Introduction
Chronic kidney disease (CKD) affects millions worldwide, and end-stage renal disease (ESRD) is a serious and life-threatening consequence. In most cases of progressive kidney disease, there comes a point when the remaining nephrons are not enough to maintain the organism’s optimal condition. The load falls on these remaining nephrons due to terminal renal failure. It can occur quickly and unexpectedly, and dialysis is the medical intervention that replaces kidney function, allowing patients to live.
For most patients, the most significant change from their previous lives is the time they devote each week to dialysis sessions. However, modern medicine and dialysis techniques make it much easier to maintain personal freedom in organizing one’s daily life. Although center-based dialysis has traditionally been the primary treatment option, home dialysis is gaining popularity as an alternative. Due to the higher quality of life, greater freedom, nurse support, and lower risk of COVID-19, receiving dialysis at home can be a more suitable option for patients than in-center dialysis.
Freedom of Patients and Caregivers
Patients with end-stage CKD who need renal replacement therapy often do not know that not only the duration of life but, correspondingly, its quality depends on the chosen method of CKD. Numerous observational studies have shown that patients on home peritoneal dialysis who effectively utilize remote monitoring and telemedicine can achieve improved clinical outcomes (Lew 95). At the same time, there is another point of view because such analyses are not randomized.
Participants who received at-home hemodialysis treatment may be younger and have fewer health problems, which explains the improvements in observed outcomes (Lew 95). Opinions on home dialysis differ sharply, with some arguing that it should be performed under supervision. Critics argue that many patients are incapable of self-care and that any interventions directly affecting health should occur within a medical setting (Lew 96). At the same time, home dialysis has strong supporters due to its advantages.
Home dialysis offers patients greater freedom and control over their lives, allowing them to plan their treatment around their daily schedule. The patient can choose a treatment schedule that provides the flexibility to maintain social, school, work, and life activities (Fresenius Kidney Care 1b). This degree of adaptability is critical for patients with hectic schedules or those who want to continue pursuing their interests and hobbies despite their diagnosis. Individuals can focus more time and energy on other areas by choosing home dialysis. It can help patients maintain a higher standard of living and freedom.
Moreover, commuting to a dialysis center several times a week can be a burden for some individuals, especially those living in rural or remote areas. It can harm care standards, as patients may be more likely to miss or postpone procedures. Thus, the main advantage is the increased comfort and ease of use, as dialysis can be performed at home without needing regular medical clinic visits for the procedure.
The equipment used is less bulky than hemodialysis equipment and can be transported with the person if they wish to travel or move around (Himmelfarb 574). It is essential to consider how dialysis treatment will impact patients, their ability to lead daily lives, and the availability of healthcare resources, which have undergone significant changes since the onset of the pandemic.
COVID-19-Related Issues
Patients with CKD are a particularly high-risk group for COVID-19 infection and high mortality in the development of the disease. It is because CKD is caused by major population diseases and older age, contributing to the high morbidity and mortality from COVID-19. Among the three groups of patients with CKD: those who do not need renal replacement therapy, patients with a kidney transplant, and patients receiving dialysis treatment, it is the latter group that causes the most difficulty (Hsu 1570). They cannot be stopped on therapy and have a high risk of a more serious course of the disorder caused by coronavirus infection.
Therefore, taking all possible measures to reduce the risk of infection is especially noteworthy. Studies confirm that the dialysis procedure within a medical setting is completely safe if preventive measures are taken in hospitals, during transport, and at home (Hsu 1571). At the same time, in these days of pandemic danger, people with chronic kidney failure have a special problem: being unable to stay at home because of forced care.
Instead, for numerous patients with renal failure, a solution to this problem could be offered that would provide more peace of mind and the ability to significantly reduce the very high risk of infection. According to research, 46 of 1,024 (4.5%) people on home dialysis have been diagnosed with COVID-19 (Hsu 1571). The prevalence of COVID-19 among dialysis patients at the center was significantly higher. Reducing the likelihood of diseases such as COVID-19 is one of the benefits of home dialysis. Being in the clinic constantly significantly increases the risk of disease among vulnerable patients. Home dialysis is safer and can be accompanied by medical care, regardless of the location.
Nurse Support
One of the most significant controversies about home dialysis is the need for ongoing medical monitoring and access to care. Proponents of the procedure in a medical institution emphasize that dialysis requires a multidisciplinary team and the control of the entire process (Himmelfarb 574). The doctor and the nurse play a vital role as the most crucial subjects in the treatment process.
The physician prescribes the dialysis regimen, monitors complications, and provides medical care. At the same time, the nurse monitors the patient’s overall condition, educates them about dialysis, and explains how to maintain their health (Himmelfarb 574). Moreover, they supervise the dialysis procedure and administer the necessary dialysis medications. It makes constant access to a nurse or physician a necessity.
At the same time, the modern world is characterized by technological developments that enable treatment to be conducted at home while remaining under close medical supervision. The patient has access to a nurse via phone or the Internet at all times. Moreover, this possibility is not time-limited, unlike the dialysis process in the center. It is especially important if the patient has medication-related problems or side effects (Fresenius Medical Care 1a).
Patients undergoing dialysis at the center typically have access to healthcare providers only during scheduled treatment periods. Thus, individuals with effortless access to healthcare providers suggest that home dialysis can offer a more patient-centered approach, prioritizing patients’ needs and desires.
Conclusion
Therefore, home dialysis offers greater ease, freedom, and the potential for improved patient outcomes, including a lower risk of illness and easier access to medical professionals. For a significant number of patients with end-stage renal failure, home hemodialysis is an excellent alternative to dialysis center treatment. This treatment option offers greater flexibility in scheduling procedures and provides more freedom in daily life.
As a result, patients do not have to give up their daily routine after undergoing home dialysis, which makes them feel emotionally and physically better. It is essential to note that the COVID-19 pandemic has highlighted the potential benefits of home dialysis, particularly in reducing the risk of infection.
Works Cited
“Home Dialysis: Which Option Is Right for You?” Fresenius Medical Care, 2019.
“Why Choose Home Dialysis?” Fresenius Medical Care, 2019.
Himmelfarb, Jonathan. “The Current and Future Landscape of Dialysis.” Nature Reviews Nephrology, vol. 16, no.10, 2020, pp. 573–585.
Hsu, Caroline M., et al. “Epidemiology and Outcomes of COVID-19 in Home Dialysis Patients Compared With In-Center Dialysis Patients.” Journal of the American Society of Nephrology, vol. 32, no.7, 2021, pp. 1569–1573.
Lew, Susie Q., and Neal Sikka. “Operationalizing Telehealth for Home Dialysis Patients in the United States.” American Journal of Kidney Diseases, vol 74, no.1, 2019, pp 95–100.