New rules may increase patients on home dialysis


Rodney Sokoloski used to get up before dawn three times a week and drive two hours from his high desert home to the Los Angeles suburb of Torrance to get hooked up to a dialysis machine.

The blood-cleansing treatment was time-consuming and often left him feeling drained even before his workday began.

Not anymore. After four months of shuttling back-and-forth, the 61-year-old last year switched to doing dialysis at home every night while he sleeps. He starts it after dinner, wheeling the dialysis machine — the size of a carry-on suitcase — into the living room where he can watch TV or chat with his wife.

"It makes you feel like you're in control of your life," said Sokoloski, whose combination of diabetes and high blood pressure led to kidney disease.

Yet only about 8 percent of kidney patients do dialysis at home. Many don't know they can. Others are afraid to try it. And a limited number of places around the country offer training and support for home dialysis.

New Medicare payment rules that just went into effect could change that. The changes give dialysis clinics more motivation to control costs and raise the amount centers get to teach do-it-yourself dialysis.

As for the patients, Dr. Leslie Spry of the National Kidney Foundation says, once they "experience the difference between home and in-center dialysis most will not return to in-center treatment."

There are two types of dialysis that can be done at home. The older and more widely used method — peritoneal dialysis — uses the lining of the abdomen to clean out waste. Patients pour a fluid into a tube in their belly and drain it out several times a day, or a machine handles that while the patient rests — the approach Sokoloski uses.

A second, newer method is home hemodialysis. Blood is drawn through a tube from the arm and pumped through a portable machine where it is cleansed and returned to the body. Patients do this four to seven days a week for about 2 1/2 hours each time.

People who prefer home dialysis say it's more convenient, allowing them to set their own schedules and even travel with their dialysis machine. They also like the idea of cleansing their blood of toxins more often because they feel better and don't need to take as many drugs.

Dialysis clinics used to bill Medicare separately for costly medications such as the anti-anemia drug Epogen and often made a profit on it. Under the new payment system, centers get a flat rate for dialysis treatments, and certain lab tests and drugs including Epogen.

This bundling may spur the industry to take a closer look at home therapy since people who dialyze in their living rooms tend to take fewer drugs than those in centers, cutting costs, according to the kidney foundation and some doctors.