Commentary: At-home dialysis not the right choice for everyone

By Frank Calio

In response to Peter Roff’s Commentary, “Rethinking kidney dialysis in the age of COVID-19” (Oct. 10) and the costs associated with treatment, his position — that policymakers should pursue solutions arising from innovations that lower costs and improve patient care — sounds great in theory. But in reality, as a dialysis patient myself going on three years, his recommendation for home dialysis could be dangerous and life-threatening.

As stated in his post, there are two types of dialysis: in-center hemodialysis — which he mentions is very expensive, mainly because of high overhead, rent, staffing, supplies, etc. — and home hemodialysis, where you do everything yourself, at greater savings to Medicare.

My bride and I researched both options. Home dialysis appeared the best way to go at first. Here is what is needed for home care: A must is a bedroom and bathroom downstairs or make one for your machine, because tubing is required for you to be able walk around the house, while attached to the kidney machine. You may need plumbing and electrical work.

Another room is needed for a month’s supply of oversized products, one for each day of the month. If you have to store them upstairs, that means bringing the boxes up and down the steps.

A patient needs a partner to train with, and we found the partner is as important as the patient, because if anything goes wrong, help is needed. That meant my bride would have to hang with me during treatments.

We heard from a few patients and families of the risk of infection, some when deaths occurred, others when it took months to recover.

You have more freedom with home treatment, which is a plus. Treatments can be done daily, or two-to-three-hour treatments can be done four to six times a week.

I ended up choosing in-center treatment for the following reasons: During my four-hour, three-day-a-week treatments, I feel comfortable knowing my clinic is staffed with a nurse or two and four technicians. I am monitored by professionals. Several times, my machine has malfunctioned, and help was there. What if I had opted for home dialysis?

Recently, I have been having blood pressure issues. When it’s running low, the remedy is to adjust the flow. How would I or my wife know how much to adjust? The same with cramping, when they must cut back on my fluids.

I have witnessed other patients who have had chest pains or illness, and within minutes, the paramedics or emergency medical services personnel are on-site. I feel safe.

Having to be at the center at 6 a.m. means early to bed and up at 4, but Tuesdays, Thursdays and weekends are free days to do as I please.

As far as his fears of contracting COVID-19 because we are in contact with others, I feel as safe in my clinic as I do in my own home.

Each machine and chair is cleaned after each patient use, and our temperatures are checked when we enter and leave the building. Masks are a must. Our chairs are distanced according to federal regulations. Staff changes their gloves each time they touch a patient or machine or whenever needed.

Patients come from all over, and we’ve never had a problem.

If there is doubt, there is an insolation room for the patient, or they are sent to the hospital.

Mr. Roff points out that in 1973, 40% of all kidney dialysis was done at home. In 2020, that number is 10%. He blames a 1972 law that made Medicare the entity responsible for dialysis payments, regardless of need.

Well, since I have been paying into Medicare for years and still do, I think in-center care is a choice I am entitled to make and not the government.

Medicare services have been cut enough under this administration. We don’t need further government regulations.

Frank Calio lives in Laurel.