Chronic renal failure (CRI, chronic kidney disease, MRC; CKD in English) is a syndrome that consists of a gradual, continuous and inexorabledecrease in kidney function until it reaches an end stage involving the initiation of replacement treatment, termed dialysis, aimed at temporarily keeping the patient alive while waiting, if it were possible, for an eventual transplantation of one or even two kidneys, from a cadaveric or living donor, even if not a blood relative.
There are two types of outpatient dialysis: hemodialysis (or extracorporeal dialysis), which requires a specific machine and is generally performed in a hospital setting, under close medical/nursing supervision, and peritoneal dialysis, which is easier to perform and does not require close medical/nursing supervision, being able to be performed at home as well. The first method, which is used in the vast majority of patients (90%), is performed, usually every other day three times a week, in a hemodialysis center present either in a hospital or in public or private facilities, the latter clearly affiliated with the National Health System, but sometimes, in selected cases, it can also be, albeit rarely, for obvious technical-organizational reasons, performed at home. Otherwise, peritoneal dialysis is performed in a "continuous" mode, that is, daily over the course of 24 hours without interruption, or more rarely in an "intermittent" mode, or even in a "night" mode thanks to a different machine from the one used for hemodialysis, and in an autonomous manner by the patient, free therefore, not to necessarily have to go to a hemodialysis center with a predetermined cadence. The first type of treatment, hemodialysis treatment, defined as "standard"if it involves three sessions per week each lasting about 4 hours, as it was first proposed and described by Prof. Vincenzo Cambi, Nephrologist at the University of Parma in the 1960s. Nowadays, however, there is an increasing tendency to prescribe "personalized" outpatient dialysis treatment with different dialysis rates, which may vary depending on the individual case.
From the foregoing, it follows that, a person on hemodialysis, having the need or desire to make a trip, involving the removal from home for a duration of more than two days, must inevitably and necessarily and well in advance, consult the physicians of the referring hemodialysis center so that he or she can, safely, for his or her own life, travel, whether for work or for his or her own enjoyment.
These are the reasons why, in order to ensure that the patient's life is not in danger, he or she must travel to the
For hemodialysis patients, the problems, related to the possibility or need to travel, are many, even in the case where such travel is performed within our national borders and not at particularly challenging distances:
- The availability at the destination location, of a free hemodialysis bed, at a hemodialysis center where they can undergo the necessary treatment, also keeping in mind an indispensable fact, represented by the accreditation to the National Health System of the accepting center, especially if it is a private and contracted facility, so that the latter can, promptly and on time, send an estimate, certifying the total costs, to the ASL to which the patient belongs to consequently, obtain written authorization with the indication of the amount of economic reimbursement. The same procedure must also be applied in the case of centers belonging to public entities, but offering dialysis treatment only under "free-professional" activity.
- Type of hemodialysis session prescribed by the accepting center; it may in fact differ mainly due to the different ways in which hemodialysis sessions may be performed due to the presence of machines of different type and brand, compared to those normally used for that given patient, which due to the different type of dialysis filters used, which in fact may consist of a different type of material than that of the filters used in the reference center; this may result in the occurrence of episodes of "intolerance"to the same, even highly symptomatic.
- The change of the medical/nursing team that constantly follows the patient throughout the hemodialysis session, who is often elderly and has various comorbidities, i.e., suffering from many other diseases besides renal, particularly of the cardiological type which, often, are also the cause of acute complications during the various sessions and, therefore, make specific treatment necessary, which, however, must be appropriate to the case and must be well tolerated by the patient, which is usually well known to the referring team but not to the accepting team, with the real possibility of a more difficult and slower resolution of such complications.
In light of these very important issues, it seems incumbent here to provide some guidance on how a hemodialysis patient, interested in supporting a trip, can do so safely. He or she can contact a hemodialysis center directly, or ask for the intermediation of the nephrology team of reference, after having identified the hemodialysis center to be entrusted, which is feasible by consulting free of charge some reliable and constantly updated websites, such as that of the Italian Society of Nephrology (S.I.N.): https://dialmap.it/
Another very useful website, maintained by ANED ("National Association of Hemodialysis, Dialysis and Transplantation Onlus"), for informing the patient undergoing hemodialysis treatment about the various logistical and bureaucratic aspects to be faced in preparation for a trip that lasts longer than two days, is the following: https://www.aned-onlus.it/tutele-sanitarie/dialisi-vacanza-in-italia-e-allestero/
After locating the hemodialysis center and going through all the paperwork, the patient is ready to go, in which case, the referring hemodialysis center delivers to the patient or, alternatively, sends by e-mail or fax,to the welcoming center a brief report on his or her clinical condition and a hemodialysis data sheet in which all the useful parameters are listed in order to set up the hemodialysis sessions.
Much easier it turns out to be to travel for a patient undergoing peritoneal dialysis treatment. In fact, in such a case, it is sufficient, since there is no need for the hemodialytic machine, that the same has all the necessary bags of dialysate (a solution that allows him to perform dialysis) sent to his new home, by means of which he can independently manage his own treatment, based basically on the introduction and removal of this solution, through a permanent catheter (small tube) in his abdomen, every 4-6h in the case of the "continuous" method.
These problems are nowadays more and more difficult to solve.
To these problems now known for decades, at the present time, the SARS Cov2 pandemic has also been added, which has made, as well as in general for all travelers, the organization of travel, for patients undergoing hemodialysis treatment, even more complicated and difficult.
The priority given in the national vaccination campaign to this particularly fragile type of patients, however, has fortunately greatly reduced the possibility that they may contract the more aggressive clinical forms of the disease and allows or will allow them, with the so-called "tourist passport" (which will be introduced for access to certain cities regions or states) to be able to travel and stay easily in locations other than their usual home, where they will undergo hemodialysis.
main sources (in addition to those already mentioned in the text)
- "Nephrology" edited by Michele Andreucci - Idelson Gnocchi, Naples, 2020 (ISBN: 9788879477024)
- "Short Dialysis" by Vincenzo Cambi, in "Topics in Renal Medicine" (V.E. Andreucci Series Editor), Springer, U.S.A., 1987 (Hardcover ISBN: 978-0-89838-858-9)
