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Home-based dialysis

HAEMODIALYSIS is a troublesome but necessary treatment for those with kidney failure. But, writes Nadia Badarudin, there are other options.

ANYONE who has been diagnosed with kidney failure may feel he has little to look forward to.

There's a waiting list for kidney transplants. Meanwhile he would have to make regular visits to hospitals or haemodialysis (HD) centres - thrice a week - and stay "hooked up" for hours to an artificial kidney machine which will remove fluid and waste materials from his blood.

But there have been advancements in treatment options which have allowed kidney patients to lead a life closer to normal. Peritoneal Dialysis (PD) allows for more flexibility - to get treatment done in the comfort of the home.

National Kidney Foundation chairman Datuk Dr Zaki Morad Mohamed Zaher says that haemodialysis is the main dialysis treatment in Malaysia, with 92 per cent patients receiving this form of treatment.

"PD was introduced to patients from the government sector back in the 1980s. However, many are unaware of the home-based treatment, and it is still under-utilised despite its effectiveness and benefits. With the rising costs of HD, patients should be given an option - this is not only slightly cheaper in the long run but can also provide a better quality of life for patients."

He said the implementations of the PD First Policy in Hong Kong, Thailand and several other countries have resulted in good clinical and economic outcomes.


PD is a self-administered treatment that can be managed by patients at home.

In PD, a dialysis solution called dialysate is administered into the patient's peritoneal (abdominal) cavity through a soft tube called catheter. The peritoneal cavity is surrounded by a thin membrane or peritoneum which works with the dialysate to serve as a filter through which waste and excess water are drawn. The used solution is then drained from the abdomen and discarded.

Dr Zaki said there are two types of PD - the continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).

"CAPD requires patients to manually infuse the dialysis solution and perform solution exchanges four to five times a day. It takes about 30 to 40 minutes per procedure, and unlike HD, the patient is not connected to any machine and free to do his work or other activities until the next procedure," he said.

APD is a procedure in which the dialysis solution is infused and drained automatically by a special APD device while the patient sleeps at night.

"APD is particularly useful for children and active students, and both types of PD are ideal for those who are afraid of needles, or those not suitable for HD such as patients with heart disease or bad blood vessels in their hands," he said, adding that patients will be trained by qualified nurses on performing PD correctly and hygienically at home.


A 2005 study showed that PD is more cost-effective in Malaysia, "as it has been shown that the average costs for one life year saved were six per cent lower for PD compared to HD."

"Home-based treatment is always cheaper in the long run, and PD is practical and convenience for patients, especially the elderly who find it hard to travel to hospitals or dialysis centres," said Dr Zaki.

PD offers treatment options that can be fit into the patients' lifestyles. "PD allows patients to have a more liberal diet compared to HD, and most importantly, it gives the patients freedom to get dialysis treatment at home, work as well as while travelling or on vacation."

He said preventing kidney disease remains the ultimate aim in the long-run, but patients need options to cope with the disease.

"They should be given choices, particularly those that might help to improve their quality of life."


THE 19th Report of the Malaysian Dialysis & Transplant Registry 2011 stated that the number of new patients on dialysis in the country is on the rise, with slightly more than 5,000 new patients starting on dialysis in 2011. It also mentioned that the number of prevalent dialysis patients have increased almost three-fold from 9,034 (in 2002) to 26,159 (2011). Increasingly, sedentary lifestyles and poor eating habits have been cited as the cause.

By Nadia Badarudin