African-Americans are nearly four times more likely than white Americans to develop kidney failure. That means tens of thousands of black Americans are waiting for a transplant and relying on dialysis while they wait.
Most go to a medical center or hospital for dialysis treatment but there's a push to get more patients to try treatment at home. WHYY/Newsworks joined a West Philadelphia grandmother to find out how home dialysis works.
Margaret Burns, 64, has two sons and two grandchildren. When her kidneys failed, Burns opted for peritoneal dialysis. A machine about the size of an old VCR sits on small cart beside her bed.
For people with end-stage renal disease, dialysis acts like replacement kidneys, filtering and cleaning the blood of toxins and excess fluid.
A permanent catheter carries dialysis fluid into Burns' stomach, then the chemical and sugar solution pulls wastes from the blood into the abdominal cavity. The body's own blood vessels act as a filter.
Burns does her dialysis for eight hours every night, while she sleeps. That's different from the hemodialysis that most Americans get at a medical center or hospital.
Burns tried hemodialysis for a few months when she first started treatment.
During hemo treatment, blood travels from the body through a needle into a machine and into a filter. The machine cleans the blood and returns it with a better balance of fluid and electrolytes. Most people go in for treatment three times a week. That regimen can be physically tough says Thomas Jefferson University nephrologist Stephanie DeLoach.
"Trying to drain three or four liters from the body in just three hours. That's an intense fluid shift for the body. Versus doing it overnight, or over six or eight hours. That gives the body a little more time to adjust and there are less drastic changes," DeLoach said.
DeLoach says early studies suggest that home dialysis patients may be healthier than people who get their treatment at a center. She and other doctors are encouraging more patients to try peritoneal treatment at home.
"Our kidneys work 24 hours a day, seven days a week, versus dialysis you just get spurts of kidney function three of four times a week at a spell. So if you could do it everyday, or if you could do it for six or eight hours that gives you more kidney function, and the better you feel," DeLoach said.
Managing dialysis at home is less expensive, so Medicare now offers incentives to dialysis companies that help patients make the shift.
Ideally, dialysis is a bridge to a kidney transplant, but many people, especially African-Americans, can wait years for an organ match. Margaret Burns says at home treatment keeps her on track. "To me it's freedom, OK. It just takes a routine. It takes somebody willing to say to themselves: 'I like being on this earth, and this is what I have to do,'" she said.
Still, DeLoach says any kind of dialysis is a hard sell. "A lot of African-Americans have kidney disease so a lot of us know somebody in our family who's been on dialysis, had a transplant, or had some other issue related to kidney disease or hypertension," DeLoach said. "Whereas a generation ago, it seemed like a death sentence people are increasingly aware of options for treatment."
"Then one visit he mentioned that his son was getting ready to finish medical school. We had a very somber conversation, and I said there's no way you want to miss your son finishing medical school. Why don't you give the dialysis a try, if you decide you don't like it you can just end it. But at least you can be there for something that sounded like a very important day for his family," DeLoach said.
The man tried peritoneal dialysis at home. Fast forward several years, the patient is doing well, his son is now a doctor in training.