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Home Hemodialysis
Home hemodialysis (HHD) is a type of dialysis treatment for end stage kidney disease that uses a machine to purify the blood and your body of excess fluids and wastes. Your blood travels through plastic tubing to a filter, where it is cleaned and then returned to you. The process is the same as in-center hemodialysis only it is done in the comfort of your own home with slightly different equipment. Dialyzing yourself at home lets you take charge of your treatment. Home hemodialysis survival may be comparable to a deceased donor transplant. Read the report here. The American Heart Association has endorsed HHD for the potential cardiovascular benefits. Read the endorsement here.
Benefits include:
Convenience because you do not need to travel to a dialysis center.
Ability to perform your own treatments on your own time.
Decreased in-center COVID exposure and risk.
Greater flexibility to continue social activities, work, school or travel.
Improved blood pressure control and fewer medications.
Fewer dietary and fluid restrictions.
Increased energy and overall improvement in quality of life.
Fewer visits to treatment centers and hospitals.
Training and Preparation
An out-patient surgery is performed to create the access for your connection to the machine before beginning home hemodialysis.
Once the access is mature (ready to use), typically 6-8 weeks, training can begin to insert needles and do your own hemodialysis at home. Training for HHD can be approximately 4-6 weeks.
HHD is done 4 or more days/week, depending on what your physician determines is best for you. Longer and more frequent dialysis is gentler on the body.
The home dialysis machines are user-friendly and some can be taken with you so you can perform your own treatments when you travel.
A family member or care provider can attend training sessions.
Rogosin has remote monitoring for people using home hemodialysis alone or dialyzing at night.
Frequently Asked Questions
Do you have to buy the dialysis machine to use at home? Your dialysis clinic will provide the machine if you need one for home use, as well as the supplies.
Can you dialyze at home even if you are non-compliant in the dialysis center? Each individual will be evaluated, including understanding why they were non-compliant in the dialysis center. Those with a high need to control situations may actually do better at home.
Do you have to redo your plumbing at home in order to be able to do home dialysis? It depends. One option uses an adaptor that fits onto the faucet. The other option may require some minor plumbing work to be completed.
Do you have to get rid of your pets to do dialysis at home? Lots of people dialyze at home and still have pets. Keep your treatment area clean and ensure your pets stay out of the room when you connect or disconnect.
Can you just decide to do dialysis at home? Anyone on your care team at the dialysis center can refer you, or you could ask them yourself!
If I do dialysis at home, will I be able to change dialysis types or be a candidate for transplant? You can always switch to another home modality or decide you’d like to go to in-center hemodialysis. Also, doing home dialysis does not make you less likely to receive a transplant.
Once I decide to do dialysis at home, can I begin right away? There’s a lot to learn and arrange for when preparing for home dialysis. But you can get started by first speaking up.
If I do home dialysis, will it cost more than dialysis in-center? Both Medicare and private insurance cover the cost of home dialysis.
If I do home dialysis, will I have to rewire my home? Any required electrical work, if needed, is simple and can often be completed sometime during the training.
Can I do home dialysis even if I am afraid to insert my own needles? Many patients have learned how to insert their own needles both for in-center and home dialysis. It can preserve the fistula, hurt less, and result in fewer complications. Patients with a specific kind of fistula (an AV fistula) can use a buttonhole technique, which uses dull needles placed into the exact same hole every time you have dialysis. Ask your nurse to learn how. Peritoneal Dialysis (PD), is a needle free option for many as well.
If I dialyze at home, can I eat and drink whatever I want? Dietary and fluid intake limitations remain in place, but you may have a bit more flexibility with your limits and choices. Always check with your medical team when changing your renal diet.
Do I need to have an HHD care partner that has a medical background? No medical background is needed. The clinic will train you and a partner, if one is required.
Does my house have to be perfectly clean at all times? Your home does not have to be perfectly clean to perform hemodialysis at home. You should have a designated treatment area with your supplies close at hand and stored in a neat fashion.
Do I have to get training to do my dialysis at home? There must be time for evaluation and practice. Everyone is a little different; both you and the staff must be comfortable with your skills before you actually dialyze at home.
Is HHD a huge burden of extra work for a care partner? It is best if you do as much of your treatment as you can. Some people do HHD without a care partner.
Can I do HHD with a dialysis catheter? The Rogosin Institute home program allows HHD with a catheter. Your nurse will train you to clean and care for your catheter. It is best to trade your catheter for a vascular access due to an increased risk of catheter-related infections.
If I do HHD, do I have to follow the same scheduled days of the week? Many different schedules are available and can be arranged at home. For instance, short daily dialysis or extended dialysis. You might also consider nocturnal dialysis if you’re interested in dialyzing while you sleep. The purpose of home dialysis is to set your own schedule.
Is there a long waiting list to learn how to do HHD? There may be a short wait to start training. Nurses may be training other patients. Ask your nurse to be certain.
Is it true that you can bleed to death easily on HHD? No one has ever bled to death on HHD. Machine alarms alert you to the detection of just one drop of blood out of place. You will have time to react and fix the problem.
Do I need a professional at home to put in my needles? The training nurses at the Rogosin Institute are professionals at training people to perform all of the tasks involved in doing your own treatment. You will not be released from training until the nurse is comfortable with you or your care partner putting your needles in, troubleshooting alarms and your capability of handling any emergencies. You will learn to be an expert. Plus, your home dialysis facility serves as 24-hour phone backup. You will always be near help.
What if I want to do HHD and my family disapproves? We have plenty of resources to educate you and your family. Your family can speak to a member of the home dialysis staff, a Wellness Ambassador, a physician or social worker to give them the information they need to understand your choice.
FAQs adapted from: Uncovering Myths About Home Dialysis, End Stage Renal Disease National Coordinating Center (ESRD NCC)