Learn more about all the different types of home Hemo dialysis.

When you are told you have kidney failure and need treatment to stay alive, it can be a difficult time in your life. If your kidney diagnosis is new, you may feel overwhelmed, confused, and angry.

However, just 50 years ago, there was no treatment. Chronic kidney disease was considered a deadly disease. 

Now, two treatments would allow you to live a long, fulfilling life: kidney transplantation and dialysis.

What is Dialysis?

Dialysis is a procedure that can help patients with end-stage renal disease to increase quantity and quality of life. 

Typically, the kidneys are responsible for removing surplus fluid and turning excess products into the urine excreted. However, in those with impairments in kidney function, dialysis is often required. 

Dialysis is a medical procedure that assists in the functions usually carried out by the kidneys in those with poorly functioning kidneys, such as people with renal disease.

Without dialysis, those with kidney issues may experience a toxic build-up of fluid and waste bi-products that can have serious health implications, including death. Therefore, dialysis enables such individuals to have an improved quality of life.

There are two main types of dialysis: peritoneal dialysis and hemodialysis. Most individuals requiring dialysis can decide which type of procedure they would prefer as they are both equally efficacious. However, both come with their benefits and disadvantages that need to be considered by the patient.

How hemodialysis works

Hemodialysis is a treatment that replaces the work of your kidneys to clear wastes and extra fluid from your blood. It is done using a special filter called a dialyzer or artificial kidney. Your blood travels through plastic tubing to the dialyzer, where it is cleaned and then returned to you. 

At the beginning of each treatment, two needles are placed into your access. These needles are connected to the plastic tubing that carries your blood to the dialyzer. 

Only a small amount of blood is out of your body at any one time. The dialysis machine pumps your blood through the dialysis system and controls the treatment time, temperature, fluid removal, and pressure.

This basic process is the same for home hemodialysis, except that you and a care partner are trained to do your treatment at home.

Hemodialysis: At home or in-center

You can do hemodialysis at a dialysis center where a nurse or technician performs the tasks required during treatment. In-center hemodialysis is usually done three times a week for about three to four hours or longer each session. In-center treatments are done at a pre-scheduled time.

You can also do hemodialysis at home, where you are the one doing your treatment. At home, you may be better able to fit your treatments into your daily schedule. Studies show that the more you know about your treatment and the more you do on your own, the better you are likely to do on dialysis.

Different types of home hemodialysis

You can do three types of hemodialysis at home. 

They are:

1. Conventional home hemodialysis

You do this three times a week for three to four hours or longer each time. You and your care partner go through a training process to do dialysis safely and to handle any problems that may come up. Training may take from several weeks to a few months.

2. Short daily home hemodialysis

You go through the treatment process five to seven times a week using new machines designed for short daily home treatment. Treatments usually last about two hours each.

You and your care will have training over several weeks. Because you are doing dialysis more often, less fluid generally needs to be removed each time. It reduces symptoms like headaches, nausea, cramping, and feeling “washed out” after treatment.

3. Nocturnal home hemodialysis

Long, slow treatments done at night while you sleep. You may do this kind of dialysis six nights a week or every other night. It depends on what your doctor prescribes for you. Treatments usually last about six to eight hours. You and your care partner will train over several weeks.

Some centers monitor your treatments by sending information from your dialysis machine to a staffed location by telephone modem or the Internet. 

It is also possible to combine daily and nocturnal home hemodialysis. Whether you can combine treatments depends on your needs, your medical condition, and your machine.

Whatever treatment option you choose, it is essential to know if you are getting the right amount of dialysis. You should do regular tests to check the amount of dialysis you are receiving. Speak with your nephrologist and your dialysis care team.

Added benefits of short daily and nocturnal home hemodialysis

Many reports indicate that people using short daily and nocturnal home hemodialysis:

  • Take less medication to control blood pressure and anemia
  • Take less medication to keep phosphorus under control to help prevent bone disease
  • Have improvements in neuropathy (nerve damage) and less restless leg syndrome
  • Feel better during dialysis and less “washed out” after
  • Have more energy for daily tasks
  • Sleep better
  • Have fewer and shorter hospital stays
  • Have a better quality of life
  • Live longer

New technology

New, easy-to-use machines are being developed for home hemodialysis. These are easier to set up, clean, and disinfect. With more recent machines, you have fewer supplies to store. If you think home hemodialysis is a good choice for you, ask your doctor about the best equipment.

Deciding if home hemodialysis is right for you

Home hemodialysis is not a good fit for everyone. You will need to learn a lot about it and be willing to be responsible for your treatment. As long as you or your care partner can pass the training and learn to place your needles, you should be able to do home hemodialysis.

Why should you consider home hemodialysis? 

 It offers the most independence and personal freedom, few transportation problems, least exposure to infections, freedom to schedule your treatments, and, most importantly, the opportunity to dialyze longer or more frequently.

It also provides the best patient survival of any form of conventional three times a week dialysis, the best quality of life, and opportunity for rehabilitation. 

Drawbacks are the space required for dialysis and the room to store supplies. Home hemodialysis patients may also need help from another person, some plumbing and electrical modifications in the home, and higher water and electricity bills depending on the machine used. 

Who can do it

Almost anyone motivated, willing to learn, who wishes to be independent, has suitable living accommodations, and does not have frequent medical complications during dialysis. 

It is simple to learn and do

Using a dialysis machine is not difficult. You need to know how to use it safely. It has been around for 44 years and, with appropriate training and support services, is just as safe or safer than dialysis in a dialysis unit. Remember, you, the well-trained patient, are in charge of your treatment. Help and advice from your nephrologist and APRN is just a phone call away.

Is it for everybody? 

No, but experienced nephrologists believe at least 20 percent of all U.S. patients could do this if they had access to a program.

What are patient concerns? 

Most patients feel they need supervision by the staff during dialysis. 

New patients are also scared of needle sticks and don’t believe they or a helper could do this in the home. 

With good equipment and safeguards, this is perfectly safe.

Talk to your nephrologist about whether it is a suitable treatment for you. Meet with a patient who dialyzes at home and see what he or she has to say about its benefits. Finally, take the time to educate yourself to make the best choice and improve your quality of life. People with kidney failure live active lives and continue to do the things they love.

(1) https://jasn.asnjournals.org/content/16/9/2778