For many dialysis patients, there's no place like home
For many dialysis patients, there's no place like home

MIDWEST CITY — When Dorothy Oberkirsch's kidneys began to fail a little more than a year ago, she feared she and her husband wouldn't be able to visit their far-flung children, lake house or farm.

Kidney failure from diabetes meant Oberkirsch, 70, likely was looking at regular visits to a clinic for hours of dialysis. The illness also meant quitting work at her home health agency, and being tied for hours to a file cabinet-size dialysis machine was not the way she wanted to spend her retirement.

"There was no give, take, whatever,” she said. "There was no possible way we were going to get to see anyone again.”

Fortunately for Oberkirsch and her husband, Jim, that's a future they're no longer facing.

She is one of a relatively small number of Oklahomans who undergo kidney dialysis with a table-top machine at home. It's portable, with some effort, so their children, the lake house and farm are no longer out of reach.

"It changes your quality of life,” said Jim Oberkirsch, 66.

In the most common procedure, called hemodialysis, patients such as Dorothy Oberkirsch use a machine with a filter to clean their blood. Proteins, blood cells and other necessary components are too big to pass through the filter, called a dialyzer, and waste products and excess fluid pass through and are washed away.

The table-top machine from dialysis provider DaVita actually requires more frequent treatments than required at a clinic, but that's offset by the portability, being able to undergo treatment in an easy chair at home, and the fact that the home regimen is less tiresome.

Oberkirsch is treated for 2½ to four hours a night, six days a week. At a dialysis center, she would have to stay for four hours, three days a week.

But it's not easy. The learning curve is steep and the consequences can be severe if something goes wrong and isn't quickly corrected — blood begins to clot within minutes.

The machine has more than 900 codes that are detailed in an inch-thick binder. The couple attended classes to prepare for home dialysis.

"If you press the wrong button, there could be a major problem,” Jim Oberkirsch said.

"We'd like to change that as an industry,” she said. "We're going to do what we need to do to keep the patient at home,” she said.

Patients who undergo dialysis at home often are healthier, she said, adding that it's important for patients to have some control over their treatment.

"It's their thing, so to speak. If they come to the clinic, it's our thing,” she said.

"It is a very, very viable option for people who are at work, who don't want to take the time out of their day to come to dialysis. ... It gives them more freedom,” Hlad said.

Patients who prefer home hemodialysis need a partner, however, in case something goes wrong.

"We're trying to do in four hours what your kidneys do in 48 hours,” Dr. Chris Sholer, a metro-area nephrologist and DaVita medical director, said of clinic dialysis.

"The difference is like daylight and dark,” Oberkirsch said. More than once after undergoing clinic dialysis, she returned home and was too tired to make it to her bed.

Patients must follow a strict diet and severely limit fluid intake. They also must calculate their "dry weight” before undergoing dialysis; if they miss the mark, their blood pressure can drop and they can become dehydrated — like an athlete after a vigorous game.

"Charley horses are nothing compared to what it (dialysis) can make your toes, feet and legs pull,” Dorothy Oberkirsch said, referring to cramps.

In the past, the technique was uncommon because it was difficult to do and required the home to have a reverse-osmosis water system.

Now, the NxStage machines DaVita uses take hanging bags of saline solution.

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