Friday, March 18, 2011

Nocturnal Home Dialysis (NHD) - Update

Have now been on NHD for nearly three months.
During that time I have had no problems during dialysis but several issues have arisen during machine setup.
Largely I have been able to resolve these problems except on one occasion when the dialysis session had to be abandoned due to the machine refusing to go into standby mode.
This highlighted the main worry about NHD - after about 4pm until 7am the next day there is no nursing or technical backup available anywhere in NZ for NHD patients.  This can be quite scary.
The official response to this unsatifactory situation is stop dialysis and get advice next day, or present to Middlemore ED if urgent.
Have had some email discussion with both Department of Renal Medicine at Geelong Hospital, Australia ( the definitive sourse of NHD information) and with Dr David Voss,Renal Physician, Middlemore Hospital and Auckland University .

Dr Voss has advised me that they will look into the justification of number of patients on HD and PD at night and the resource required to provide a dedicated nurse and technician for the home patients, other than the current plan of "stop and continue next day after getting backup advice." 

For those interested in some of the technical aspects of  NHD such as needling and methods of securing needles so they are not at risk of being pulled out during sleep see blog images

Saturday, January 29, 2011

Nocturnal Home Dialysis (NHD)

After being rejected for addition to the kidney transplant list I have become aware of an alternative way of acheiving prolonged life with no renal function.
Nocturnal  home Dialysis (NHD) is dialysing at home on a kidney machine at night during sleep.
One month ago after re training at Middlemore Home Care Unit I commenced NHD for 8 hours per night, three nights per week.(Mon, Wed, Fri).
Because the dialysis is applied over a longer period the process is much gentler on the body than 4 hour daily sessions.
Medical studies indicate that in fact the mortality rate of NHD patients is not significantly different from kidney trnasplant patients.
By eliminating the long dialysis break between Friday morning to Monday evening even more benefit can be acheived ie by nightime diaylsing Mon/Wed/Fri/Sun/Tues/Thurs/Sat.
I shall discuss this with Middlemore Home care team in due course.