Home dialysis basics

What are my home dialysis treatment options?

Dialysis is a treatment that removes waste and fluids from the body when your kidneys no longer work well enough to keep the body healthy. Today, there is a range of dialysis treatment options available, including a number of choices that allow you to conduct dialysis at home. If you're a patient interested in at home dialysis, these options allow you, your doctor and your dialysis partner to choose the treatment that best suits your clinical and lifestyle needs.

There are two distinct types of at home dialysis that are currently available: at home hemodialysis and peritoneal dialysis. Each type has its own very specific procedures, requirements and equipment/supplies. If you are considering dialysis at home, you should discuss the treatment and equipment options with your doctor and decide if one of them is right for you.

Home hemodialysis

During at home hemodialysis, blood is sent from the body to an outside machine (dialyzer) that filters out the waste and extra fluids then returns the blood to the body. Hemodialysis is typically conducted in a dedicated facility with specialized nurses and technicians who specialize in hemodialysis.

However, dialysis can also be done in a patient's home, known as at home hemodialysis.

Once you and your doctor have determined that at home hemodialysis is right for you, you will begin a comprehensive safety and training program that is tailored to your specific medical and learning needs.

In most cases, you will learn to perform at home hemodialysis treatments with a dialysis partner. An access will have to be created to allow blood to flow from your body to the dialyzer, so it can filter waste and remove extra fluid from your body. There are different ways to create an access, and you will discuss with your doctor which one is right for you and your treatment. There are three types of at home hemodialysis:

1. Short daily home hemodialysis
   Performed five or six times a week, typically for two to three hours per session.
   Traditional home hemodialysis
   Performed three times per week, typically for about four hours per session. This is similar to the treatments received at a local dialysis center.
2. Nocturnal home hemodialysis
   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 could be spent at work or with family.

It is important to note there are various home hemodialysis equipment options available to accommodate/support these treatment choices.

Peritoneal dialysis

Peritoneal dialysis is a type of at home dialysis performed by running dialysate into a catheter through the peritoneum (a protective membrane that lines the abdominal cavity). This allows blood to be filtered inside the body. Because peritoneal dialysis filters blood inside the body, there are fewer equipment requirements than at home hemodialysis. Many patients perform peritoneal dialysis at home or at work without assistance.

Prior to beginning peritoneal dialysis treatment, a small, flexible catheter is placed by a surgeon in your abdomen. This catheter is used to fill your abdominal cavity with a warmed, specially prepared fluid called dialysate (dialysis solution). The dialysate stays in your abdomen for several hours and absorbs waste and excess fluid from your blood. You then drain it out and replace it with fresh dialysate.

There are two types of peritoneal dialysis:

1. Continuous ambulatory peritoneal dialysis (CAPD)
   Performed four to five times per day without a machine.
2. Continuous cycling peritoneal dialysis (CCPD)
   To reduce the number of daytime exchanges, patients undergoing peritoneal dialysis can use an assist machine (called a cycler) to do exchanges, usually while they sleep at night.

Peritoneal dialysis patients generally perform four to five fill-and-drain exchanges per day.

Is it safe for me to do at home dialysis?

Yes. After speaking with your doctor and determining that at home dialysis is right for you, one of the first steps before receiving treatment is participating in a comprehensive safety and training program. In addition to receiving extensive training on how to conduct safe and efficient at home dialysis, your dialysis provider and doctor will be in contact with you on a regular basis. Most at home dialysis providers also offer 24/7 phone support.

Related articles on DaVita.com

• Home hemodialysis and peritoneal dialysis: A look at the two main types of home dialysis
• A brief overview of home hemodialysis
• A brief overview of peritoneal dialysis