By Jill Foran

When Zoeanne Smith received a kidney transplant in 1998, she was thrilled that her days of travelling across the city three times a week for inpatient dialysis treatments were over. “Those visits were so time-consuming,” recalls Smith, a child and youth care counsellor whose kidneys failed in 1992, when she was 24 years old. “It was such a long commute, the treatments were draining, and it took at least five hours out of my day each time.”

Two years after her surgery, however, her transplant failed. Gutted by the outcome and dreading the commute to a dialysis clinic again, Smith found hope when her doctors referred her to Humber River Health, where she enlisted in a homebased dialysis program that allows her to receive treatment while she sleeps.

OVERNIGHT TREATMENTS

In the late 1990s, Humber became one of the first hospitals in North America to establish a nocturnal home dialysis program, in part because the doctor overseeing the kidney program at the time, the late Dr. Andreas Pierratos, thought that long, slow treatments are gentler on the body, and allow for more waste and fluid removal. In the morning, people can go about their day with improved energy and less need for medication.

Humber does have in-centre dialysis, but having to come in three times a week for four hours is a taxing routine for patients with busy lives and personal commitments. Home dialysis, meanwhile, gives patients far more flexibility when it comes to maintaining an independent and active lifestyle. It also allows for more frequent and longer treatments, which, in turn, can lead to improved clinical outcomes. Despite home hemodialysis being more complex, and requiring more patient training, along with potential plumbing and electrical upgrades to a home, it’s the preferred method at the hospital. In fact, 18 per cent of Humber patients are on home hemodialysis, compared to the Ontario average of 5.1 per cent.

“At Humber, we’ve long been leaders in promoting the view that all suitable patients should be encouraged to choose a home dialysis method as their first treatment option,” says Dr. David Mendelssohn, Medical Director of the hospital’s nephrology program.

While home dialysis patients at Humber operate fairly independently, all need to visit the Home Dialysis Clinic every few months. There, a multidisciplinary team comprised of a social worker, pharmacist, dietitian and nurse clinician assesses them, and a nephrologist receives input from the rest of the team and addresses any issues. Should a problem arise between clinic visits, patients can contact the nurse clinician, who will either assist with the issue, refer them to a different team member or advise them to come in.

Dr. Mendelssohn notes that kidney disease can be silent, often caused by diabetes or high blood pressure. It’s important to keep kidneys healthy with a balanced diet and regular exercise. He also recommends people visit a primary care physician regularly for annual physical exams, and routine blood and urine tests to detect problems early.

MORE FLEXIBILITY

For Smith, now 56, the nocturnal route was the obvious choice, and for the past 24 years, she’s stuck to the same routine. “An hour before bed, I start the dialysis machine and set up. I put the tubing in place, take my blood pressure and other readings, then hook myself up and go to sleep,” she says. “In the morning, I disconnect, take everything off, put the machine to clean and go about my day.”

The regimen affords her more flexibility than she expected after her transplant failed. “I was able to go to school, and I can work full time because I always have my days free,” says Smith, who was the first person to conceive while on nocturnal home dialysis, giving birth to a healthy baby girl about two years into the program.

“There were no issues with the dialysis when I was pregnant or when she was born. I love the freedom this program gives me.”

Care in the community

Less travelling to treat complex conditions is always Humber’s goal.

Humber is always working to improve accessibility to high-quality kidney care. For instance, glomerulonephritis (GN) is a group of rare inflammatory kidney diseases that used to be treated only at certain academic hospitals. In 2020, however, Humber hired Dr. Laura Berall, a GN specialist, and opened its own GN clinic. Now these patients are cared for within their own community.

In May 2023, Humber Meadows Long Term Care (LTC) Home opened its doors as a new, fully integrated LTC home with 320 licensed long-stay beds. Located by Humber’s Finch campus, the facility features a variety of on-site care services, including a six-chair hemodialysis unit, run by Humber. “Patients at Humber Meadows no longer need to get in an ambulance and come to the hospital for their dialysis treatments,” says Dr. Mendelssohn. “They can get treatment on site, which is much more convenient.”

 

To read our full magazine, Care Closer to Home, click here.