Friday, 19 October 2012

Talking improves your dialysis!

I had to read the article twice to be sure I wasn't missing something. But talking with your doctor during dialysis seems to improve the end result!

An article in eAJKD reports on a presentation at the National Kidney Foundation in May 2012. Here is the video interview with the lead researcher.

There's an abstract from the presentation available as well

Medical staff having a general conversation with patients for anywhere from 5 - 30 mins (but the actual time doesn't seem to matter much, 5 - 10 mins is perfectly okay) was found to be beneficial. "We found that just 'talking' about non-treatment issues was positive," said lead researcher Judith Beto from Loyola University in Illinois, USA.

Chronic hemodialysis education may result in boredom and disinterest, meaning patients may struggle with noncompliance secondary to depression, explain Beto and team.

The health educators just talked about living with hemodialysis in general, without trying to set an educate the patient goal of any sort.

The research showed that 84% of dialysis patients who received what was called “talking control support therapy” had at least one health improvement activity. The talking between the patients and the techs in the study was more like talking between friends rather than the kind that often occurs in dialysis clinics, with the tech just lecturing the patient for bad lab values. Both the worker and the patient shared information about themselves on a more personal level. The talking also covered issues such as life with dialysis.

"Talking control" is a cognitive behaviour, similar to befriending, which has been studied in depressed older populations in the primary care setting, say the researchers, who believe their findings are the first to use the technique in a dialysis population.

So, next time you're in for dialysis, or monitoring a patient of dialysis, have a chat!

Monday, 8 October 2012

Home Dialysis Option

I've just read an article, dated 4th October 2012, that says home dialysis is now an option for some dialysis patients. Pardon? It's been an option for a while, hasn't it!

A recent article in Clinical Journal of the American Society of Nephrology highlights the lack of acceptance of home hemodialysis, despite frequent claims that this is a cost effective solution. Newer home hemodialysis systems are easier for patients to use, but it suggests that many patients and physicians have little experience with home dialysis and so don't ask or prescribe it. The article hopes to overcome any barriers to using home dialysis

At the present moment, less than 2% of US dialysis patients are using home dialysis, partly because of the time to train the patient in its use, and a doctor and dialysis center willing to use the method.

But everyone involved in the chain of events from diagnosis to implementation is used to the standard idea of visiting a dialysis clinic at regular intervals. However the home option is cheaper and evidence is beginning to suggest that patients who can stick to the regime are healthier, the researchers said. One wonders why the insurers who are paying for treatment haven't spotted this option.

Many studies have shown that peritoneal dialysis is within the ability of many patients, and home hemodialysis units can also make life easier of the user. Including making holidays more practical.

But home dialysis does require a fair bit of commitment by the patient, and may not suit everyone. A little bit of effort to stick to the hygiene standards, a dedication to not taking short cuts or skipping a session. Not difficult, really.

But less than 2% of users out of almost 500,000 US dialysis patients says something is wrong. Are doctors hesitant to recommend it? Unfamiliar with the concept? Or just going through the same old routine of recommending a dialysis clinic with which they might have a financial arrangement?

Back in September 2011 we reported on a Scottish dialysis patient who undertook a long distance canoe trip, along with his portable dialysis unit, to raise awareness and money to fund more such machines (at the time there only 2 such machines in Scotland and about 70 in England).