- The patient starts learning to do treatments at the clinic, working with dialysis nurse.
- The patient must have a helper who trains with them at the clinic. The helper can be a family member, neighbor, or close friend. Some programs do not require a helper if the patient can do all the tasks alone.
- The clinic will provide a machine for the patient's home and assist with ordering the necessary supplies. The patient does not have to but the machine. Supplies, such as dialysis solution, will be delivered to the home once or twice a month.
How long does training take?
Training often takes 3 to 8 weeks. The training staff makes sure the patient is confident about performing each task before home HD. Someone from the clinic will be available to answer phone calls during treatment times.
What about visits with the doctor?
The patient returns to the clinic once a month to see the nephrologist, dialysis nurse, dietitian, and social worker. A blood sample will be tested to ensure the HD treatments are working and o monitor and problems, such as anemia.
What are the risk of home HD?
Home HD has the same risks for complications that exist with in-center HD,
- Including low blood pressure
- Air embolism
- Dialysis line separation
What are the advantages of home HD?
- Home HD lets the patient set the schedule. The patient can choose treatment times to fit other family member.
- Patients report feeling more in control of their lives and their illness
- More flexible schedule
- People who do home HD say it improves their quality of life. Those who have switched from standard to more frequent home HD say hey have more energy, feel less nauseous, and sleep better. Many say they value the control they gain by doing their own treatments.
What are the schedules like?
Treatment plans usually follow one of two schedules:
- Long nightly treatments
some people dialyze at night while they sleep. Then they have the whole day free for other activities. The longer time of nightly HD allows for a slower blood flow rate. Because the treatments are so long, they remove more phosphorus and other wastes than short treatments can. Many people who do nightly HD no longer need blood pressure pills or phosphate binders. Nightly HD is done from 3 to 4 nights per week.
- Short daily treatments
Some people dialyze at home during the day. Because they do it every day(or at least five or six times a week) they do not have to dialyze as long. They can finish in 2 or 3 hours. And they save even more time because hey do not have to travel to and from the clinic. Daily treatments keep blood pressure more level than standard HD. Many people who do daily HD no longer need blood pressure pills.
What are some barriers to home HD?
- Although growing, the number of clinics that offer home HD is limited. Some patients may find that the nearest home HD clinic is an hour or two away.
- Insurers that pay for HD treatments, including Medicare, have set payment based on the standard schedule of three treatments per week. Clinics may limit daily HD to those who have employer group health plans because payment from medicare alone would not cover their costs.
The home must have room for the HD machine, supplies, and in some cases a water purification machine.
- The patient must be medically stable enough to undergo dialysis without professional supervision.
- The patient must demonstrate compliance with dialysis schedules.
What if I am interested in home hemodialysis?
- Talk to your physician
- Talk to your nurse
- Talk to your social worker
- Talk to you family or others who may be willing to be your dialysis partner.
- Remember every patient's case is different it is always worth the talk.