When it comes to hemodialysis, a medical procedure that removes excess waste, water and blood from the kidneys when they are in renal failure, the United States administers the treatment very differently than many other countries around the world. According to Dr. John Agar, an author of a new study in the Clinical Journal of the American Society Nephrology (CJASN), one place in particular where American dialysis differs is in his native Australia.
“We just want to pull American dialysis up by its bootstraps and make it better,” Agar explained during a recent visit to the States for a conference on this very subject.
Location and time are the distinguishing factors between dialysis practices in the United States and abroad. In the United States, Agar pointed out, dialysis treatments are limited in terms of where and when patients can access the treatment. “It's almost entirely facility-based and institutionalized,” he said. “Very little dialysis is done where patients actually like to dialyze. In Australia we dialyze very differently. We have a very large at-home population.”
Roughly one third of Agar’s current hemodialysis population self-dialyzes at home, and after experiencing the difference between facility- and home-based dialysis, Agar’s patients found the advantages were too good to give up. “One can dialyze as often as one likes, and that, generally, is more frequently than what is offered by facility dialysis in the U.S.”
Agar’s patients tend to dialyze about five times per week for longer periods of time, because they have the option of doing it through the night. Home dialysis allows for access to “a much gentler, more subliminal dialysis by increasing both hours and frequency and therefore reducing the brutality of the dialysis therapy,” Agar said.
But the convenience of at-home dialysis came with a set of what Agar called “unintended consequences.” In terms of power and water, hemodialysis is a resource hog. “When you have a patient who dialyzes in the dialysis center, it is the center's responsibility to pay for the quite significant and large water and power bills that accompany dialysis,” he said. “Our (home dialysis) patients were going back to work; they were feeling good; their rehabilitation was excellent, but their pocketbooks were hurting, and their budgets were being plundered by the increased power and water utility costs of dialysis.”
That’s when Agar and his team stepped in. Agar and his fellow researchers used this opportunity to study whether solar power could be harnessed to help decrease power and water bills stemming from home dialysis. The team of researchers from Greenlong Hospital in Victoria, Australia, discovered that solar power could help offset high utility costs and make hemodialysis treatments more environmentally friendly.
Agar attacked the water problem first. “Dialysis is water and power hungry,” Agar said. “It uses huge amounts of water — anything up to five or 600 liters of water per dialysis treatment.”
The researcher spent several years lobbying for a government-subsidized home dialysis program to help patients offset the costs associated with their healthcare demands. Agar and his team also worked to minimize water consumption through a process known as reverse osmosis reject water-recycling systems.
“The water that was used for dialysis wasn't just sent down the drain but was redirected for household uses,” Agar said. “Water can be reused for laundry, toilet flushing and perhaps the garden outside.”
The reverse osmosis worked so well, the hospital where Agar treats his patients implemented the process to help offset their own water costs. “We have plumbed it into ward toilets and janitor stations,” he explained. “If there's any left over, it goes to the gardens, and the same applies to our satellite dialysis centers.”
Today, about 100 liters of water get recycled every week for “our relatively small dialysis unit of 140 patients,” Agar said.
Power was the other issue Agar and his team faced. The researchers established a solar-assisted dialysis program that included four home dialysis machines. “We’re a sun-drenched country in Australia,” Agar said. “We have a system set up to save water and use alternative power sources like the sun. We metered our dialysis machines and we saw we could erect on our roof a solar array sufficient to power the dialysis-related equipment and the dialysis reverse-osmosis systems.”
Because the solar array is metered and connected to the national electrical grid, the researchers are able to track how much power they are using, as well as how much power they are directing to the grid. The researchers get paid for the power they donate to the grid and are charged for what they draw from the grid to run the dialysis-related equipment. The researchers found that after the first 12 months of the program, power costs were reduced by 76.5 percent.
“At the end of the day, we have a solar array sitting on our roof generating the amount of power that is roughly equivalent to what we use,” he said. “It’s generating a nice little income. We’re actually coming out ahead because we have free power and an income stream.”
The model Agar and his team have developed stresses both convenience (for the patient) and conservation, and it could provide the blueprint for imagining a more efficient – and overall more responsible – dialysis practice here in the United States.
Rita Flórez is a nationally published writer. Her work has appeared in GOOD and VenusZine.com, as well as a variety of regional newspapers and magazines.