A new programme offered by New Zealand’s Counties Manukau Health (Counties Manukau DHB) is giving more time back to patients who need dialysis.
Nocturnal Dialysis was introduced at Middlemore Hospital earlier this year for patients experiencing kidney failure who require regular dialysis treatment.
Patients who dialyse at hospital usually receive dialysis for five hours three times a week, but by the time travel and set up time is included this essentially takes up the whole day. Under the nocturnal dialysis programme patients are now able to receive eight hours of treatment in hospital overnight while they sleep. This allows patients to get on with their lives during weekdays, including continuing to work and meet family commitments, according to renal consultant Chris Hood.
The programme has taken about a year to get up and running. To make it sustainable the patients selected are trained to set up the dialysis machines themselves and become more independent in their care. This has allowed the programme to run with no need for extra funding, Dr Hood says.
Under the programme, an area in the Scott Dialysis Unit has been set aside with beds for six patients. Recently this was extended from six to 12 patients The patients arrive at the hospital at about 8pm and after setting up settle in for eight hours of dialysis before finishing at 5am. Two nurses are present to monitor patients and help with the more technically challenging aspects of dialysis.
Dr Hood says the hope is that some patients will use this extra training as a kick start to achieving full independence and operating their dialysis by themselves.
“The benefits of Nocturnal Dialysis for patients can be huge. Many have work and family commitments which they struggle to meet with weekday dialysis sessions. This option frees up large chunks of their life,” Dr Hood says. “Many of the patients have also noticed that they feel much healthier as well”.
Dr Hood hopes to be able to expand the program as demand increases.
New Lease of Life for Patient Raymond Kamuta
These days Raymond Kamuta leads an active life. He is studying, does volunteer work and regularly hits the pool for aqua walking. But this wasn’t always the case.
Mr Kamuta, who is part of the new nocturnal dialysis programme at Middlemore Hospital, says when he first learned, in 2014, that he had kidney failure his response was shock, then denial.
“I was sort of like a rebel. I didn’t listen to the nurses. I didn’t go to my treatment. I still thought I was ok,” he says.
It was only once he started to feel very sick that he began to follow medical advice, but it wasn’t without its challenges.
“They [the nurses] gave me this brochure and it said ‘End Stage of Life’ and I thought ‘Oh my gosh I’m going to die now,’ until I spoke to one of the nurses and she explained to me as long as I follow the guideline, I will be ok.”
In the beginning Mr Kamuta was treated with dialysis for five hours at a time but a few weeks ago he began receiving eight hours of dialysis overnight at Middlemore Hospital and he says he is not looking back.
“When I first started Nocturnal Dialysis I was a bit shady about it because it is so long. But I have noticed that I am feeling better – like I can do things. I do a lot of walking now which was limited before and my breathing is perfectly fine.”
Mr Kamuta says having treatment overnight frees him up for his daily activities. “It gives me ample time to do what I want to do,” he says.
He is one of 12 patients arriving at Middlemore with blankets and pyjamas at around 7.30pm on Mondays, Wednesdays and Fridays.
Once the patients arrive they weigh themselves to check how much fluid they have gained over the last two days and then they are set up with the dialysis machine, leaving the hospital in the small hours of around 5am in the morning.
He says he has no difficulty sleeping in hospital and generally only wakes up once his treatment is finished.
As an added bonus he has become friends with the other five nocturnal dialysis patients – they’ve already had a lunch date and regularly share tips with each other about how to manage their condition. He is also very happy with the care he receives on the ward, especially from the charge nurse assigned to the ward, who he says makes him feel safe and at home.
Mr Kamuta says he understands he will likely remain on dialysis until he can receive a donor kidney.
“I’m happy with the machine, until there’s a donor, I’m happy as.
I go home [after treatment] and I am active. I get ready for work. I do aqua walking.
Those sorts of things I don’t take for granted anymore.”