidneys have been severely damaged and lost almost all of their ability to function.

The functions of the kidneys
The kidneys are two bean-shaped organs that are located at the back of the abdomen behind the liver and the intestines.

Every day, your kidneys filter your blood, removing waste products that are collected as part of your normal bodily functions, along with any excess fluid. The waste products and excess fluid become urine, which is stored in the bladder until you go to the toilet.

If the kidneys fail, an excess of waste products can build up in your blood, leading to a range of symptoms including:

  • Vomiting
  • Itchy skin
  • Fatigue
  • Swelling of the feet, hands and ankles.

Without treatment, such as dialysis, kidney failure will eventually prove fatal.

Types of dialysis
There are two types of dialysis:

  • Haemodialysis
  • Peritoneal dialysis

Haemodialysis is the type of dialysis that most people are aware of. It involves inserting a needle, which is attached by a tube to a dialysis machine, into a blood vessel. Blood is transferred from your body and into the machine, which filters out waste products and excess fluids. The filtered blood is then passed back into your body.

Peritoneal dialysis
Peritoneal dialysis is a less well known method of dialysis, although it is becoming more common. Peritoneal dialysis involves using the peritoneum as a filter.

The peritoneum is a thin membrane that lines the inside of the abdomen, and surrounds and supports the abdominal organs, such as the stomach and the liver. Like the kidneys, the peritoneum contains thousands of tiny blood vessels, making it useful as a filtering device.

During peritoneal dialysis, a small flexible tube known as a catheter is attached to an incision in your abdomen, and a special fluid, known as dialysis fluid, is pumped into your peritoneal cavity. The peritoneal cavity is the space surrounding the peritoneum.

As blood moves through the peritoneum, waste products and excess fluid are moved out of the blood and into the dialysis fluid. The dialysis fluid is then drained out of the cavity.