Treatment

At-home dialysis treatments

For over 40 years, dialysis patients have had a choice in their at-home treatments. Peritoneal dialysis (PD) and at-home hemodialysis have been available since the 1960s. PD is the most popular at-home treatment, due to its ease of use. Now, new technology has made at-home hemodialysis more affordable and easier to learn and perform. Both types of treatment programs are effective for many end stage renal disease (ESRD) patients.

Peritoneal dialysis

Peritoneal dialysis (PD) is the most common at-home dialysis treatment. Patients who opt for PD treat themselves daily with little or no assistance from others.

PD uses a thin membrane in the abdomen called the peritoneum. A fluid called dialysate is placed in the abdomen through a small, flexible tube called a catheter. The dialysate draws and captures waste and fluid from the blood vessels that pass through the peritoneum. After a certain amount of time, the dialysate is drained and fresh dialysate is introduced.

The filling and draining of dialysate from the body (called an exchange) can be done manually or with a machine called a cycler.

Continuous ambulatory peritoneal dialysis (CAPD) is done manually. A bag of dialysate is held above or near the patient’s head on an IV pole or a coat rack and attached to the catheter. The dialysate fluid will fill the abdomen and remain there for a prescribed period of time (usually between 4 to 6 hours). Each exchange generally takes about 20 to 30 minutes to drain and 5 to 10 minutes to fill. For patients who work, manual exchanges can be performed in a clean area in the workplace.

There are two types of automated peritoneal dialysis (APD). The most popular type of PD is continuous cycling peritoneal dialysis (CCPD), which uses a machine called a cycler to automate exchanges. This machine is programmed to fill and drain the abdomen automatically at night. It performs several exchanges while the patient sleeps with one exchange during the day. Nighttime intermittent peritoneal dialysis (NIPD) is similar to CCPD, except the peritoneum is left empty during non-treatment hours.

The home training nurse teaches the patient and/or a partner how to perform PD safely at home. PD training usually takes about 2 weeks until people are comfortable with the procedure.

At-home hemodialysis

There are three types of at-home hemodialysis: conventional home hemodialysis, short daily home hemodialysis and nocturnal home hemodialysis.

Conventional home hemodialysis is done three times a week for approximately 3 to 4 hours each session. This schedule is similar to hemodialysis done at a dialysis center. Some patients will do their treatment every other day, which works out to be three times a week the first week, and four times a week the second week. Many patients read, watch television or chat on the phone while they have their treatment.

Short daily home hemodialysis consists of 5 or 6 treatments a week for a few hours each session depending on the patient’s size, labs, access and other factors. The doctor will provide a dialysis prescription for the amount of time each session will last. Some patients on conventional hemodialysis experience side effects (such as low blood pressure, dizziness and nausea) caused by large amounts of fluid being removed during a dialysis session. More frequent treatments reduce these uncomfortable symptoms because less fluid builds up between dialysis sessions.  

Nocturnal home hemodialysis is done at night while a person sleeps. It is usually done every other night, but can be done up to six times a week, with each session lasting between 6 to 8 hours. This extended treatment time means less waste and fluid will accumulate in the body, which may leave the person feeling better and more energetic.

All three types of at-home hemodialysis require a hemodialysis machine in the home. For safety reasons, at-home hemodialysis requires that a care partner is available to help the patient. The patient and care partner (who can be a spouse, family member, or any trusted individual) will be trained to set up, clean, operate and disinfect the machine. Training generally takes from a months to six weeks, or until both are comfortable and skilled enough to start at home hemodialysis. 

Which at-home treatment is best for you?

Your choice of treatment depends on a variety of factors: your medical condition, your lifestyle, and your level of comfort in administering your treatment at home. Your doctor will recommend the best option suited for you based on these factors as well as your desired treatment method.

Because you will be responsible for treating yourself, you will be expected to monitor your condition and report any changes you see and feel to your doctor immediately. Always ask your doctor before you make any changes to your dialysis schedule or want to switch dialysis treatments. Remember, you will perform your treatment at home, but you will not be on your own. Before beginning any type of home dialysis, you will be trained by a professional. Once you start dialyzing at home, help is always available by phone if you have problems or questions.

Although at-home dialysis is not right for everyone, it could be right for you. Talk to your doctor to learn if you could benefit from at-home treatment.