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By Leslie Shepherd - The Home Dialysis Program always said that when it had 100 patients who were receiving dialysis at home, it would have a big celebration. But before the party could be held in April, the number had risen to 115 patients and is still climbing.

“It’s more than just a number, since of course there is a patient and a personal story behind each one,” said Liz Anderson, the clinical leader manager for the Kidney Care Centre, Home and Satellite Dialysis Units. “But it is an important milestone for us 25 years after the home dialysis program began at St. Michael’s.”

Anderson attributed the accelerated growth in the Home Dialysis Program over the last two or three years to four things:

• A urologist dedicated to the program, Dr. Jason Y. Lee, for peritoneal dialysis catheter insertions. Dr. Lee surgically implants the catheter in advance, and when the patient is ready to begin dialysis, Dr. Jeffrey Perl, a nephrologist performs a minor surgery to bring the buried portion to the surface. By burying catheters in advance, the patient has their access already in place when it’s time to begin dialysis and dialysis can be started in a more timely fashion.
• A dialysis co-ordinator/nurse navigator, Mina Kashani, dedicated to the program, guiding patients through dialysis options and their journey if they choose home dialysis
• The program now treats patients from Toronto East General Hospital, which does not have its own home dialysis program
• A case manager in charge of daily clinical operations, Fatima Benjamin-Wong

The program currently has 20 patients on home hemodialysis, where their blood is filtered through a machine that eliminates impurities and fluids. Eighteen of them do “conventional” dialysis three times a week, while two do nocturnal home dialysis, which is performed for six or eight hours while the patient sleeps at night.

Ninety-five patients have chosen peritoneal dialysis, in which their abdominal lining, or peritoneum, acts as a membrane across which fluids and impurities pass. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out through a catheter inserted in the abdomen. This can be done manually, during the day, while patients go about their normal activities. But most use a machine to fill and empty their abdomen three to five times during the night while they sleep.

The Home Dialysis Program is also celebrating a physical expansion. It recently received approval to hire two additional nurses and it’s acquiring additional space on 2 Shuter for a satellite clinic to conduct peritoneal dialysis training. It has also started seeing some patients in Huntsville and Parry Sound via telemedicine, reducing their travel and financial costs. Nurses in the program made home visits totaling 700 hours last year.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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