Kidney failure patient tries at-home dialysis

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After 42 years of marriage, Roger and Raynelle Cash of Flowery Branch, Georgia, are not just husband and wife.

They are "care partners," working as a team to give Roger the kidney dialysis keeping the 62-year old alive.

Cash's kidneys failed in 2014, after a 20-year long battle with polycystic kidney disease.

"I was in pretty rough shape when I went into dialysis," he says.  "So, even in the dialysis, I started feeling better, because they were taking the excess fluid off me."

At the time, Cash would go to a Fresenius Kidney Care dialysis center 3 days a week at 7 am. 

There, he would spend up to 4 hours hooked to a machine filtering the toxins from his blood.

It was grueling.

"You feel pretty drained the days you have dialysis," he says.  "And, in-center dialysis has a lot more variation, you feel good, feel real bad, feel good, feel real bad."

After his sessions, Cash would go to his job as a maintenance technician at a manufacturing plant.

But instead of feeling better, he started feeling more rundown.

"The longer I stayed on the in-center, daytime dialysis, the worst I felt," he says. "The weaker I got, the worse I felt."

So, Cash switched to an overnight, or nocturnal, dialysis center, thinking he could sleep through 8-hour sessions.

It didn't work.

"I was not sleeping in the center," he says.  "I kept trying to work while I was nocturnal.  Ultimately, it basically put me into a physical collapse."

He went on medical leave from his job and grew depressed.

That's when Fresenius Kidney Care offered the Cashes another option.

The company would train Roger and Raynelle to do his dialysis at home, using a machine called a dialyzer.

At first, his nephrologist at the time, Dr. Dinesh Chatoth, who is now the Associate Chief Medical Officer at Fresenius, says Cash was reluctant.

"His concerns were, number one, the machine looks pretty complicated," Chatoth remembers.  "And, number two, how am I going to use these needles and stick myself in order to go on dialysis?"

Cash had a painful experience as a young boy when he says a nurse mistakenly gave him a penicillin shot in his arm.

It left him uncomfortable with needles, especially the idea of sticking himself.

But, he decided to try home hemodialysis.

"In all honesty I got desperate," Cash says.  "Because I wanted to keep working,"

The Cashes went through 2 and half months of training at Fresenius, learning to set up, clean, and sterilize the machine.

They practiced sticking Roger with the needle.

When the time came for the real thing, Raynelle stuck Roger first, then he took over.

"It turned out to be quite a lot easier than I thought it would be."

Dr. Chatoth says the needles can be challenging for patients.

"There is phobia around that," Chatoth says.  "But, once we can break through those barriers, once they experience better health, they tend to thrive and do better on dialysis at home."

Chatoth says Medicare and many insurance providers will pay for at-home dialysis for qualified patients. 

He says it's less expensive to do the treatment at home, rather than in a center.

About 12 percent of Frensenius Kidney Care patients do at-home dialysis, Chatoth says.

Most, 10 percent do peritoneal dialysis, through a catheter in their belly.

Only 2 percent use the dialyzer for home hemodialysis, like Cash.

Cash sets his own hemodialysis schedule, 4 nights a week, 3 hours at a time.

He does it after work and before going to bed, in case he feels tired.

"Just about 2 and a half months into it, I woke up and said, 'You know, I feel a lot better,'" Cash says.  "And, I felt better days and days in a row."

He and Raynelle have now been using the dialyzer for about 3 years.

Roger Cash has had a few bumps in the road, including a recent bout with colon cancer. 

But, he says he's feeling good, and back at work.

"I am not as fast as I used to be, and I'm not as strong as I used to be," Cash says. "Don't have the stamina I used to have, but I can still get the job done.  That meant a lot to me."