A new, do-it-yourself treatment for kidney failure, which eliminates patients' dependence on costly and confining dialysis machines, is being used successfully for 53 patients by Georgetown University doctors.
For a person suffering kidney failure, the new dialysis method means a far freer lifestyle. Patients who once spent much of their time attached to a machine that removes waste products from the blood are now able to dialyze themselves, without assistance, while at home or at work.
Those who have used the new method say they feel better and enjoy life more with it than when they were forced to rely on the most common method, outpatient hemodialysis, in which a patient is periodically hooked up to a machine at a treatment center.
"They love it," Dr. James F. Winchester, director of the Georgetown program. "The first month they start to notice changes. After two months they really feel great. Most have said, 'If I had to go back on hemodialysis, it would be very difficult.'
"It's freedom -- control over their lives," he said. "They don't have to be linked to a machine for five hours three times a week."
The new technique also promises to reduce health care costs nationally, since it is only about half the price of the hemodialysis. Treatment of kidney failure which is covered by Medicare, cost the U.S. government approximately $1 billion in 1979, according to the National Center for Health Technology.
Persons using the method -- called continuous ambulatory peritoneal dialysis, or CAPD -- remove fluid wastes from their bodies four times a day by running salt solution in and out of their abdomens through an implanted tube.
The Georgetown program, which started in July 1979 under Winchester's direction, is the largest in the Washington area. The method was developed by Texas physicians in 1977, and Winchester estimates that 10 percent of the 50,000 dialysis patients in the country now use it.
To begin using CAPD, a patient at Georgetown undergoes an operation in which a slender tube or catheter is implanted through the skin of the lower abdomen so that it hangs inside the abdominal cavity.The catheter is connected to more tubing that attaches it to a plastic bag containing about two quarts of salt and sugar solution. Winchester's team then shows the patient how to hang the bag so that the fluid flows through the tubing into the abdomen.
Once the fluid is inside -- which Winchester said takes 10 minutes -- the patient can clamp the tube, roll up the bag, tack it inside his clothes and go about his normal activities. Five hours later, he simply unclamps the tube, puts the bag on the floor, and allows the fluid to drain, much as gasoline is siphoned out of a gas tank.
Fifteen minutes later, when the fluid has drained out, the patient replaces the old bag with a new one and repeats the process. During the night, fluid stays in the abdomen for up to eight hours while the patient sleeps.
Richard Herson, a 53-year-old vice president of the Xerox Corp., who lives in McLean, chose continuous ambulatory peritoneal dialysis last September when he learned his kidney failure had become severe enough that he would otherwise need treatment on a machine.
He said he simply changes the fluid while doing paperwork at the office or watching television at home. It does not limit his activity except for the inconvenience of carrying two-quart bags of fluid on long trips.
"Compared to all the known alternatives," he said, "it's very good. The only problem really is changing the fluid four times a day, and the discipline involved in that."
Herson has had several bouts of peritonitis, an infection of the abdominal lining that is one of the technique's side effects. But Winchester said the development last year of a better connector for the tubing had reduced the frequency of such infections to about one episode per patient every ten months. He said most such infections are mild, and can be treated by giving a patient antibiotics and adding medication to the fluid.
Despite the infections, Herson said he has never contemplated switching methods. "I'm a coward on needles and hospitals in general," he said. "Hemodialysis was a little more scary proposition for me."
He added that he no longer notices the presence of extra fluid in his abdomen. "You have to contend with maybe more than the usual amount of indigestion," he said. "It might change my contour a little bit . . . . I have some bulges where I wouldn't normally have them."
Winchester, whose CAPD patients range in age from 3 to 74, said the treatment improves general health because it continuously removes waste products from the blood, rather than letting them build up between machine treatments at a dialysis center. The method works because the fluid bathes the peritoneum, the delicate lining of the abdomen which receives a rich blood supply through thin-walled vessels called capillaries. Waste products filter through the vessel walls into the salt solution, and are removed when the fluid is drained.
Winchester said the treatment costs $14,000 a year, of which $8,500 is for solution and tubing. The cost may fall as more companies begin manufacturing products for this kind of dialysis.
In contrast, Winchester said, hemodialysis at a center costs $26,500 a year, and hemodialysis at home on a rented machine costs $18,000.
Although lower cost and better health are important advantages of CAPD, they are not the reasons why Winchester predicts more and more kidney patients will choose the new method. "The real motivation is independence," he said.