“We now have the technology to deliver dialysis at home, an approach that has better outcomes for patients and is cheaper,” says Dr. Jaime Uribarri of Mount Sinai Hospital.
The specialist: As the director of the home dialysis program at Mount Sinai, Jaime Uribarri specializes in treating patients with chronic kidney disease. He has been practicing as a nephrologist for over 30 years.
Who’s at risk: For almost 400,000 Americans with end-stage renal disease, dialysis is built into quotidian life.
“End-stage renal disease is when the kidneys can no longer function to clean toxins from the blood, at which point they need to be replaced, either by transplantation or dialysis,” says Uribarri. “Dialysis is a procedure that allows us to hook patients to a machine that filters waste products from the blood, replacing the function of their own kidneys.”
Although many underlying causes can contribute to kidney disease, diabetes and hypertension are by far the most common ones. “Seventy percent of patients in the U.S. [who] need dialysis [is] due to diabetes or hypertension,” says Uribarri. “High blood glucose produces inflammation that induces scar tissue, which decreases the amount of healthy tissue in the kidney, reducing its ability to filter the blood; high blood pressure eventually also destroys the kidneys, but through different mechanisms.”
Controlling blood glucose and blood pressure numbers are the most important things you can do to prevent kidney disease from progressing to kidney failure or to prevent kidney damage in the first place.
The vast majority of patients receive dialysis out of the home.
“Most patients go to the hospital or to a satellite dialysis unit three times a week to be hooked into a dialysis machine for a few hours at a time,” says Uribarri. “However, we now have the technology to deliver dialysis at home, an approach that has better outcomes for patients and is cheaper.”
Currently, fewer than 30,000 patients across the country receive peritoneal dialysis, the most common form of home dialysis.
There are two types of home dialysis: hemodialysis and peritoneal dialysis.
“Hemodialysis cycles blood out of the body through a machine that removes waste products before sending it back, a process usually performed three times a week for a few hours,” says Uribarri. “Peritoneal dialysis places a special tube in the abdominal cavity that allows patients to do exchanges of fluid either several times a day or at night with the aid of a machine called a cycler.”
Although home dialysis might sound extremely technical, just about anyone willing to participate in their own care can be trained to do it.