Kidney disease is a common disorder in the United States, and many people diagnosed with a kidney disorder must receive kidney dialysis treatments. John Stokes, MD, a kidney specialist at University of Iowa Hospitals and Clinics, is conducting a study that may help lead to better results for some patients who receive dialysis. Stokes offers these comments:
How many people in the U.S. and Iowa receive dialysis?
Today in the United States about 350,000 people require dialysis treatments, and in Iowa about 2,500 patients need dialysis treatments.
We hear a lot in the news today regarding kidney-type disorders. Is this a situation where these types of disorders have increased over the last 10 to 20 years?
It is true that over the past 10 or 20 years, the number of people on dialysis has increased substantially, and the reason for that is largely due to the increased rates of diabetes, hypertension, and high blood pressure, which causes kidney failure. More and more people have these underlying problems and as a result are having kidney failure.
What are some of the factors that are leading to more diabetes?
I think probably the most important factor is that obesity and being over weight are increasing and that increases the risk of getting diabetes. Once diabetes starts in that setting, sometimes patients don't even know that they have it and may have it for many years before it's discovered. And sometimes when it's discovered, patients already have kidney damage, and once that kidney damage has started, it's very difficult to slow down or to stop completely.
What are their options for receiving dialysis?
People who have kidney failure to the point where their kidneys are no longer able to support their life, the first option is a process called dialysis. This is the removal of the waste products that the kidney ordinarily would do. With the help of machines and devices, the waste products that build up are removed. Without dialysis, people would die. So dialysis is lifesaving. Most people on dialyses go to a center and get dialysis through a machine. The technicians and nurses hook them up to a machine, their blood goes through the machine, and the blood is returned to the patient. A typical treatment lasts for three to four hours, maybe three times a week.
You are helping conduct a research study involving nocturnal dialysis. What is the purpose of that trial?
As the name implies, nocturnal dialysis is dialysis that's done at night and the idea is that our kidneys ordinarily work 24 hours a day, seven days a week. They essentially never stop. When someone's kidneys have failed, the dialysis procedure usually lasts three or four hours only three times a week, so the dialysis standard treatment, while being lifesaving, really only provides a fraction of the ability to remove the waste that a normal kidney would.
So we think that we could do a lot better than the standard, three times a week dialysis. We're testing the idea that if we provide dialysis all night long, six days a week, patients who require dialysis will do better than if they get the standard therapy three times a week for a few hours at a time. The idea is if we remove a more waste products by longer dialysis and more thorough dialysis, then the patients will be better, they'll be happier, they'll perform better.
Can we assume that eventually people could do this in their home, they wouldn't' have to go to a center?
Yes, that's the general idea and home-based dialysis therapy is already here. We have many patients in our program that do their dialysis at home. And doing it at home at night would be, of course, the most convenient.
Our study is designed to test whether doing dialysis at home either using conventional methods or doing dialysis at home all night, six nights a week, provides better treatment. This is different than going to a center and getting dialysis. We're testing whether home intensive dialysis, the nocturnal dialysis, is better than home standard dialysis.
Who is eligible for the study?
Almost anybody on dialysis is eligible. Of course we require they be adults, and have to be on dialysis. We also require they have a partner that lives in the same dwelling so that that partner can help, at least a little bit, with some technical aspects.
Where can people obtain more information about the study?
We're happy to talk to anybody who would like more information. The University of Iowa Dialysis Unit number is 319-356-4003 and people who are just interested in home dialysis can pull up on the Web some general explanations about home dialysis. Try Googling 'home dialysis central.' |
