Chattanooga Kidney Centers offer two options for dialysis in the home setting, Peritoneal Dialysis and Home Hemodialysis.
PD uses the thin membrane, called the peritoneum, which lines the abdomen to perform dialysis treatments. During treatments, a cleansing fluid called dialysate is put into the patient's abdomen through a small, flexible tube called a PD catheter.
The dialysate pulls the waste and extra fluid from the patient's blood into the peritoneal cavity. The dialysate remains in the abdomen for a specified amount of time before it is drained and replaced with fresh dialysate. The time during which the dialysate remains in the patient's abdomen is known as the dwell time. When the dialysate is drained, the wastes and extra fluids are also drained, and fresh dialysate is replaced to clean the blood. This filling and draining process is called an exchange because the dialysate that has been in the abdomen is being exchanged for new, fresh dialysate. Exchanges can be done manually or with a machine called a cycler.
There are three basic requirements patients must meet in order to qualify for PD. Patients must have the motivation to adhere to a treatment schedule, basic manual dexterity and a functional peritoneal membrane
The benefits of PD include:
- Fewer negative side effects (such as nausea, vomiting, cramping, and weight gain) than in-center hemodialysis
- Fewer dietary restrictions than in-center hemodialysis
- Needle-free treatments
- Direct shipment of PD supplies to your home or travel destination
- Infrequent trips to the dialysis center
- Greater flexibility and freedom in your treatment schedule
In addition, because PD patients take an active role in performing their dialysis, they are more involved in their care and more educated about their conditions. Research indicates that patients on dialysis who are more involved in their healthcare tend to be healthier and have a better outlook regarding their treatment.
In order to perform HHD, you'll need to be trained by a home dialysis training nurse. Training typically takes four to eight weeks to complete. You'll learn how to operate the equipment, handle supplies, insert needles, record medical information and disconnect from the machine.
A required care partner—your spouse, child, sibling, friend or neighbor—will be trained as well so that he or she can assist you during your HHD treatments. With the help of your home training nurse, both you and your care partner can build confidence by the time you begin dialyzing from home.
Training often takes 3 to 8 weeks.
The patient returns to the clinic once a month to see the nephrologist, dialysis nurse, and dietitian. A blood sample will be tested to ensure the HD treatments are working and to detect any problems, such as anemia or high potassium levels that should be treated.
Home HD lets the patient set the schedule. The patient can choose treatment times to fit other activities, such as going to work or caring for a family member.
The patient can dialyze more often at home. People who dialyze at a clinic skip 4 days each week, so wastes and fluid build up in their bodies. Dialyzing at home five to seven times per week means wastes and fluid don't build up as much in the body. Muscle cramps that are common in people using the standard HD may be less common in those who choose home HD because wastes and fluid are cleared more often.
Treatment plans usually follow one of two schedules:
- 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 they 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.
- 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. This gentle treatment is easy on the patient's access and heart. 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 6 nights per week.
The schedule can be tailored to fit each person's needs.
Because use of home HD is still increasing, researchers have not been able to do large studies that compare home treatment with standard HD. But dozens of small studies have found better results in patients who do daily or nightly home HD. Reported benefits include
- better blood pressure control with fewer drugs
- better control of phosphate levels in the blood
- less limited diet and fluids than standard HD
- reversal of some heart damage caused by high blood pressure
People who do home HD say it improves their quality of life. Those who have switched from standard to more frequent home HD say they have more energy, feel less nauseous, and sleep better. Many say they value the control they gain by doing their own treatments.