Hey there, time traveller! This article was published 7/3/2016 (2053 days ago), so information in it may no longer be current.
Blair Waldvogel’s treatment for kidney disease is almost a full-time job.
Four days a week, about six hours a day, he is bound to his home, tubes running from his arm to a machine that does the job his kidneys once did: filtering out waste and excess water from his blood.
"After the kids go to school, I start my dialysis and finish just before they get home," says the 50-year-old, who has been on dialysis for more than five years and is awaiting a transplant.
Besides forcing him to give up a career as an executive, his condition’s biggest toll has been on his family. Even summer vacations are out of the question.
"We were thinking maybe we could go to Wisconsin Dells (Wis.) recently, but when I phoned down, the cheapest place I found with a discount was $980 (U.S.) per treatment," says Waldvogel, whose two boys are nine and 12. "It’s so expensive, and then you’re kind of paying to not be on vacation while you’re there."
Waldvogel could soon have much more freedom thanks to new dialysis technology installed in his home.
Called NxStage System One, it’s smaller, involves fewer home renovations (which are paid for by Manitoba Health) than were previously necessary and is easier to use than the the past generation of home-hemodialysis equipment. But its biggest advantage is it’s portable.
While it could be a game-changer for the 1,600 or so Manitobans on dialysis, the treatment remains a last resort — outside of a transplant — for kidney failure, often caused by chronic kidney disease.
Despite many advances, life for both patients and their families revolves around the painstaking treatment, says Dr. Paul Komenda, medical director of the home hemodialysis program at Seven Oaks General Hospital.
"By no means would we suggest this is the preferred treatment," he says. "It’s still very difficult and the broader public health strategy is to prevent the next wave of dialysis."
The number of Manitobans on dialysis is growing rapidly.
In the last five years, patients receiving dialysis grew by 30 per cent. That rate of growth will likely continue as the population ages and Type 2 diabetes rates — a leading cause of chronic kidney disease — rise as well.
Increasing awareness with public campaigns, such as Kidney Health Month in March, are crucial to effective prevention strategies, says the executive director of the Kidney Foundation of Canada’s Manitoba branch.
"We certainly believe the kidneys are just as important as the heart," Val Dunphy says, adding the kidneys are the body’s "master chemist," balancing water, acidity and minerals in the blood, among other important roles.
"Everyone needs at least one kidney, or you need treatment to live — the two treatments being dialysis or transplantation — and that’s what most people don’t realize."
While the causes of chronic kidney disease vary — Waldvogel’s, for example, was caused by a childhood illness — the majority of people diagnosed with chronic kidney disease suffer from two common conditions: high blood pressure and/or diabetes.
Though it doesn’t receive as much public attention as heart disease or cancer, about 15 per cent of Manitobans have chronic kidney disease — the highest rate in Canada. "That’s one in eight Manitobans," Dunphy says.
Among indigenous populations, which often have higher rates of diabetes, the number is three in 10.
However, most people can manage chronic kidney disease with diet, exercise and medication. They likely will never require dialysis or transplant, Komenda says.
Moreover, recent groundbreaking research — such as the work of University of Manitoba researcher and physician Dr. Navdeep Tangri that can accurately predict kidney-failure risk — is helping health-care providers gain ground against the disease.
Yet many patients’ illnesses will progress to kidney failure all the same, and new treatment technology such as NxStage should make their lives easier.
The biggest impact of the new NxStage equipment will be on rural patients, who often travel several hours for treatment three to four times a week at one of the satellite clinics across Manitoba or a Winnipeg hospital.
The previous generation of home-hemodialysis equipment used enormous amounts of water and was usually unsuitable for rural homes that rely on wells and septic fields. NxStage technology uses much less water, so "we’re able to put people on it that we weren’t normally able to do so for before," Komenda says.
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The technology has undergone two years of testing in pilot programs in Manitoba, and is available to all suitable patients in the province. So far, about 25 Manitoba patients are using NxStage. They include Shawn Hafenbrak, a phys-ed teacher from Winnipegosis, who recently went on disability because of his illness.
Like Waldvogel, he hopes the new equipment will allow him to be less tied to his home.
"If I want to go to for the weekend to Grand Rapids or The Pas, I will be able to take my machine with me," says Hafenbrak, a Type 1 diabetic. "That’s what’s going to be good about it."
While not yet approved for travel, both men are hopeful they will be able to enjoy one of life’s pleasures — a vacation — someday soon.
"That’s the hope: to be able to do these things so my family isn’t so burdened by my illness and treatments," Waldvogel says. "My kids would love to go to Disneyworld."
What do the kidneys do? The two bean-shaped organs are the body’s filtration system, and are made up of more than one million of tiny tubular structures called nephrons that clean the entire blood supply every five minutes — the equivalent of about 180 litres every 24 hours. Their main role is removing waste and excess water from the body by making urine. But they also help control blood pressure, regulate minerals in the blood such as calcium and phosphorus, activate vitamin D for bone health and aid in red blood cell production.
What is chronic kidney disease? CKD is defined as abnormal structure or function of the kidneys for more than a three-month period, says Dr. Paul Komenda, a nephrologist. Patients usually don’t notice symptoms at first. It’s often first detected through blood and urine tests. But symptoms can involve appetite loss, fatigue, malaise, headaches, itchy and dry skin, nausea, weight loss, high blood pressure, sleep problems, changes in urination, and swelling in the feet and ankles. Left untreated, the nephrons are increasingly damaged and the kidneys fail, requiring dialysis or transplant.
Causes: The main causes of CKD are high blood pressure and diabetes (types 1 and 2) along with numerous less common ones, including glomerulonephritis (inflammation of the kidneys) and prolonged urinary-tract blockages from, for example, an enlarged prostate or kidney stones.
— Mayo Clinic; kidney.ca; Winnipeg Regional Health Authority