To all SWs at this board,
I now have the oppotunity I have hoped and prayed for. I have the support to travel to any location in the U.S to obtain quality dialysis. I would appreciate any recomendations that you as SWs may know of for units that offer PROFESSIONALISM, STRONG PATIENT EDUCATION, CHOICE (i.e. modalites, non-resuse), CLEAN. I would like to be trained in home hemo, buttonhole and would especailly like a unit that uses Braun. Thanking you in advance for any referals.

Home hemodialysis is an underutilized treatment option for kidney failure but one that produces good outcomes for patients. I'm happy to see that you're interested in this option.

A center that trains people for home dialysis has to be Medicare certified to do this. You can find out which centers are certified to do home hemo training by doing an advanced search on the database of facilities. You can find this at http://nephron.com/cf/usaadvanced2.html. If you select "all" in the first box for location (you can go anywhere) and select "home hemo training" you will get a list of 1615 providers. This doesn't mean that they all DO home hemo training, but that they are certified to do it. I would narrow my search more and look at areas where I might want to live if truly you can go anywhere. For instance, since Seattle was the birthplace of home hemodialysis, I chose to look by city, typing in "Seattle" and found 2 facilities -- one is NKF Haviland Kidney Center and the other is a children's hospital. You can do the same looking for whatever location you choose.

Next, once you have your list of clinics, you might want to look at Dialysis Facility Compare to learn more about different clinics, their ownership, their services, shifts after 5 p.m., etc. This web site is at http://www.medicare.gov/Dialysis/Home.asp.

Since there is no database that will tell you what patient education is provided, whether patients are encouraged to learn and ask questions, or whether a clinic has patients doing the buttonhole technique, you might want to join an online support group like Dialysis_Support. You can do this at http://groups.yahoo.com/group/dialysis_support/. This is an active support group with over 400 members. I know several are home hemodialysis patients and would be happy to tell you what you'd like to know.

Dear Ms. Witten,
Thank you for your suggestions. What I need the most are personal recomendations either from patients or staff. I did pose my question at dialysis_ support, but got only about 3 responses. And two of the units suggested are in areas with an extremely high cost of living. Not many members of the group considered their units worthy of recommending as far as being top quality. I need a way to find more, personal recomendations. Can you help me brainstorm where further to inquire?

You could try posting your message to one of the following:
1) Dialysis Online has bulletin boards for patients as well as staff. I noticed that someone posted a message on the patient bulletin board today asking for a recommendation of a unit. Their web site is www.he.net/~brumley/renal/.
2) KIDNEYDISEASE is a listserv moderated by Dr. Steve Fadem who is a nephrologist, patient advocate, and cancer survivor who understands chronic illness from personal experience. You can sign up at http://nephron.com/kidneydisease.html.

You might also look at the News section of RenalWEB to see information about outcomes measured for the large corporations. This might help you choose. There are still a large number of privately owned dialysis clinics and hospital-based clinics that are not affiliated with corporations. If you have family or friends in different areas of the country, perhaps you could ask them to check out clinics in their areas for you.

Finally, the reason why I suggested home hemo in my last posting is that you would be trained to do your own dialysis and would then not have to worry about whether the person sticking you or dialyzing you was well trained because you'd know that you were that person. Doing home hemo would allow you to live farther from a center (less expensive) than if you had to get to a center 3 times a week.