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Dialysis at night getting popular

By ELENA LESLEY
Published February 19, 2007


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After Joe Bockskopf's kidneys failed, regular dialysis sapped his energy and wasted his time.

Three days of each week, he sat for hours in dialysis centers, as machines sucked the toxins out of his blood.

Then, he'd go home to sleep. He often felt awful.

Sympathetic to the drawbacks of dialysis during the day, his doctor offered him an alternative: nocturnal dialysis.

The suggestion changed Bockskopf's life.

"Before nocturnal, it took everything I had just to drive home to sleep," he said. "Then the next day I could only do small things."

Now he's back to fishing and riding his motorcycle.

While nocturnal dialysis is prevalent in much of Europe, it has only slowly caught on in the United States. Several clinics in the Tampa Bay area, including St. Petersburg, already offer the programs and a new clinic is scheduled to open in Tampa this year.

Dr. Charles Prentice, medical director of the clinic in Citrus County where Bockskopf gets his treatment, applauds the spread of nocturnal programs in the region.

"There's nothing a daytime patient gets that a nocturnal patient doesn't get better," he said.

* * *

When a person's kidneys stop functioning, they have to manage the problem for the rest of their life. Kidney transplants, if available, generally last no more than seven years.

Many people turn to dialysis.

The dialysis equipment "is like a large washing machine for the blood," Prentice said.

But it's not as good as an actual kidney. While healthy kidneys function all the time, the "artificial kidney" created by dialysis runs only when patients are hooked to the machine.

For most people, that's three times a week for about four hours each session.

But when patients do dialysis at night, "we can run the blood through the pump at a slower speed," said Bridget Didsbury, Inverness clinic manager. "They get about eight hours on the machine, which is closer to a real kidney."

While patients get antsy having to sit for four hours worth of dialysis during the day, they can sleep through the eight hours at night, especially when they're in a clinic remodeled for the purpose.

Patients in the St. Petersburg office operated by Fresenius Medical Care North America, which also runs the one in Inverness, can drift off in a dimly-lit room full of oversized recliners. If they have trouble sleeping, they can browse the Internet or enjoy a wide selection of cable TV channels.

"Except for ESPN," joked Herbert Davis, 63, preparing for dialysis on a recent Friday evening. "They need to work on that."

Davis, of Gulfport, started on St. Petersburg's nocturnal program a couple months ago. He wanted to free up his days to find part-time work but has discovered the nocturnal dialysis also has health benefits.

"I feel better, much better," he said.

For those who have read up on nocturnal dialysis, that's not a surprise. Studies, mostly out of Europe, show that nocturnal dialysis can lower blood pressure, loosen dietary restrictions and even allow patients to take fewer medications.

Doctors in this field "always dream of something like this," St. Petersburg clinic medical director Dr. Gerald Rizzo said of getting to oversee his own nocturnal program.

* * *

Though many doctors believe it leads to healthier patients, and even longer lives, Medicare's flat reimbursement rates keep the procedure from being financially viable for most clinics.

Medicare "doesn't pay an extra penny for dialyzing twice as long," said Bob Loeper, regional vice president for Fresenius.

That makes nocturnal dialysis a risky undertaking for many clinics. Plus, there's no guarantee that, if you offer the service, people will be willing to sleep away from home.

"Certain people will never spend the night," Rizzo said. "Others want to live for the moment."

For interested patients, Fresenius has developed a model that fosters slow nocturnal growth. If a clinic has a large enough pool of patients interested in, and stable enough for, nocturnal dialysis, the company will invest the start-up costs.

Expenses and revenue eventually balance out, Loeper said. Though about 85 percent of dialysis patients are on Medicare, companies are also using their facilities for more hours and can treat more patients.

"Reimbursement is a negative incentive, but a positive incentive is using the clinic at night," Loeper said. "It's like having the night shift."

Rizzo sees the company's investment in nocturnal programs as the first step toward the ideal dialysis setup: at-home nocturnal.

The company already offers this service in some parts of the Northeast. Spouses or other people who live with patients are trained to do the dialysis themselves, and then homes are watched by a central monitoring system.

But whether at home or in-center, health care workers say they hope nocturnal dialysis continues to become an option for greater numbers of patients.

Those who have tried it, swear by it.

"Their labs improve, their general sense of wellbeing improves," Didsbury said. "We probably would have a riot if they had to go back to days."

Elena Lesley can be reached at elesley@sptimes.com.

[Last modified February 19, 2007, 00:58:17]


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