Mary Epp awoke from a deep sleep to the shrill sound of her dialysis machine's alarm. Something was wrong.
It was 1 a.m. and Epp, 89, was alone at home in Marion Junction, Alabama. Epp has been on home dialysis since 2012, and she knew what to do: Check the machine, then call the 24-7 help line at her dialysis clinic in Birmingham, Alabama, to talk to a nurse.
The issue: Hours before, a woman who helps her had put up two small bags of dialysis solution instead of the large ones. The solution had run out.
The nurse reassured Epp that she'd had enough dialysis. So Epp tried to unhook from the machine, but she couldn't remove a cassette, a key part. A man on another 24-7 help line run by the machine's manufacturer helped with that.
Was the troubleshooting difficult? “Not really. I'm used to it,” Epp said, although she didn't sleep soundly again that night.
If Washington policymakers have their way, a growing number of older adults with serious, irreversible kidney disease will do home dialysis. In July, the Trump administration made that clear in an executive order meant to alter how patients with kidney disease are managed in the U.S.
Changing care for the sickest — about 726,000 people with end-stage kidney disease — is a top priority. Of these patients, 88 percent receive treatment at centers and 12 percent get home dialysis. By 2025, officials say, 80 percent of end-stage kidney disease patients are expected to receive home dialysis or kidney transplants. Older adults are sure to be affected: Half of the 125,000 people diagnosed with kidney failure each year are age 65 or older.
There are two types of dialysis that most kidney patients have: peritoneal, which requires an implanted catheter, or hemodialysis, which involves drawing blood and cleansing it with a special machine.
Home dialysis has potential benefits: It's convenient; recovery times are shorter; therapy can be delivered more often and individualized; and “quality of life tends to be much better,” said nephrologist Frank Liu, director of home hemodialysis at the Rogosin Institute in New York City.
But it isn't right for everyone. Seniors with bad eyesight, poor fine-motor coordination, depression or cognitive impairment generally can't handle this therapy, specialists note. And frail older adults with conditions such as diabetes, arthritis and cardiovascular disease may need significant assistance at home. Up to a third of patients who try home dialysis end up switching to dialysis centers, Liu said.
It takes determination
Jack Reynolds, 89, prides himself on being disciplined, which has helped him do peritoneal dialysis at home in Dublin, Ohio, seven days a week for 3 1/2 years.