RICHARD J. HAMBURGER

Richard Hamburger, MD, Professor of Medicine at Indiana University, Indianapolis, Indiana, presented the medical perspective emphasizing the candidates who can go home. The ability to cope with problems is necessary, and desire is the great equalizer. No diagnosis precludes home dialysis. Home dialysis that can benefit the patient’s quality of life and can be accomplished by the program should be attempted.

Leonor Ponferrada, BSN, RN, Dialysis Clinic, Inc., Columbia, Missouri, presented the nursing perspective of predialysis patient education. She espoused a philosophy that the educated patient makes “the choice of therapy”. She described predialysis education at the University of Missouri and Dialysis Clinic, Inc. in Columbia, where a dialysis educator meets with each patient an average of three times before the dialysis modality and site of therapy are selected. She also described the Missouri Predialysis Education Program (PEP), developed by the Missouri Kidney Program, wherein information is presented to a group of predialysis patients in a series of meetings. Ms. Ponferrada identified lack of timely referral and lack of reimbursement as major barriers to effective predialysis education. She also outlined the assessment of home dialysis candidates. In contrast to home peritoneal dialysis patients, home hemodialysis candidates must have a partner, a telephone, and a home visit to assess the utility needs and space requirements before embarking on training.

Leanne Peace, MSW, LCSW, Dialysis Clinic, Inc., Columbia, Missouri, described the predialysis psychosocial assessment and the role of the social worker in the dialysis therapy decision-making process. Her assessment includes evaluation of the patient and the dialysis partner, their interpersonal relationship, past emotional coping skills, financial stressors, and suitability of the home environment. Ms. Peace also described results of a home hemodialysis patient/partner survey. Although almost all patients reported choosing home hemodialysis therapy to gain a sense of control over their treatment, after being on home therapy patients stated that the major benefit of home hemodialysis was an improvement in their health. Hemodialysis partners gave the following advice: partners need to talk to and communicate with the patients, and do not feel guilty and or get mad at your partner because things do go wrong. Patients responded that they would advise other patients to: (1) put total effort towards their care, (2) take time to learn things right the first time, (3) speak to someone else who has been on home hemodialysis, and (4) stay calm.

George Harper, a retired high school principal, and 18-year home dialysis patient then delighted the audience with a description of “Home hemodialysis, the road less traveled. Why I chose home hemodialysis.” He described his illness and his choices. Early on he took charge, asked for a bigger dialyzer, and chose home dialysis as a therapy that would allow him to continue working and least affect his lifestyle. He credits his wife (his dialysis partner) with his long survival on dialysis, and he answered questions on why he had not chosen cadaveric kidney transplant. He talked about taking control of his treatment, thus avoiding the risks of in-center dialysis and underdialysis. He reported that he dialyzed every other day. The audience enjoyed his slides of traveling and performing hemodialysis in his recreational vehicle.

Judy Weintraub of Los Angeles, California began dialysis in April 1975 after her disease began in childhood. The audience appreciated the tale of her renal failure and her ability to cope. Ms. Weintraub switched to peritoneal dialysis 11 years ago. She described how she felt after the change from hemodialysis to peritoneal dialysis; she felt better and required no transfusions. Ms. Wientraub stated that she now knows that she gets the best dialysis, the highest quality care, and the most consistent dialysis possible, and takes control of herself at home. She argued for staff support 24 hours per day, 7 days per week. She drew a parallel between the new parent who calls the medical team frequently and the new home dialysis patient who calls the dialysis unit frequently, in contrast to the experienced parent and patient who still require support but call infrequently.