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Abu Dhabi, UAEWednesday 12 December 2018

'This is no kind of life': UAE kidney patients call for dialysis at home

Home dialysis treatment will give patients facing repeated hospital journeys 'control of their lives'

The majority of haemodialysis patients have to be connected to a machine at hospital for at least three hours, three to four times a week. Mohammed Salem / Reuters
The majority of haemodialysis patients have to be connected to a machine at hospital for at least three hours, three to four times a week. Mohammed Salem / Reuters

Kidney dialysis patients in the UAE, some facing seven-hour round trips for treatment, have issued a plea for home treatment.

Most haemodialysis patients have to be connected to a machine at hospital for at least three hours, three to four times a week, with long travel times adding to the ordeal.

Some family members have had to leave their jobs to care for their loved ones, while others have relied on domestic helpers and drivers.

Families told The National they can spend up to seven hours travelling to and from dialysis sessions at Mafraq Hospital, Tawam Hospital, Rahba Hospital or Skeikh Khalifa Medical City.

“You have no idea how difficult the life, if you can call it a life, of a dialysis patient is,” said dialysis patient Saleha Al Seiari, 29.

She received home haemodialysis treatment after suffering a fractured leg but says this service was halted two months ago. She is trying to get the service reinstated.

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Home Healthcare Services is the only provider in the UAE to offer haemodialysis to patients at their home, but it is only for elderly, bed-ridden Emirati patients.

In most countries the service is an option for all patients but not yet in the UAE. It is a source of frustration for many patients and healthcare professionals.

“I know of younger patients who are struggling to get to their classes. I know of mothers and fathers who are struggling to hold on to their jobs. I know of schoolchildren who can’t go to school.

“The saddest patients are dialysis patients but I am positive, I am optimistic that this will be a choice for everybody in the near future,” said William Prinsloo, chief strategy officer of Home Healthcare Services (HHD).

A medical team from Home Healthcare Services packs supplies to take to a dialysis patient's home. It is the only company that offers home dialysis services. Leslie Pableo for The National 
A medical team from Home Healthcare Services packs supplies to take to a dialysis patient's home. It is the only company that offers home dialysis services. Leslie Pableo for The National 

In the UAE, it is reported that more than 2,000 patients are undergoing dialysis and this figure expected to double in the next five years.

In Abu Dhabi, around 370 out of every million people currently require dialysis sessions.

National health insurance provider Daman said it provides home treatment to patients it considers housebound for medical reasons.

"This includes members who require a special vehicle to transport them safely, such as an ambulance, as well as patients attached to equipment requiring constant electrical supply.

"It also includes individuals suffering from conditions that put them at high risk should they leave their homes, such as refractory epilepsy,” Daman said in a statement.

It said coverage for home dialysis could be discontinued if a patient no longer meets criteria for the service.

Home haemodialysis was developed in the US, UK and Japan in the early 1960s and by the early 1970s, for stable patients who could deliver the therapy for themselves at home.

Some 59 per cent of patients on dialysis in the UK and 32 per cent of patients in the USA receive dialysis at home.

In the UAE, patients eligible for the service are also sent a nurse to administer the treatment.

HHD began offering home haemodialysis in 2012, with only three patients and today they have more than 150 patients in Abu Dhabi and Saudi Arabia.

“The idea of developing this therapy was to give renal patients an alternative option. Patients have control of their lives again. Their quality of life has improved,” Mr Prinsloo said.

“Also the burden on the patient’s families is a lot less. They don’t have to take their families three times a week and wait for them for at least three hours to finish therapy,” he said.

Dr Nizar Attallah, a nephrologist at Cleveland Clinic Abu Dhabi, said that, while home haemodialysis machines are more expensive, overall the costs are lower.

"With the number of dialysis patients increasing year after year, patients are becoming a financial burden on hospitals, he said.

“Because they need more supplies, more staff and they are typically sicker than most patients, so they get admitted more.”

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He said it was also a burden for insurance companies. In the US, dialysis patient would cost $100,000 (Dh367,000) per year.

Home haemodialysis patients don’t require large support staff, so the costs are less, he said.

“Studies also show that, in general, survival rates are similar to in-centre dialysis but the quality of home haemodialysis patients’ life is better. Patients get to spend time with their families and are usually more active. The other important issue is that most of them can keep their jobs,” Dr Attalla said.

He said there are four main reasons why home haemodialysis is not more prevalent in the UAE.

“One, is education about the availability. A lot of patients don’t know about it. The second is training of physicians on home therapies. The third is that we have an older population who have complications such as amputations and cardiac problems and lastly is insurance.

“The home haemodialysis machine is slightly more expensive, but because of lower number of admission and better quality of life, the overall cost is cheaper.

"For example, in the US, there is a push for everyone to go on home haemodialysis because they want the younger population to work, but in the UAE the push is for just bed-ridden patients because of the expense. But in reality, despite higher costs, the annual care of the patient is cheaper.”