Phoenix, Beautiful Mary, Mummy Escaped from the Museum and Home Hemodialysis: Deep Analysis between Comics, Habits and Reality

Abstract

Recurrent question about home hemodialysis is closely related to the above cited title; it can be similar to an escaped mummy able to fix all universal mistakes or it can be assimilated to the Phoenix or more commonly linked to a female uselessly chased by everybody. Home hemodialysis represents a very intricated puzzle of the last 30 years but it allowed thousands of patients with chronic kidney disease a better survival. Most of these patients, mainly youger patients, gave a great impulse to first patients' organizations to witness their strong desire of living an average life although facing a chronic disease. Home hemodialysis can be also assimilated to a traveling mummy because dialysis reached people all over the world through home treatments. It was said that old washing machines were transformed in hemodialysis monitors in Japan. Home hemodialysis could be identified as the favourite daughter of the economic boom of 1960s when technology came into private houses and medical know-how was changing and chronic hemodialysis was moving its first steps together with hospital resuscitation units and imaging revolution. In this historical context, hemodialysis changed life habits of several million people without working kidneys. Before industrial, political and public (transplantation vs hemodialysis) involvement, home hemodialysis was based on a simple sentence: “go home or die”. That context led to great expertises and awful reminders: great expertises, often forgotten, are linked to 1960s and 1970s years in which home hemodialysis improved survival of many patients excluded from hospital or ambulatory treatments. Home hemodialysis should be actually preferred for low costs and better compliance for all patients requiring home treatment. Awful reminders are linked to patient's physical dependence from familiar habits. Why are we now speaking of home hemodialysis? Dialysis treatments are expensive and patients' number is growing, especially at the age of 65; these data clearly affect public welfare in all countries in which dialysis treatment is free of charge for all patients; home hemodialysis is less expensive. Therefore, home hemodialysis could allow to protect job's place supporting an average quality of life. Home hemodialysis could lead to better hemodialytic performances; daily hemodialysis and long night hemodialysis provide better results in terms of efficiency and clinical outcomes, quite similar to kidney transplantation. Home hemodialysis is less aggressive, more flexible and, because of its low costs, more efficient, due to treatment customization; an example is represented by pregnancies in women who underwent night hemodialysis. On the other hand, home hemodialyis gets scared because many nephrologists do not have correct knowledges and they often appeal to various exceptions (alibi) such as older age, high risk patients and familiar habits. There is no agreement on indications for home hemodialysis; while in Italy it is not allowed, home hemodialysis is preferred for higher risk and older patients in Holland. We also have to meditate on physicians' role and their employment; home hemodialysis cannot be restricted in given time lapse but it has to be flexible and it needs flexible nephrologists always available. Home hemodialysis should not be dictated to physicians or patients but it should be encouraged by wise managers. Encouraging home hemodialysis could bring advantages to patients (more choices for their chronic therapy), to administrators and managers (less expensive treatments with average quality), to nurses (crucial role in managing patients and their needs) and to physicians (dialysis treatments customization) all contributing to improve dialysis patients' quality of life.