Dr. Spry estimates that of the 450,000 people currently on dialysis in the U.S., only about eight percent of those patients are getting their treatments at home. The other 90-some percent of hemodialysis treatments still occur at a dialysis facility.

The typical treatment time is three to four hours and there are usually three treatments a week. The issue with this set up is the patient often feels exhausted and it takes about six to eight hours to recover after each treatment. Dr. Spry is also a scientific advisor to an NIH study involving shorter daily treatments for two to three hours with a NxStage dialyzer the size of a lunch box. It weighs about 80 lbs, but is fully portable.


Healthy kidneys filter about 150 liters of blood a day, helping to eliminate urea and creatinine and other chemical waste molecules in the blood for an average weekly filtration of about 1,000 liters. Typical in-center dialysis clears about 60 to 80 liters. Home treatment is comparable, but instead of three times a week, it's five or six. More frequent treatments at home are showing some major improvements in patient outcomes, including fewer signs of depression, improved fluid control, decrease of sleep apnea, and fewer signs of depression. Some patients showed a 60 to 80 percent decrease in the use of blood pressure medication within the first six months.

"I think this is good stuff," says Dr. Spry. "It's a push as far as the amount of weekly treatments required, but early data shows that they feel better."

The study is scheduled to be completed by late 2010 and preliminary data indicates that more frequent treatments could improve life expectancy and perhaps even rival cadaver kidney transplantation - good news considering the average wait time for a kidney transplant is three to four years. However, the best outcomes for people with kidney disease are still associated with living donor transplantation.

With all of these pros, why have so few providers opted to send their patients home to dialyze? Here is the drawback - the initial expense of sending a dialysis nurse home with the patient to train them on the technology requires a lot of upfront costs, but Dr. Spry says it's cheaper as soon as the patient is all set up at home. Once the initial training costs are out of the way, those patients no longer have to come into the clinic to be treated and that saves on facility manpower.

"It's quite expensive initially, but after the initial cost, all I have to do is pay for the patients' supplies at home," says Dr. Spry. "I don't have to pay for any employees or nurses to care for them other than the routine monthly visits when they come into my office."

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