Nursing support is enabling more patients with kidney failure to clean their blood at home

Until recently, patients with non-functioning kidneys had only two options. The first was to come to the hospital three times a week and spend four hours a day connected to a hemodialysis machine that cleans the blood.

However, according to Mr. Go, hemodialysis chairs at the JGH are in constant use, and new slots in the schedule are not readily available. A similar scarcity of chairs exists in hemodialysis centres across Quebec, he notes.

The alternative is peritoneal dialysis, which can be performed at home or in any handy location by the patient, who has had a catheter implanted in the peritoneal cavity (in the abdomen), allowing dialysis fluid to flow in and out.

Peritoneal dialysis: The basics

With each dialysis exchange, the contents of a plastic bag of water, electrolytes and sugar (known as dialysate) are infused into the peritoneal space, where the mixture gradually draws excess fluids and toxins out of the blood.

After about four hours—during which the patient is free to resume their regular activities—the solution is drained and disposed of. These exchanges are typically performed up to four times a day, depending on the patient’s prescription and needs.

The considerable advantage of peritoneal dialysis is that patients retain their mobility and independence. In fact, Mr. Go says, it is not uncommon for some patients to perform the procedure while away from home or even on vacation outside the country.

The down side is that peritoneal dialysis consists of many painstaking steps, including precautions to ensure proper hygiene and to prevent infection.

Training in these steps is provided at the JGH by Nurse Clinicians Ersie Alexandre, Nawal Massaa and Raheleh Seyed, who offer guidance, perfect the exchange technique, and deliver ongoing support to ensure that procedures are performed safely and confidently at home.

But despite this expert coaching, the steps can be difficult to master for patients who lack the necessary manual dexterity, the ability to memorize all of the instructions, or the discipline to stick to the schedule.

Providing a solution

A recently introduced solution is assisted peritoneal dialysis, in which a licensed practical nurse (LPN) visits the patient at home up to three times a day to assist with the dialysis exchanges. The number of visits is tailored to what the patient’s specific requirements.

“Peritoneal dialysis has always been an excellent option, since it allows patients to have greater autonomy and flexibility in performing their own exchanges on their own schedule in their preferred environment,” says Dr. Sharon Nessim, a JGH Nephrologist.

“With the new assisted peritoneal dialysis, the procedure can be offered to a broader group of patients who would benefit from having their dialysis at home, but would not have been able to do so without nursing support.”

Since the ultimate goal is to bolster the patient’s independence, Mr. Go says, the LPN is there primarily “to offer help, and not necessarily to take over.”

For example, he explains, “the LPN might observe the patient and offer a reminder if they forget something, or correct them if they make a mistake.”

For one patient, flexibility is the key advantage of peritoneal dialysis

For Edgar Iwaz, peritoneal dialysis is a formula for flexibility—enabling him to complete a crucial, painstaking medical procedure several times a day, while retaining the independence to keep working and even enjoy a vacation outside the country.

“At first, there was a lot to learn, with many steps to remember and carry out,” recalls Mr. Iwaz, for whom peritoneal dialysis became a daily necessity in 2021.

“The nurses were very helpful in training me, but it took at least a week of constant flushing and cleaning until I got the hang of it. Then it became routine and went more smoothly.”

This form of dialysis is being promoted by the Division of Nephrology at the JGH as a practical alternative to hemodialysis, in which patients must come to the hospital three times a week and spend four hours a day connected to a machine that cleans their blood.

By contrast, during each peritoneal dialysis exchange—performed at home or wherever the patient chooses—a solution containing water, electrolyes and sugar is infused through a catheter into the peritoneal space in the abdomen.

There the mixture gradually draws excess fluids and toxins out of the blood. After about four hours—during which the patient carries on with his or her regular activities—the solution is drained and disposed of.

Mr. Iwaz, a self-employed installer of ceramics at construction sites, is constantly on the go, but he always manages to find the time and an appropriate place for his peritoneal dialysis.

For instance, he says, he sometimes steps into a supermarket and uses the bathroom, if it’s clean. During long highway trips in pleasant weather, he pauses at roadside rest stops and, on occasion, has hung his plastic bag of dialysates from a low-hanging tree branch.

This mobility and sense of independence have even made it possible for him to enjoy a vacation in Punta Cana, among other destinations.

Mr. Iwaz began coming to the JGH for kidney problems in 2010, and although his condition gradually worsened over the years, he was reluctant to begin hemodialysis.

Then, early in the COVID-19 pandemic, he was diagnosed with a blocked artery and underwent surgery. Afterwards, his overall condition was assessed and he was strongly advised to begin peritoneal dialysis—which he did in January 2021.

Although the procedure is now second nature to Mr. Iwaz, he’s hoping to eventually dispense with it by getting  a kidney transplant.

To improve his health and increase his chances of qualifying for a transplant, he underwent gastric bypass surgery in December 2025.

As a result, his weight has dropped from about 108 kilograms (nearly 240 pounds) to roughly 70 kilograms (154 pounds).

“All I can do now,” he says, “is keep the peritoneal dialysis going and hope for the best.”