ASOURCE Navi

As the epidemic of the new coronavirus infection spreads, it is said that more and more people are refraining from visiting medical institutions due to fear of corona infection. However, regular visits to the hospital are essential for dialysis patients, because without artificial dialysis, their lives will be at stake. Under these circumstances, home dialysis is now attracting attention.

Regular hemodialysis requires hospital visits about three times a week (3 to 5 hours each time), and is a treatment performed by many people sharing the same space at the same time. Many of the patients are the elderly, who are at high risk of developing severe disease, and those with underlying diseases such as diabetes. In many facilities, beds are said to be about 1 meter apart with curtains. The infection route of the new corona is droplet infection and contact infection. transmission of infection may occur. Although dialysis facilities are always focusing on infection control, there have been reports of group infections due to the spread of the new coronavirus.

Home dialysis is attracting attention as an option to reduce the risk of infection. Since home dialysis does not require going to a dialysis facility to receive treatment, it is a dialysis method that is suitable for preventing corona by avoiding the 3 Cs (closed spaces, crowded places, and close-contact settings) today under the epidemic of the new coronavirus. It can be said. Home dialysis includes home hemodialysis (HHD) and peritoneal dialysis (PD). In home hemodialysis, a device for dialysis is installed at home, and the patient himself/herself performs procedures such as circuit assembly, puncture, state management during dialysis, and blood return. Dialysis can be done at home at your leisure. Due to restrictions on insurance coverage, hemodialysis is generally performed three times a week at dialysis facilities, but with HHD there is no such restriction, and dialysis can be performed frequently and for a long time, which is expected to improve the prognosis. I can do it. However, when starting home hemodialysis, training is required, and it is particularly difficult to insert a needle into the shunt. In addition, HHD requires that a caregiver be present in case of an accident. As a result, the number of home hemodialysis patients nationwide remains at about 700, or 0.2% of all dialysis patients.

On the other hand, PD can be treated anywhere as long as there are three places where peritoneal dialysate, equipment, and bags can be exchanged. In continuous ambulatory peritoneal dialysis (CAPD), the dialysate is infused and replaced about four times a day by the patient himself through a tube called a catheter inserted into the abdomen. There is also automated peritoneal dialysis (APD), which uses a machine to change dialysate while you sleep. It is easy to operate, and a dedicated machine automatically fills and drains the liquid. Since you can use the time freely during the day, it is suitable for work and school, and you only need to visit the hospital once or twice a month. There are about 10,000 PD patients nationwide, accounting for about 3% of all dialysis patients. However, PD has individual differences in the treatment period. Because the efficiency of dialysis decreases and the peritoneal membrane hardens, the period that can be continued is said to be 5 to 10 years.

As of October 2nd last year, 7 home dialysis patients (HHD and PD) were infected with the novel coronavirus. The 80's were non-existent. From this fact, it became clear that at-home dialysis is more effective in preventing the new coronavirus in people over 70, who are at high risk of becoming seriously ill and dying. In addition, when a dialysis patient is infected with the new coronavirus, dialysis is supposed to be performed under hospitalization management, but home dialysis places less of a burden on medical personnel than regular hemodialysis, and provides stable medical care during the pandemic. It is thought that it will lead to the maintenance of a system that can be done.