When Mark Moore had to start dialysis in his early 30s due to polycystic kidney disease, he felt he had lost the battle with the genetic disease he was diagnosed with as a child.
“It was very scary,” he says of his first dialysis treatment in Dublin on May 26, 2021. Tallaght University Hospital. It was a process he was familiar with, as his late father, aunt, and uncle all required dialysis for the disease, in which cystic masses affect kidney function. But when the treatment decision was made during a Friday clinic appointment and he had his first session the following Tuesday, he had to quickly come to terms with the knowledge that it was his turn.
“But it was actually one of the best things that ever happened to me. I didn't realize how sick I was and how much pressure I was under. After my first dialysis, I was running through the hallways of Talaat, calling everyone and telling them how good I was feeling.”
Because of a family history of kidney disease, the now 36-year-old was tested for kidney disease when he was 11 years old while being treated for another illness. His parents didn't think much of him at the time, and it wasn't until he started showing symptoms in his early 20s that it started to become a problem. “I played a lot of GAA football and was a goalkeeper a lot. The cyst would burst and I would bleed.” He also said he had high blood pressure, “which is just one of the things that comes with the disease.” also had to be dealt with.
The start of the dialysis regimen required three trips a week from her home in Baltinglass, Co Wicklow, to Tara Hospital for three hours of treatment each time. The HSE provides transportation for dialysis patients, which in addition to the time actually spent at the hospital, requires a journey of up to an hour each way, depending on traffic conditions.
It's great that you can [home dialysis] It won't take away your work time or time with your kids, so you can do it while you're sleeping.
— mark moore
“It was having a big impact on my work schedule,” said the drug manufacturer, who works 12-hour shifts, day and night, in a 24-hour operation at Pfizer's Grange Castle factory in Dublin. says Moore, a process engineer. Having to undergo dialysis meant he could no longer do that shift pattern. So when he was given the option to do dialysis at home, he jumped at it.
At the hospital, he was undergoing hemodialysis, in which blood is taken out of the body, filtered by a machine, and pumped back into the body. Filtration removes waste products and excess water from the blood. This is one of the jobs normally performed by healthy kidneys, which produce urine to eliminate them from the body.
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The at-home treatment Moore has been using since late 2021 is peritoneal dialysis, in which a cleaning solution is flushed in and out through a tube inserted into the lining of the abdomen while she sleeps.
“I approached it like a duck to water,” he says. After about three training sessions in Tallaght and the team visiting my home to set up the equipment, everything went smoothly and there were no teething issues. At first, he explains, you may experience a little drainage pain as fluid comes in, stays there, and then drains. One nightly session consists of 5 cycles of this and lasts 8 hours.
“I started with seven nights, but my blood condition was so good that it was later reduced to six nights.”
If you work night shifts, the treatment will be performed during the day while you are sleeping. Peritoneal dialysis requires more frequent treatment than hemodialysis, but is gentler on the body. He says he hasn't felt any after-effects, but the more intensive hemodialysis often leaves him tired, exhausted and very hungry by the time he gets home from the hospital.
The convenience of home dialysis is also a big advantage for Moore, who has two young sons, Noah, 5, and Ollie, 3, with his wife Michelle.
Michelle, whom he describes as “amazing,'' plays a big role in his success with home dialysis. She has the machine ready to start dialysis by 9pm after he gets home from his day shift at 8pm to get enough blood. That is until I have to report to work at 5:45 a.m. the next day. Then clean the machine and dispose of the garbage bag.
“It's great to be able to do it in your sleep because it doesn't take away from your work time, time with your kids, time to go to soccer with your kids, etc. It allows you to live your life.”
He is one of just over 300 patients in Ireland undergoing dialysis at home. This corresponds to approximately 12% of dialysis patients. Professor George Mellott, HSE national clinical lead for kidney services and consultant nephrologist at Tallaght Hospital, is determined to oversee that rate increase.
That benefits both patients and the health care system, he says.
Home dialysis patients not only avoid 150 long hospital visits a year, often with very long commutes, but also have more flexibility in deciding when to receive treatment (such as at night), lower risk of infection, and You can bring your own equipment. They can continue this important treatment during the holidays. Regarding medical services, the annual cost savings per patient who can manage dialysis at home ranges from €30,000 to €50,000.
Although it is a win-win, home dialysis has been extremely under-resourced until recent years, and patient numbers have barely increased. Peritoneal techniques originated in the 1980s, while hemodialysis was introduced into home therapy programs about a decade ago. “But it had no structure whatsoever,” Mellott says. “I'm not criticizing this, but it evolved organically. Sometimes it was pushed onto people because the hospital system didn't have the capacity.”
Despite the time-saving and convenience aspects, dialysis clearly leads to an increase in patients working from home. Professor Mellot compares it to the self-catering and hotel experience. People receiving center-based dialysis drive there and back from their homes. The machine is ready and a trained dialysis nurse administers the treatment. During this time, light refreshments will be provided. A specialist doctor or nutritionist will assist you if necessary.
With home dialysis, “the patient does all the work, and that brings the disease home,” he says. Patients must arrange deliveries, store supplies, set up machines, clean up afterward, and dispose of waste. However, the benefits of this approach have clearly increased during the COVID-19 pandemic, when patient demand for home dialysis accelerated due to fear of going to the hospital.
In advocating for the development and funding of modernized treatment pathways, Professor Mellott said that unless there was better support for patients being treated domestically, patients would revert to center-based treatment. insisted. The aim is to remove more of the 2,500 people on dialysis from in-center treatment. HSE statistics released in March showed that of the 2,502 patients receiving dialysis at the time, 1,461 were receiving dialysis in dialysis units at HSE hospitals and 736 in dialysis units contracted to the HSE. 305 patients were receiving dialysis at home.
Improving support for home dialysis patients includes having more specialist nurses on a regional basis to assist with training and occasional home visits. These patients need the same access to a dietitian when they typically attend a hospital clinic six times a year as do patients who enter a dialysis unit three times a week.
Professor Mellott also encouraged elderly and frail patients to start home dialysis, or who have physical difficulty lifting fluids or drain bags containing up to 14 liters of dialysate. We advocate support from nurses and medical assistants to help patients continue with home dialysis in cases where they are unable to do so. liquid. You may not have family to help you, or you may not want to impose anything on yourself.
We have kept very detailed records since 2009 and have seen 3% growth each year for the past 15 years.
— Professor George Mellott talks about the incidence of chronic kidney disease
Other barriers to home dialysis include the cost of electricity. When it comes to electricity bills, most people need to be employed to benefit from income tax relief. At-home hemodialysis requires modifications to your home, essentially a dedicated room to house the necessary machinery and equipment. As of April 1 this year, 63 people were receiving home hemodialysis, which typically occurs every two days.
Although home dialysis is not an option for many people, depending on their individual circumstances and medical complications, Professor Mellott aims to raise the national patient rate to 20 per cent, and the renal ward in Talaat, which he heads, He said he has already achieved his goal. . As the population ages, the incidence of chronic kidney disease and renal failure is expected to continue to increase. The two main causes are diabetes and high blood pressure. Professor Mellott explains that people who would have died from heart disease years ago are now surviving with the insertion of stents, but the same vascular factors that affect the kidneys are still present.
“We have kept very detailed records since 2009 and have seen 3% growth every year for the past 15 years.”
According to the HSE, around 5,257 people with chronic kidney disease or kidney failure received dialysis or kidney transplant treatment in 2023, an increase of 109 on the previous year.
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Approximately 191 kidney transplants were performed last year. These are “another way to treat kidney failure”, explains Professor Mellott. Although a transplant should significantly improve the recipient's health and quality of life, it is not a cure. These people may have many pre-existing complications such as diabetes. “I still have to take a lot of pills. There is a risk that the disease will come back with the new kidney.”
Mark Moore has been on the transplant list for more than two years, but has been temporarily taken off the list as he prepares to have his right kidney, which is prone to infections, removed in July. This will keep his body in good condition to receive the transplant.
But after this midsummer nephrectomy, he will have to go back on hemodialysis in the hospital for eight to 10 weeks “to help one kidney a little bit.”
After the post-surgery recovery period, you should be able to resume peritoneal dialysis at home.
Moore said she was always happy to experience hemodialysis at the hospital and see that side of it.
“It was very humbling for me…and I'm really grateful to now have the opportunity to undergo peritoneal dialysis.” [at home]. Highly recommended. ”
