Intermountain Healthcare’s new center will help more dialysis patients give themselves treatment at home

(Rick Egan | The Salt Lake Tribune) Raul Gutierrez goes through the steps to setup his machine, as an in-home dialysis patient. Thursday, Sept. 5, 2019.

Kearns • Raul Gutierrez chatted casually as he polished and connected a series of color-coded tubes so complex that he looked as though he could be arming a bomb.

“When you do, a thousand times, one thing, you are the master,” Gutierrez said, pushing the green, kidney-shaped “go” button on his dialysis machine.

But mastery, to him, is not just about operating the array of medical devices in the TV room of his Kearns home. It’s mastery over his own body, Gutierrez said, that in-home dialysis returned to him after kidney failure thrust him onto an endless treadmill of doctor’s visits, lab work and exhausting dialysis treatments.

“I feel better because I’ve got my own control,” said Gutierrez, 48. “That changed my life.”

The complicated, taxing medical regimen for kidney disease is what Intermountain Healthcare hopes to simplify with its new Kidney Care Center in Murray, said physician Suji Lee, the center’s medical director.

“Care in the United States is fragmented,” Lee said Thursday at the center’s grand opening. Primary care physicians, specialists, nurses and technicians are scattered from clinic to clinic, disrupting communication between caregivers and forcing patients to schedule long batteries of appointments, often with months-long gaps between them, Lee said.

By bringing renal specialists, pharmacists, dietitians, nurses and social workers together under one clinic, Lee said, “The right hand knows what the left hand is doing.”

And, she said, it cuts down on the amount of time patients spend shuttling from doctor to doctor — a crucial measure for kidney disease patients, who often are trying to juggle work and family along with a time-consuming schedule of dialysis treatments. When kidneys fail, dialysis removes waste, salt and extra water from a patient’s blood to keep electrolytes safely balanced.

Patients may have to go to dialysis centers three times a week, for hours each visit — plus travel time.

That’s where in-home dialysis can come in, said Marc Harrison, Intermountain CEO.

"We’re going to make the pivot from dialysis in centers to dialysis in home as much as possible," Harrison said. "... People can spend their whole lives, it feels like, in a dialysis center. It affects them emotionally, physically. It affects their family. It can really tear families apart."

The emotional and physical toll of dialysis merged for Gutierrez, chipping away at his quality of life for the year or so he was making thrice-weekly visits to a dialysis center about 25 minutes away from his home. The treatments left him drained, he couldn’t work full weeks in his construction business, and financial stress added to his depression.

"I'd think, after the dialysis I'll go to work. But then I'd feel depressed and tired," Gutierrez said. Just sitting at the center and watching the other patients come and go — many of them much older than Gutierrez — left him feeling hopeless about the years of treatments to come.

"You come home and you sit and you think, 'This is my future,'" he said.

But in January, doctors said that Gutierrez was a strong candidate for at-home treatments. He and his wife and daughter underwent a two-week training program to learn the complicated process of setting up and connecting to the dialysis machine.

Initially, Gutierrez said, the fear of making a mistake was stressful. While hooked up to tubes that pour blood in and out of the port in his arm, small deviations would produce nerve-wracking beeps from the tablet that digitally monitors the transmission of fluids.

But now, the beeps are more benign. During a recent morning treatment, the tablet sounds an alarm first thing, and Gutierrez realizes with a chuckle that he forgot to remove a clamp on one of the tubes. He is unfazed when it beeps urgently again; the needle has shifted in his arm as he was standing up to display the machine's features.

“When you start it’s a little hard, but every day you learn,” he said.

It didn't take long for Gutierrez to notice major improvements in his stamina and mood after switching to in-home dialysis, he said. Because he can hook up more frequently at home, the treatments are less intense and less fatiguing — and he usually does them right before bed, so he starts his day fresh.

Just a few months earlier, he thought of himself as a sick person, he said, and his coworkers and family began to anticipate his need for frequent rest and recurring sadness. Now he can work six days a week, and people who don’t know of his medical history have this consistent reaction when they learn his kidneys are only 3 percent operational, he said: “'You don’t look like Dialysis Guy. You look like you.'”

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