Home dialysis basics

The basics of home dialysis

Dialysis is a medical treatment that removes waste and fluids from the body when your kidneys no longer work well enough to keep the body healthy. First invented in the late 1940s, dialysis has been a life-saving procedure for millions of patients suffering from kidney failure across the world. Although most dialysis treatment is performed at a hospital or outpatient facility, at home dialysis has been experiencing a resurgence in popularity as a safe, effective and preferred method of treatment for some patients.

The ability to dialyze at home can offer considerable lifestyle benefits. For many patients, at home dialysis can provide a level of flexibility not possible at a dialysis center. Whether it's additional time spent working, with family or fulfilling other obligations or interests, at home dialysis allows patients to arrange their treatments around their own schedule. At home dialysis also saves time because there is no need to drive back and forth to a dialysis center three days per week.

Additionally, research has shown that patients who perform some types of at home dialysis may experience better quality of life and better clinical results - especially those who take advantage of their home setting to have more frequent or extended dialysis. Many patients even choose to dialyze at night while they sleep, enjoying the benefits of extended dialysis without losing time with family and friends.

There are two main types dialysis that can be performed at home:

Home hemodialysis (HHD)
During at home hemodialysis, the blood is cleaned of waste products and extra fluids as it is pumped by a machine through a dialyzer or filter. In order for the blood to be carried to the dialyzer, a vascular access is needed. A vascular access is normally created under the skin using a person's own blood vessels. The patient and their dialysis partner (if needed) will receive training on how to use it.
Peritoneal dialysis (PD)
Peritoneal dialysis differs from at home hemodialysis by filtering and cleaning blood within the body rather than through an outside dialyzer. With peritoneal dialysis, the patient's abdomen is filled with a special solution called dialysate that helps remove waste and extra fluids from the blood. During the process known as an exchange, the solution is then drained from the abdomen, taking the waste with it. Many patients perform peritoneal dialysis at home with no assistance.

People considering at home dialysis should talk with their doctor and decide if at home treatment is right for them and, if so, which type best fits their needs.

Home hemodialysis

Since its development in the 1960s, thousands of patients have enjoyed the wide range of clinical and lifestyle benefits that at home hemodialysis (HHD) can provide. One of the greatest benefits of at home hemodialysis is that it can be customized to accommodate the specific treatment program determined by doctors. Every patient is unique and with at home hemodialysis, so is every treatment.

In some cases, at home hemodialysis treatments require a dialysis partner. This can be a spouse, parent, child, professional caregiver or other responsible person who can be relied upon to provide support in performing treatments. Together, the patient and dialysis partner develop a plan to perform regular dialysis treatments that fit their schedules and specific needs.

In order to begin treatment, a vascular access will have to be created. The access allows the patient's blood to travel to and from the dialysis machine so that toxins, waste and extra fluid can be removed from the body.

Treatment choices

Today, there is a range of at home hemodialysis treatment optionsavailable. At home hemodialysis provides physicians the ability to regulate the frequency and duration of treatments in order to provide the best care. There are three types of at home hemodialysis that use the same equipment and techniques, but vary based upon the specific needs of the patient:

Short daily
Performed five or six times a week, typically for two to three hours per session.
Traditional
Performed three times per week, typically for about four hours per session. This is similar to the treatments received at a local dialysis center. At home hemodialysis patients also have the option to perform treatments with greater frequency.
Nocturnal
Performed during sleep, typically six to eight hours a night, three or more nights a week. Many patients enjoy the ability to spend the night dialyzing and not lose time during the day that can be spent at work or with family.

Equipment

There are various at home hemodialysis equipment options available to accommodate and support the full range of treatment choices. Whereas the first machines were large and difficult to use, the new generation of dialysis machines are designed with at home hemodialysis patients in mind, offering increased flexibility and a much more manageable experience.

The newest at home hemodialysis machines are designed to take up less space and require fewer supplies to store. Some new equipment options are also designed to be mobile, allowing patients the ability to travel for work or leisure with their machines. Reliable and user-friendly, the machines and water treatment equipment now available for at home hemodialysis patients are easy to use and maintain.

It is important to note that some homes might require plumbing and/or electrical modifications to accommodate at home hemodialysis equipment.

Training

After a patient has decided with his or her doctor that at home hemodialysis meets their treatment needs, the next step is to participate in a comprehensive training program to learn how to conduct at home hemodialysis treatments safely and effectively. During training, patients will learn all the skills and techniques needed to regularly perform treatments independently.

The majority of training is done at dialysis centers, and many programs include follow-up training at home to better prepare patients for the experience they will have after the training is complete. The training program should cover a wide range of topics, including how to use the specific type of equipment, create a hygienic environment, manage supplies, handle needles and keep an organized log of treatments, among other essential tasks.

Training needs vary from patient to patient, but typically a patient (and his or her dialysis partner if they have one) can learn to perform treatments within six to eight weeks. Training should be conducted on an individualized basis and customized to a patient's specific therapy and learning needs.

Peritoneal dialysis

For nearly 30 years, peritoneal dialysis (PD) has been a safe and effective form of dialysis. Improvements in technology over the years have made peritoneal dialysis easier and safer, allowing patients to enjoy the benefits of dialyzing from the comfort of their own home. Because peritoneal dialysis effectively filters and cleans the blood without the use of a separate dialyzer, treatments can be done more easily from home or on the road.

To perform peritoneal dialysis, a patient must first have a catheter placed in his or her abdomen to allow the fluid to enter and drain. The catheter is a small, flexible tube about the thickness of a pencil. It is inserted off to the side, below the belly button, and goes into the abdominal space called the peritoneal cavity. The catheter is placed into the body in the operating room by a surgeon or trained nephrologist, which is usually an outpatient procedure. The catheter remains permanently in the abdomen, and is taped onto the outside of the body so that it doesn't interfere with everyday activities like work, exercise, recreation, showering or sexual activity.

Treatment choices

There are two types of peritoneal dialysis that perform the same function but use different equipment and treatment schedules.

Continuous ambulatory peritoneal dialysis (CAPD) |
The exchange process is usually performed 4-5 times per day without a machine.
Continuous cycling peritoneal dialysis (CCPD)
For patients receiving CCPD, an automated machine called a cycler performs most exchanges at night while the patient sleeps.

Equipment

Although peritoneal dialysis does not require a dialyzer, it still requires equipment and a sterile environment for performing regular treatments.

Prior to beginning treatment, patients have a small, flexible catheter placed by a surgeon in the abdomen. To perform regular exchanges, patients will need a supply of dialysate bags as well as empty bags for the solution to drain into at the end of each treatment.

For patients performing CCPD, a special cycler machine is needed to automate the exchange procedure, filling the abdomen with dialysate and then draining it at the end of the treatment. Larger bags of the dialysis solution are also needed for CCPD.

Maintaining a supply of dialysate bags is essential and most dialysis providers will ship quantities to a patient's home or wherever they travel within the United States.

Training

After the catheter is in place and healed, the patient will visit a peritoneal dialysis nurse and begin learning how to perform PD. There are several training sessions over a one- to two-week period. Family members are encouraged to participate in training and provide support, although it is not necessary to have a partner to perform PD. In addition to learning how to do peritoneal dialysis, information is given about diet, fluid management, good hygiene and medication management.

A dietitian and social worker will meet with the patient and be involved in some of the teaching sessions. Patients watch videos, read instruction manuals and actually perform fluid exchanges-during which they drain the dialysate from the peritoneal cavity and then replace it with fresh dialysate-until both the nurse and patient feel that the patient is ready to begin performing the treatments at home without the nurse's support. Learning about PD and how to perform it is pretty easy for most people. People with certain handicaps, such as learning disabilities, blindness and amputations have been taught to successfully perform home dialysis with PD.

Home treatments usually begin two to three weeks after the catheter has been placed and training has been completed.