\n\tBrett Kelman<\/span><\/p>\n

Nieltje Gedney was half-asleep in her West Virginia home, watching murder mysteries over the hum of a bedside hemodialysis machine, when she felt something warm and wet in her armpit.<\/p>\n

A needle inserted into her arm had fallen loose, breaking a circuit that the machine used to clean her blood. It was still pumping, drawing and filtering blood as designed, but the blood was now spilling into her bed instead of returning to her body.<\/p>\n

Gedney, a leader of the Home Dialyzors United support group<\/a>, knew what to do. Armed with a decade of experience with hemodialysis, she calmly applied pressure to her arm and pressed a red button that turned off the pump. Her blood loss stopped. In the seconds her needle was loose, Gedney\u2019s blood had soaked through her pajamas, bedsheets, and quilt.<\/p>\n

\u201cI sat up and looked down, and I was literally covered in blood,\u201d said Gedney, 71. \u201cIt was a bloodbath.\u201d<\/p>\n

On that frightful night last year, Gedney survived a rare and very dangerous complication of hemodialysis \u2014 a venous needle dislodgment, or VND. About 500,000 Americans with kidney failure rely on hemodialysis to mimic the function of healthy kidneys by pumping their blood through an external cleaning machine. If the venous needle dislodges, the machine continues to pump and clean blood, but the blood escapes. The patient is methodically drained and, unless someone intervenes, can die in minutes.<\/p>\n

By some estimates, at least one American is killed this way every week.<\/p>\n

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A relatively simple solution is available in Europe: An alarm detects blood loss with a disposable sensor patch, then automatically shuts off the dialysis pump. Dialysis companies in the United States have not embraced this fail-safe technology, so it is largely unavailable to Americans. The alarm costs $649 and each patch about $2.25. Neither is covered by Medicare, which insures most dialysis patients.<\/p>\n

\u201cThat\u2019s the ugly side of dialysis,\u201d said Debbie Brouwer-Maier, a 40-year dialysis nurse and member of the American Nephrology Nurses Association\u2019s VND task force. She said the dialysis industry resists \u201cany item that\u2019s going to improve care if there is added cost.\u201d<\/p>\n

\u201cThe patch is the problem,\u201d Brouwer-Maier said. \u201cIt\u2019s a disposable you have to buy without being reimbursed for every single treatment the patient does.\u201d<\/p>\n

Currently, most American dialysis treatment occurs in a nationwide network of clinics where patients sit in rows of chairs for hours at a time about three times a week. Only about 2% of patients undergo hemodialysis at home, sometimes with the aid of family or a caregiver.<\/p>\n

But hemodialysis is changing: The Trump and Biden administrations promoted home dialysis with increased Medicare payments<\/a>. A new generation of portable machines offer better results, more independence, and a lower overall cost to the government and insurers. Home patients can be treated more often or for longer periods, putting less stress on their bodies, and may find it easier to travel or keep a day job.<\/p>\n

Dialysis experts and patient advocates interviewed for this article agreed that many hemodialysis patients, if carefully selected and thoroughly trained, would benefit greatly from the momentum toward home care. Some also worry that no amount of training could erase the increased threat of needle dislodgment for those who dialyze at home while alone or asleep.<\/p>\n

\u201cIt is the widowmaker heart attack of dialysis,\u201d said Ankur Shah, a Brown University nephrologist. \u201cIf you have a VND at home, and you go one or two minutes before you recognize it, you are now trying to intervene while you are physically going into shock.\u201d<\/p>\n