The Noonan, Georgia, native joined the practice in 2005, becoming home dialysis director in 2007. He received his undergraduate degree in religion from Birmingham Southern College in 1993, followed by a medical degree from the University of Alabama School of Medicine in 1997. He trained in internal medicine at Baptist Health Systems where he also served as chief medical resident. A nephrology fellowship, completed in 2005, followed from Washington University School of Medicine.
Home dialysis popularity has waxed and waned in the last few decades, Giles says. Current support for the option stems from the general trend in medicine to be less patriarchal and more patient-centered, coupled with an increased awareness that patient autonomy is a good thing. Also, home dialysis offers significant cost savings for patients.
In March, Nephrology Associates, in conjunction with dialysis services provider Fresenius, opened a freestanding home dialysis-training center. Previously, home training occurred in the practice’s in-center clinic. Four years ago, Giles and his associates had about 45 patients on home dialysis. “Our home program has doubled, growing faster than our overall dialysis patient population in our group,” he says. Just over 100 of the practice’s patients opt for home dialysis today.
Of the center, planned for two years, Giles says, “It was not just needed due to growth. We wanted to make a statement to patients that home dialysis is just as important as in-center dialysis.”
The new facility, on West Lakeshore Drive in Homewood, is in the same building as the Southern Medical Association. “There’s a fireplace in the lobby with comfortable couches. There are paintings on the wall. It’s a reassuring place,” Giles says. “We wanted to create a less clinical environment.”
The setting helps alleviate worry for patients who might be nervous about taking on a more direct role in their own health. “Home dialysis can be both anxiety-producing and, later, empowering,” Giles says. Instead of a dependent role where the patient merely shows up at the in-clinic, the patient takes ownership.
Giles readily ticks off the advantages of home dialysis: “You can stay in your own home. You don’t have to go to a clinical setting three times a week. And there is autonomy and stability in the delivery of your care.”
Also, he says, “Most patients find they feel a little better because they don’t have the intense cleaning you get at an in-center unit three times a week.” That intensity can leave patients feeling wiped out. Because home dialysis occurs more frequently, anywhere from four to six times weekly, patient fatigue is less. “It’s a more gentle dialysis,” he says.
Training for peritoneal home dialysis requires three to seven days while home hemodialysis training is a three-to-five week commitment. A patient must have a partner to co-train with, “someone who has a deep vested interest in the health of the patient,” Giles says.
A partner is especially crucial with the more complicated hemodialysis. “The partner will have to put the needles in the patient’s access to do the procedure,” Giles says as an example. “That would be very difficult for the patient to do themselves.” For some families, dealing with the technology can be daunting.
Giles believes the benefits outweigh any barriers. “I’m a big fan of people having freedom and patient autonomy. Half the people starting dialysis begin with central venous catheters,” he says. Those patients have a two and one-half times rate of mortality than the people who start any other form of dialysis, whether in-center or at home, peritoneal or hemodialysis. A central venous line increases the risk of infection and inflammation, which can result in heart attack and strokes.
“For that reason, we try to refer patients to our TOPS–Treatment Options Programs–for education on their options before they even begin dialysis,” he says.
“We’re trying to offer our patients choices,” Giles says. Toward that end, he believes the new training clinic will help more patients who are looking for the best choices to improve their health and quality of life.
