Our kidneys work hard every day to get rid of waste products such as water, acids, potassium, and other things, which keeps us healthy. Sometimes the kidneys can get so damaged that they can no longer meet the needs of the body. People can suffer from kidney disease or even kidney failure. At this point they may need to begin dialysis, which is a process where a machine helps get rid of these toxins and waste products from the blood of the patient essentially cleaning their blood.
While dialysis is not new, currently available machines and advanced technology have allowed for different methods of implementation, such as home dialysis. Listen to an interview with Peggy Bushey, nurse and site supervisor for dialysis at the University of Vermont Medical Center. A transcript of the interview is included below.
UVM Medical Center: Our kidneys work hard every day to get rid of waste products such as water, acids, potassium, and other things, which keeps us healthy. Sometimes the kidneys can get so damaged that they can no longer meet the needs of the body and those people can suffer from kidney disease or even kidney failure. At this point they may need to begin dialysis, which is a process where a machine helps get rid of these toxins and waste products from the blood of the patient essentially cleaning their blood. While dialysis is not new, currently available machines and advanced technology have allowed for different methods of implementation, such as home dialysis, and we’re going to hear about that and other things about dialysis today from Peggy Bushey. She is a nurse and site supervisor for dialysis here at the University of Vermont Medical Center. Thanks for coming.
Peggy Bushey: Good morning, thank you for having me.
UVM Medical Center: So we should start from the beginning and explain more about dialysis and who would need it.
Peggy Bushey: So our patients essentially have lost their kidney function and they still need to get rid of the fluid and toxins in their body, so they come to us three to four times a week. Part of the dialysis machines and setup is what we call an artificial kidney. It’s essentially a filter that their blood is circulated through and we’re able to remove the amount of fluid that needs to come off their body that they’ve built up and also the toxins, so they’re able to feel better, think better, the heart’s able to work better, and essentially be able to live.
UVM Medical Center: And it’s a kind of a long process, right? One dialysis session lasts how long?
Peggy Bushey: A dialysis session lasts between three and five hours and the patient’s coming to us three to four times a week depending on how bad their symptoms are.
UVM Medical Center: And are all of these folks waiting for kidney transplants, or are not all of them candidates for that?
Peggy Bushey: All of our patients are referred to the transplant program and are evaluated. Currently we have about 20% of our patients who are active on a transplant list. Some patients feel that the complications of transplant might be something they really don’t want to deal with, that they would just rather maintain the dialysis treatments. Some folks aren’t candidates, either due to age or other medical problems or diagnosis.
UVM Medical Center: Is there a most common cause for kidney failure or one that’s getting more common?
Peggy Bushey: High blood pressure, diabetes, I’d say those are at the top. There’s polycystic kidney disease, which are cysts on the kidneys. That’s usually a genetic problem, familial problem, but I’d say based on our patient population, diabetes and high blood pressure.
UVM Medical Center:Which are very, very common and diabetes is growing all the time.
Peggy Bushey: Absolutely and I think that folks don’t realize the importance of really monitoring their insulin or their blood sugars and also really looking at their blood pressures. I know they say that’s a silent killer and our patients who wind up on dialysis, a lot of them say, “I wish I would’ve paid more attention.”
UVM Medical Center: Because there are things that you can do about blood pressure for sure. Medications are pretty effective but diabetes, once it gets started it’s kind of hard to control isn’t it?
Peggy Bushey: You are supported through your endocrinologist or through your primary care physician. There is insulin. There is monitoring, diet, weight control. Things that we really don’t want to acknowledge but they’re there, very important, and they do prevent really the complications from diabetes. Not all of them can be prevented but if you can do something to keep things at bay, it’s really important.
UVM Medical Center: I learned a few years ago about some of the great work you folks do here in infection prevention. You zeroed-in on what could be any of the possible causes and essentially eliminated infections and did work even with the Centers for Disease Control to pass along what you had learned here to other dialysis centers.
Peggy Bushey: Yes, back in 2009 our infection prevention colleague Sally Hess worked very closely with us and really woke us up to the opportunities that were available to decrease infection rates in dialysis. One of the big avenues of infection, or opportunities of infection, are dialysis catheters.
UVM Medical Center: So these are folks who have like a permanent IV?
Peggy Bushey: Right, it’s a central vein catheter. It’s in the upper part of their chest and it actually goes directly into the superior vena cava to the heart. Way back when, it was almost expected that if you had a catheter, a dialysis catheter, that you would at one point get an infection. Back in 2009 the CDC recognized that infections in dialysis were a very big cause of hospitalizations and deaths. So we really took a closer look at it.
UVM Medical Center: And so how do you think you were able to be so successful with it?
Peggy Bushey: One of the things that we did was, again, to recognize that that was an issue and to become more aware of it. The second thing we did and to our benefit and to our patients benefit, was to join forces with the CDC. Actually back then they started with a very small group. It was 16 facilities throughout the United States. We met in a small conference room down in Baltimore and we brainstormed about dialysis infections and realized that there was no central repository for best practices and that there was really no place to go to for resources on how to prevent infections.
UVM Medical Center: So this is part of what you developed with the CDC and these are guidelines that were distributed throughout the country, right?
Peggy Bushey: Yes, over the years we went from having nothing to having a robust website with many tools, audit tools, resources, and guides for dialysis facilities to decrease infections. And we’ve actually seen from the beginning a drop in infection rates by about 75%.
UVM Medical Center: You’re listening to Peggy Bushy. She’s a nurse and site supervisor of home dialysis at the University of Vermont Medical Center. We’re talking about dialysis, giving you the ABCs of that, and this would be the perfect opportunity to talk about home dialysis. This is something that’s becoming more common?
Peggy Bushey: Absolutely. Actually when dialysis first became a modality of treatment, folks had to go home and dialyze. There weren’t dialysis centers as we know them now and then the move went to really bringing patients in so we could monitor them, thinking they could get better care if they had medical caretakers and over the course of I’d say the last 20 years the focus has turned around now. We’re seeing that patients can dialyze at home. They can dialyze safer. They can dialyze gentler. There has been new equipment introduced that allows for a slower gentler dialysis. There’s the hemodialysis and then there’s peritoneal dialysis, which is a bloodless dialysis.
UVM Medical Center: Explain that.
Peggy Bushey: There’s a catheter that sits in the belly and you’re able to instill dialysate, or fluid into the belly. It sits there for a while, absorbs the extra fluids and toxins, and then you drain it out. Patients can do that manually a few times a day or they can go on a cycle at night for about eight hours where a machine would do it for them and then just fill their belly during the day. Again, absorb all the toxins and fluid and drain in the evening.
UVM Medical Center: So can the patients handle all this themselves or do they have somebody coming in with some medical training to help them with that, particularly I’m thinking about the infections?
Peggy Bushey: If the patient chooses hemodialysis at home, they would have to have a caregiver. Somebody that would watch them because they are on a dialysis machine with about a unit of blood circulating through the machine at all times so you’d have to be there to watch for drops in blood pressures or disconnections or any other symptoms.
You really have to have somebody right there to watch you and to initiate any intervention that would be necessary. The patient and the care partner are trained here at the home dialysis clinic. It takes about three to four weeks for the patient and the caregiver to feel comfortable enough to go home. Our home dialysis staff, which is very, very dedicated, makes a home visit the day the patient goes home and works with the patient and the caregiver at every step along the way. If they need more support they’ll visit the home again. If they need to come back in to get more training, we offer that too.
The peritoneal dialysis, or the bloodless dialysis, takes about a week really to pick up the technique and the patient does not need a caregiver. Instead of coming into a dialysis center three times a week where, again, they get kind of rung out, they’re able to dialyze at home four to five days a week –shorter dialysis sessions. So it really works more like their kidneys. We found that the infection rates are lower. Hospitalization is lower. Because patients dialyze more or less on a pretty daily basis, medications and diet restrictions are just about dropped off. So the home dialysis program actually gives patients a chance to take their life back, and that’s a quote from one of our patients. Being able to dialyze in their home at their own schedule and being able to get the support of their family, it’s just made them feel more in control and many patients are able to go back to work. They can travel on home dialysis, which affords them opportunities that in-center dialysis makes a little more difficult.
You can do it but it’s more difficult to arrange for treatments. They feel so much better. We’ve had patients tell us that they haven’t been able to work in over a year and after two or three home dialysis treatments, the more gentler kind, they’re able to go back and lift bales of hay. So when you see the difference that it makes in a person’s life, it really sparks the passion in our staff and allows us to see the benefits of this unique modality to give them a lifestyle that enables them to enjoy life and to enjoy their families.
UVM Medical Center: That’s great. And one of the advantages that’s in my mind about this is cutting down on the travel, which is a huge problem, particularly in a rural state. It allows me to introduce the whole topic of how in Vermont, in a rural state, we’ve been able to provide dialysis in most areas with the UVM Medical Center working with other hospitals and in fact you’re about to hit 20 years, or have this year, with the Rutland dialysis clinic. So explain a little bit about that relationship.
Peggy Bushey: Back in 1996 actually Rutland Dialysis Facility was established at the Rutland Regional Medical Center. Currently it serves about 45 to sometimes 50 patients on dialysis six days a week. Again the patients come about three times a week and are offered life-saving treatment there. They don’t have to drive to Burlington. It’s a wonderful dialysis center. CMS or Medicare actually rates dialysis centers on a five star, four star scale and the Rutland Dialysis Satellite has been able to achieve a five star status almost every quarter.
UVM Medical Center: That’s really amazing.
Peggy Bushey: It is amazing.
UVM Medical Center: And so we have how many of these around the state where we help support one way or another?
Peggy Bushey: Rutland is one of six dialysis satellites that we have around the state. We have one in Newport, Saint Albans, South Burlington, Barre, and then Rutland and then we have our home dialysis clinic and also we have an acute dialysis clinic at the medical center hospital itself.
UVM Medical Center: I think it can’t be overstated the importance of eliminating that travel because it’s so difficult for people to do that. Think about winter time and all that. And the amount of time. I mean you can’t exactly hold down a job when you have this in your life three or four times a week.
Peggy Bushey: Absolutely and we find that, especially I guess in Vermont, that just being able to arrange for travel for either patients to travel back and forth by themselves or to arrange for volunteer drivers or SSTA is very difficult. So being able to offer that service, life-saving treatment, in the patient’s own community is absolutely a benefit and I think staying in there, I don’t think, I know, staying in their own community affords them the support of their family and also the local resources.
UVM Medical Center: So it’s a great example of hospitals working together if you think about it.
Peggy Bushey: Absolutely, absolutely.
UVM Medical Center: Well we’re going to have to leave it there on that great note. Congratulations on all this progress and the 20th anniversary. We’ve been talking to Peggy Bushey, she’s a nurse and site supervisor of home dialysis here at the UVM Medical Center. Thanks for joining us.
Peggy Bushey: Thank you for having me.