The choices facing Robert Mueller ranged from bad to worse.

With his kidneys failing, Mueller needed to begin the regimen that defines the lives of hundreds of thousands of seriously ill Americans: sitting in a chair three times a week, four hours at a time, hooked to a machine cleaning deadly toxins from their bodies.

Typical daytime dialysis in one of dozens of Colorado clinics would have forced Mueller, 57, to quit his day job as a Safeway checker.

The solution arrives every Monday, Wednesday and Friday night.

Three evenings a week, Mueller makes his way to Fresenius' Aurora dialysis clinic and settles in for a night of naps, computer games and blood cleaning. By 3 a.m., Mueller is back home and feeling healthy

"I'm in great shape," Mueller said. "I'm definitely ill, and it's a life-support treatment, but I see people with migraines and allergies and I feel sorry for them. I'm nothing like that. I feel really good about it."

A combination of government nudges, patient demands and private company initiatives are pushing more patients such as Mueller into dialysis alternatives. It can be cheaper and healthier to treat kidney patients overnight or at home, and 3 percent patient growth each year is forcing the system to change.

Only a few percent of American kidney-failure patients get dialysis at home, far lower than in other industrialized nations. Nocturnal dialysis can be gentler on patients by more slowly and thoroughly clearing their blood. Clinics can spread the growing patient load over more shifts.

Fresenius and its primary for-profit competitor, Denver-based DaVita, want nocturnal and home dialysis numbers to rise.

"Are we stuck in one particular therapy, or can we tailor therapies for different people?" said Dr. Eduardo Lacson Jr., vice president of clinical science for Fresenius. "The onus is on giving patients the choice."

The challenges of moving away from the daytime, in-clinic standard are great. In nocturnal care, doctors and clinic staff need to be available for more shifts. Patients must alter routines. For in-home care, patients and caregivers need detailed training and open access to medical advice.

Denver nephrologist Dr. Melissa Yanover believes the changeover is inevitable and largely positive. She has a young patient awaiting a transplant who is on nocturnal dialysis at home, allowing him to pursue a medical degree.

A central Fresenius site remotely monitors the home patients and can alert family members or doctors to problems.

"It gives him all day free to be a student, and he's home sleeping in bed instead of sleeping in a dialysis unit," Yanover said.

"It's like being released from house arrest," said Dr. John Moran, DaVita's head of home therapies.

Medicare and kidney-care advocates also want more patients to consider an alternative called peritoneal dialysis, which is untethered from clinics. The method uses the patient's abdominal lining as a filter, injecting fluid that absorbs waste during the day and then flushes it out through a catheter.

The push for home therapy may be good for the government and for dialysis companies, but it's also a patient-friendly effort, said Bobbi Wager, a nurse, transplant recipient and past president of the American Association of Kidney Patients.

"We as health-care professionals can get caught up in numbers," Wager said. "Sometimes we forget about the quality-of-life issues."

Michael Booth: 303-954-1686, This e-mail address is being protected from spambots. You need JavaScript enabled to view it or twitter.com/mboothdp

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