WAILUKU, Maui — Hana will be the first community in the nation to host a communal home dialysis service.

The arrangement was just approved by the Centers for Medicare and Medicaid Service and could benefit other remote areas where access to dialysis treatment facilities is limited.

Two Hana residents with end-stage renal disease have been traveling three times a week to the Maui Dialysis Clinic in Wailuku and two more are expected to start dialysis soon. It's a 112-mile, five-hour roundtrip drive on a winding two-lane highway, and the journey is taxing on patients and their families.

A Centers for Medicare and Medicaid Service official came to Maui from San Francisco to experience what the Hana patients must go through and made the drive from Wailuku to Hana, calling it "an eye opener."

"No patient should go through such interminable hardship if alternative means of receiving care and services are possible," said CMS official Ed Japitana in an e-mail to Liberty Dialysis-Hawaii LLC.

Liberty Dialysis, which operates the Maui clinic, has been working closely with Hana residents, county and state officials and others since 2006 to establish a communal setting where patients could use their home dialysis units while under the care of family members or trained aides.

"It's the right thing to do to help the community have dialysis close to home. It's hard on these patients, and it's part of our mission to integrate ourselves into the community and do what we can to help our patients," said Jane Gibbons, executive vice president of Liberty Dialysis-Hawaii LLC.

Lehua Cosma, whose mother, Cecelia Park, requires dialysis three times a week, said it's difficult for many patients to undergo treatment at home. Dialysis in a home setting usually requires a minimum of 100 square feet of space to accommodate a machine and supplies, and many Hana residents live with extended families in homes where space and privacy are limited.

Cosma founded the group Hui Laulima O Hana four years ago to bring dialysis to the East Maui community. With her mother soon able to undergo dialysis at home, Cosma said the family will be able to spend more time together and save money they've been spending on gas and other driving expenses.

Two other hurdles must be cleared before the communal dialysis service can start: A site must be located and money raised to purchase six dialysis units at a cost of $20,000 each — four for patients and two backup units.

Hui Laulima O Hana has its eye on a plantation-era house used as a physician's residence by Hana Health.

The state-owned property was placed under county control under a 1927 governor's executive order stating the land must be used specifically as a residence for a county physician. The county may request that the Board of Land and Natural Resources ask Gov. Linda Lingle to issue a new executive order allowing broader use of the property for healthcare purposes.

Mahina Martin, spokeswoman for Mayor Charmaine Tavares, said the county was waiting for CMS approval and will now take steps to make the physician's residence available for dialysis patients. Wastewater improvements and other work will be needed before the property can be used.

Hui Laulima O Hana already has secured $5,000 from the county for renovations and $50,000 in start-up funds, and is raising money to pay for aides and other needs.

Gibbons noted the "unfaltering" commitment by Cosma's group and others to bring dialysis to Hana.

"What makes this situation unique is that unrelated Hana community members have stepped up to the plate to offer to learn dialysis to care for and support these patients," she said.

Gibbons also credited CMS for being "willing to take a look outside the box and take care of their beneficiaries outside of traditional home dialysis."

The nonprofit Pacific Renal Care Foundation is collecting donations to purchase the home units.