Renal insufficiency, who can do dialysis at home? – breaking latest news

In Italy, patients on dialysis for severe renal insufficiency there are about 50,000, but most of them go back and forth three times a week to the Center where they are in charge to make the purification treatment. While those who resort to the home dialysis they are just 10%, calculates the Italian Society of Nephrology (Sin). Still a very limited number. Also due to the lack of awareness and information of the patient. it is an ethical and professional duty on the part of the nephrologist specialist to propose all available therapeutic opportunities, including home therapy, which is equally effective and indeed improves the subject’s quality of life and his survival in the first two years of dialysis, reducing costs for the NHS state Valerio Vizzardihead of the peritoneal dialysis service (the technique that is performed at home) of the Asst Spedali Civili of Brescia and coordinator of the Sin study group dedicated to this treatment.

Activation

The start of the home dialysis process (totally free) is managed by the health facility, included the logistics for the monthly sending of all the necessary material by courier (bags, catheters, caps, plasters, gauze, disinfectant), which can also be shipped to the holiday destination (in Italy and abroad, inside and outside the EU). The procedure used at home independently by the patient peritoneal dialysis, which involves the surgical application of a catheter under the navel that reaches the abdominal cavity and is filled with a special liquid that removes the waste accumulated in the blood due to the failure of the kidneys. In the context of peritoneal dialysis there are two techniques. The most common one automated, carried out through a device (provided on free loan) which automatically performs dialysis exchanges during night sleep. That manualless used because it is more inconvenient, involves exchange operations four times a day. Once a month, the patient goes to the reference dialysis center for a check-up. More rarely you opt for extracorporeal hemodialysis (less than 1% of cases), the technique used in the Centres: requires the expert help of a caregiver, who must insert two needles into the arteriovenous fistula (the surgical connection between an artery and a vein) created in the arm, connected with two tubes, one that sends the blood to the purification machine and the other that receives the clean blood. Frequency and duration of treatment depend on the state of intoxication of the organism. It is possible to request reimbursement from the Municipality of residence for the cost of electricity for medical equipment (a lump sum that varies from Region to Region).

Requirements

the patient’s commitment is necessary and, if this is not autonomous, the collaboration of a motivated caregiver. Those on dialysis have an average age of 70, and perhaps more disabling pathologies, and are not always able to manage themselves at home, especially if the partner is elderly and frail – he explains Anthony Santoroprofessor of Nephrology at the University of Bologna and director of the Scientific Committee of the National Hemodialysis Association—. Peritoneal dialysis is generally not indicated for those who have undergone abdominal operations. The training takes place at the dialysis center and is aimed at both the patient and the caregiver. It involves a commitment of about three hours a day for a couple of weeks. If a reliable assistant is missing, he could be sent home a nurse every day for starting the machine in the evening and turning it off in the morning in the case of peritoneal or for 4-5 hours for haemodialysis. But an expensive and not very widespread service at the moment, explains Santoro. Extracorporeal hemodialysis requires special attention: There is a risk of imbalance syndromes and if the needle is inserted incorrectly of bleeding and infection at the site. Home dialysis makes the person responsible for his state of healthallows him to realize how he feels and what he needs, to realize what’s not working, preventing any complications. In practice, the sick person will feel less sickwill have a much freer life, will be able to plan therapy according to personal needs, continue to work and have better social reintegration, concludes Santoro.

Teledialisi

Telemedicine leads to further benefits. To ASL Cuneo 2 the training is managed remotely through a totem placed in the patient’s home, equipped with a monitor with camera. At the end of each session, an algorithm evaluates the level of learning. Once the training is over, we leave the totem to the most critically ill to monitor them as needed – he points out Right Viglino, director of Nephrology —. We also deliver it to those undergoing pre-dialysis to assess the environmental, family and aptitude situation through specific interviews and tests. cooperation in the couple is important, avoiding burnout. With an app, the parameters are collected and television visits are made. Throughout the country there are currently 12 Centers operating with this system.