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On March 11, we celebrate World Kidney Day. The theme of this year’s celebrations is “Live well despite kidney disease”. How to take care of the health of these organs in times of a pandemic? What are home dialysis and remote patient monitoring?
Kidney care during a pandemic
Chronic kidney disease is often referred to as the silent killer. According to statistics, about 4,2 million people suffer from it, and as many as 90% of them are not aware of it. This is because the condition develops slowly, initially without any specific symptoms.
For fear of infection with the SARS-CoV-2 virus, many patients give up preventive examinations at the nearest health center. Kidney abnormalities can be detected with basic urine and blood creatinine tests. It is enough to do them once a year. Unfortunately, experts are alarming that an increasing number of patients with end-stage renal disease are visiting their offices. In such cases, it is necessary to introduce renal replacement therapy, i.e. dialysis, and in the future – organ transplantation.
Therefore, undergoing preventive examinations is imperative to detect kidney disease at an early stage. Everyone should remember about annual tests, especially people suffering from diabetes and hypertension, as well as those with a family history of kidney disease.
It is also worth remembering that advanced kidney disease increases the risk of developing other, no less serious conditions, including heart disease, strokes and even sepsis. Patients diagnosed with chronic kidney disease, and in particular those undergoing dialysis, have a greater risk of infection and severe COVID-19 transition.
Modern peritoneal dialysis and remote patient monitoring – an opportunity for patients receiving renal replacement therapy in times of a pandemic
When we think of dialysis, the most common image is that it takes many hours away from home. I am talking about hemodialysis, which is the dominant method of cleansing the blood of harmful and unnecessary metabolic products. Patients often complain that the necessity to undergo dialysis completely destabilizes their daily life.
The average duration of the procedure is 4 hours, and is most often repeated 3 times a week. Adding to this travel time, it is not hardly surprising that for people with kidney diseases it can be a big obstacle. It is even more difficult in the era of a pandemic, when we try to maintain an appropriate social distance and care for proper hygiene. The solution to this problem may be peritoneal dialysis, performed at the patient’s home.
The latest data shows that around 20 of dialysis patients in Poland, only over a thousand use the option of peritoneal dialysis, despite the fact that 78% of patients who qualify for renal replacement therapy do not have absolute contraindications for starting treatment in this form.
Since the WHO announced a global pandemic in March 2020, many health authorities have issued recommendations to administer home dialysis in eligible patients. This not only allows you to continue treatment, but also reduces the risk of infection with SARS-CoV-2. The patient does not have to stay in a dialysis center and has no contact with patients who may be a potential source of infection.
There are two options for peritoneal dialysis: daytime and nighttime. In many cases, the night option turns out to be much more convenient – the so-called automatic dialysis with a cycler. The patient goes to sleep as he does every night, and the cycler performs the entire procedure during sleep. It is not only convenient, but also safe. In addition, the entire procedure can be monitored remotely.
The cycler itself sends information about each procedure to the Peritoneal Dialysis Outpatient Unit, so the patient does not have to remember to keep a patient’s diary. Thanks to remote monitoring, treatment data is sent to special software, where they are saved. A properly developed algorithm informs the doctor if there was anything going on during dialysis that should attract his attention. Thanks to this, it can react quickly in the event of any irregularities.
In home dialysis, the exchange between the dialysis fluid and the patient’s blood occurs all the time (by osmosis), which is a more physiological process. The work of the artificial kidney in the dialysis center is limited only to the duration of the procedure. Another advantage is the ability to travel. Dialysis fluids are delivered to patients anywhere, which increases the comfort of movement. You just need to take your dialysis equipment with you, the cycler.
Peritoneal dialysis is worth considering as the first form of renal replacement therapy. First, it is more comfortable for the patient and does not significantly affect the comfort of his / her life. Second, the diet for people on peritoneal dialysis is much milder. Patients undergoing hemodialysis in the center must pay attention to a significant reduction in fluid consumption, as they cleanse of fluids only during dialysis (2-3 times a week).
Modern peritoneal dialysis performed at home is a completely safe and effective procedure. Moreover, it increases the survival rate of patients with chronic kidney disease and also helps maintain a good quality of life. In addition, it allows you to save time due to the elimination of the need to transport to the selected center. Thus, the patient gains time to continue their professional work, develop their passions and rest.
Expert opinion
We asked prof. dr hab. Beata Naumnik, head of the XNUMXst Department of Nephrology and Transplantology with the Dialysis Center at the Medical University of Białystok, nephrology consultant of the Podlaskie Voivodeship.
“In times of pandemic, peritoneal dialysis is the method of choice. This is because it makes the patient independent of the dialysis center. This is a fundamental benefit because the collective transport itself takes place 3 times a week. In addition, the center has several stations where hemodialysis is performed. This increases the risk of infection with the SARS-CoV-2 virus. Patients undergoing peritoneal dialysis at home have better established hygiene and sanitary habits, which is an additional advantage in the time of a pandemic.
In a training course of at least 2 weeks, they are taught not only how peritoneal dialysis works and what to expect during the procedure, but also the importance of thoroughly washing hands and applying masks. As a result, they become more aware of threats and more attentive. Statistical data informs about the advantage of using peritoneal dialysis over hemodialysis.
In Podlasie, at the end of 2020, there were 376 chronically hemodialysed patients, while only 40 patients used peritoneal dialysis. 83 hemodialysis patients contracted SARS-CoV-2 virus, while those undergoing peritoneal dialysis at home only 4. There were 17 deaths in the hemodialysis group, while no deaths were reported in the peritoneal dialysis group.
Nationwide, deaths of patients with chronic kidney disease undergoing home dialysis are isolated and most often occur in patients with multiple comorbidities. It should be remembered, however, that not every patient can undergo peritoneal dialysis for purely medical reasons.
The option of remote patient monitoring is a great help. He has the choice of whether the cycler is to be equipped with a special attachment or not. All my patients are currently under remote monitoring. It is convenient for both the patient and the doctor. Data on the course of the procedure is sent directly to the clinic. If the doctor notices any irregularities, we can remotely reprogram the cycler and we contact the patient by phone.
Thanks to this, the patient can benefit from the new, improved program tailored to his needs during the next dialysis. It is activated automatically. Home dialysis is not only safe and effective, but also reduces the frequency of visits to the dialysis center. »