Dialysis on the go

For some kidney patients, new portable equipment offers a world of freedom, eliminating the need to spend hours tethered to a machine at a medical clinic several times a week.

By RANDOLPH FILLMORE, Special to the Times
Published May 1, 2007

Rick Nare, 59, retired editor and grandfather of two, had never been on a cruise before. Ah, but what a good way to celebrate his March birthday, he thought.

He studied the brochures, picked the cruise line, and there he was -- in a lounge, then on the balcony outside his stateroom, looking out at the pink streaks of a Caribbean sunset. He sipped a tropical drink, read a bestseller and underwent a minor miracle: kidney dialysis.

Thanks to new, portable hemodialysis equipment, those with chronic kidney disease who require hemodialysis can have home-based or portable treatment instead of enduring long hours of dialysis in the clinic. Nare had brought his portable unit onboard.

An estimated 400, 000 Americans have chronic renal failure, or end stage renal disease, and must periodically cleanse their blood of toxins and excess fluid, a task normally carried out by the kidneys. Most of these patients must visit a dialysis clinic three days a week for three-hour sessions.

So for those who can take advantage of it, dialysis at home -- or in the middle of the Caribbean -- opens a new world.

"It's not for everyone, " cautions Nare, who lives in Tarpon Springs.

Before leasing his portable hemodialysis equipment -- the costs are reimbursed by Medicare, just as his clinic visits were -- Nare and his partner, Pete Petersen, first had to go through 90 hours of system training. This took place at Renal Advantage Inc. of Palm Harbor, where Nare had been receiving dialysis.

"You can't do it unless you have a helper, " said Nare. "It takes teamwork. It takes about as long as dialysis in the clinic, but doing it at home has given me a lot of flexibility and freedom."

At first, the task was a little daunting.

"After the first day of training, we came home and said, 'Nah, we can't do it, '" recalled Nare, who was diagnosed with end stage renal disease in 2003.

But Petersen, who is 58 and retired from a career in information technology, was quickly able to manage the system, the cartridge filters (about the size of a laptop computer) and the several feet of tubing.

He must also decipher and record the dialysis-in-process reports produced every half hour as the equipment does a system check, reporting how many liters of blood have been cleansed and the status of the whole process.

The procedure has become routine for them.

"It is a little stressful to learn, " concedes Cheryl Veilleux, director of Renal Advantage in Palm Harbor. She says her center has about 13 patients on NxStage Therapy, the portable dialysis treatment.

"Doing dialysis more often, however, is not as hard on the body. People feel better when they have treatments more often and more slowly."

Home dialysis may not cut costs, but having dialysis perhaps six days a week helps keep people out of the hospital, Veilleux said.

While undergoing treatment, Nare says, he "feels nothing, " not even the pressure that the system exerts drawing his entire supply of blood out and pumping it back in during the three-hour treatment.

Nare and Petersen left for Fort Lauderdale and the cruise toting the portable, TV-sized unit in its carrying case, along with a suitcase full of other supplies, such as syringes and Band-Aids.

The self-contained plastic cartridges containing tubes and filters (the equivalent of an artificial kidney) that load into the machine, as well as the liquid for cleansing, stored in sterile plastic bags, had already been delivered to the ship by NxStage.

The trip and dialysis went off without a hitch, and Nare is contemplating another cruise, to celebrate the big Six-Oh.

Randolph Fillmore is a Tampa freelance writer who specializes in medical and scientific topics.

Fast Facts: Dialysis treatment
Rick Nare uses the System One device developed by NxStage Medical Inc. For information, go to www.nxstage.com.