So you want to live? Yes, a tough opening line, but every dialysis patient needs to understand the facts. Your doctor, rightly, will tell you that dialysis is not a cure, it’s a treatment. And, they should tell you that a transplant is not a guarantee.
It’s a fact that the life expectancy of dialysis patients, on average in years, is measured on the fingers of two hands. And, it is fair to say that if you stick with the absolute minimum of dialysis YOU think you can get away with, then start cutting the number.
The key to a much improved life expectancy is to improve your treatment. You need to get beyond the the 3 days a week for four hours mentality and consider daily dialysis, which can be for 3 or 4 hours a day, or nocturnal. To do this though, unless you are in an area that has a dialysis unit that offers nocturnal options, then the solution lies in dialysing at home.
I’ve banged on a bit about home dialysis before, but the real benefits are that you can take real control of your treatment and have a major impact on your long term health. Unless something quite radical happens in UK dialysis centres, the cost constraints that govern provision of facilities, nursing and supplies will continue to restrain centres to the standard 3 days x 4 hours routine as that ensures a reasonably controlled shift process, and moves through the maximum number of patients. When you see patients on dialysis with low pump speeds, clammering to come off early because they are bored or have something more important to do, you realise that many just do not get sufficient treatment to maintain good health. (and, to be frank, what can be more important than extending your life for as long as possible?)
A concerted effort to move all able bodied and those with the facilities to accommodate dialysis equipment should be trained to go on home hemo, this reduces costs to the NHS after the 16-18 month payback period, so freeing cash, and space to offer those that cannot go home a more considered dialysis regime at hospital so that they achieve better clearances because they are no longer ‘rushed’ to get off in 4 hours. The money saved through the home hemo route can then be ploughed back into the development of bigger and better facilities for those needing hospital treatment and may even offer the option to start nocturnal units, as is becoming increasingly ‘popular’ in the States.
All round, the average life expectancy of ALL dialysis patients will be enhanced.
And…. given the earlier blog post from me on finding an intelligent solution to the stalled donor situation, is this not one area for strong consideration. A case of changing the way we do things to achieve better results rather than trying to change the world on donor organs where half that world wants no change.
