Advice to home hemo patients

If a patient dialyzes in center and gets an infection, the nurses give them a drip of vancomycin, take a blood culture, and notify the nephrologist. Sometimes the infection and resulting fever are solved in a few days, avoiding hospitalization. This is best for all concerned.

If you dialyze at home, you probably will be told to go to a hospital emergency room when you have a fever because you are immuno-compromised. Once in the hospital, you will be subjected to a variety of doctors including infectious-disease specialists who probably aren’t familiar with infections and fevers as they pertain to hemodialysis patients. As a result, you will spend a week or more in the hospital at great cost, mostly to undergo a variety of unnecessary tests and experiments with antibiotics (eg. Doribax) which don’t work. Eventually, the dox will figure out that you need a vanco drip or a drip of Ciprofloxacin and a fluoroquinolone such as Levaquin. Your fever will stop in a few hours. The problem is that hospitals treat every infection as deadly. They are NOT familiar with hemodialysis patients and infections, which are quite common. In most cases, the infection is access-related. HD clinics deal with these problems on a daily basis. Dox in hospitals don’t.

My advice to you is to get a prescription for Levaquin from your neph and renew it annually. Also get a supply of culture tubes which you can draw at home. These are to be used for emergencies and on weekends when clinics and doctors aren’t available. Of course, if you take the antibiotic, you will notify your neph immediately and take his or her directions. Don’t take Tylenol because this will only mask the seriousness of the infection and make you think you are OK with a lower temperature. You are not OK unless the infection is treated with antibiotics.

But the antibiotic proabbly will keep you out of the hospital. It is very tough for home HD patients to be hospitalized. You won’t get proper dialysis. You won’t get proper meds and you won’t get a proper diet and exercise. You should try to avoid hospitalization at all costs because you could also get another infection in the hospital! Your immune system is not the best on a floor with a variety of sick people. Also, don’t take any advice from a hospital doctor unless you first discuss it with your nephrologist, social worker, and HD nurses. They are the ones who are most familiar with the needs of HHD patients.

I am highly reluctant to go the ER, I haven’t ever since starting dialysis. Not needing to go is a function of luck but it is also good habits. I really believe that infections can be avoided by routine, thorough hand washing immediately before treatment every time.

But you’re right - the hospital can’t be the ideal place to treat an infection. More emphasis should be placed on keeping people at home for treatment.