Home dialysis basics
Home dialysis - Keys to success
By Courtney Mawhinney, R.N.
As interest in home dialysis as a treatment option for chronic kidney disease continues to increase, I often get questions from concerned patients about what it takes to be a successful candidate for home dialysis.
Every patient has unique medical and lifestyle needs that help me determine the best course of treatment on a case-by-case basis. Generally speaking, the most successful candidates for home dialysis are those patients who are dedicated and want to take control of their treatment, keep working full-time or maintain a flexible and active lifestyle. The truth is, I've had patients with all types of backgrounds and histories succeed in home dialysis programs without complications.
As with in-center dialysis programs, home dialysis patients continue to work closely with their doctors and health care team that monitors and oversees their ongoing care just as they would if they visited a dialysis center for their treatments. Home dialysis can help people receive the treatment they need and maintain the freedom they value – at a time when they might not feel like they have control. Because they have more flexibility in managing their treatment, home dialysis patients tend to see a positive impact in their ongoing care as well as how they live. There are, however, a few key factors that can help determine a patient’s overall success with home dialysis treatment.
Common sense and safety
As with all forms of dialysis or other medical treatments, safety should always remain the top priority for anyone on home dialysis. All home dialysis patients participate in customized training programs to teach them how to safely administer their own treatments as well as handle potential issues or problems that might arise. We would never send a patient home unless we were confident that they could initiate, monitor and complete their home treatments with confidence. Once you’re home, your doctor and nurse will monitor you closely to make sure you’re getting the support and clinical care you need. Our home dialysis patients keep information about their treatments, a set of emergency numbers and a phone nearby in case of an emergency. Although patients dialyze at home, they are never alone. We provide 24/7 on call nursing support.
Compliance
Along with the freedom and flexibility of home dialysis comes the personal responsibility to adhere to the frequency and length of treatments prescribed by your doctor. Even though home dialysis allows patients to conduct treatments outside a medical setting and without direct supervision, it’s critical to closely follow your doctors’ instructions. You will work closely with your health care team to monitor your care and make sure that your dialysis is being conducted according to your doctor’s orders. Your involvement in your own care will empower you to influence the quality of your life each and every day.
It's important to remember that although you’ll be doing dialysis more often than at a dialysis center, the extra responsibility and time spent will allow you to take a more active role in your care and the long-term benefits will make it all worthwhile.
Time management
I tell our home patients that being in the driver’s seat for their own care requires a strong commitment to effective time management. The most successful home dialysis patients I work with are those who learn how to integrate their treatment schedules seamlessly into their daily lives and routines. Your physician will tell you how many days a week to dialyze and for how long, but from there, you are free to arrange your dialysis treatments around work schedules or other obligations and requirements.
For people already juggling complicated schedules, adding home dialysis into the schedule isn’t so difficult if you think about ways to optimize your time. If you know you’re going to have a long day and won’t be home until late, make sure to do as much setup as possible in the morning so you have less to do later in the day. By making sure to prepare your equipment and supplies to be ready when you are, many patients find it easier to comply with the number and duration of treatments prescribed by their physician.
Some patients find it helpful to develop a weekly calendar to keep track of treatments. For those with dialysis partners, it’s also important to coordinate schedules when planning your weekly treatment routine.
Making space
I always explain to my patients who are considering home dialysis how performing their treatments will affect their living spaces. All types of home dialysis require a good place to perform treatments. If you dialyze at night, you can sleep in your own bed. If you choose daytime hemodialysis, you will need an appropriate chair. Peritoneal dialysis does not require a special chair.
You will also need space for equipment and supplies. Different types of home dialysis require different equipment and supplies, so it’s important to talk about the different options with your health care team. If you’re concerned about finding enough space in your home, you can work with your health care team to receive smaller packages of supplies on a more frequent basis. This will keep you ready to do home dialysis on a regular schedule without requiring you to keep a lot of supplies on hand.
Most importantly, I tell my patients to set things up in a way that is easiest and most comfortable for them. Envision what you see yourself doing when you dialyze and then find a way to incorporate your equipment and supplies into that vision. Maybe you have a great view from your home and want to look out the window, or maybe you want to watch television -- every patient is unique, so make sure you find a solution that fits you.
Family and dialysis partner support
A number of our home patients have been nervous or apprehensive about performing home dialysis themselves, but I’ve also had many friends and family members contact me with concerns about their loved ones performing home dialysis on their own. Understandably, it can be difficult to imagine a loved one performing treatments without assistance. But in my experience, nearly anyone can do home dialysis if they have the right training and dedication. That’s why I always recommend patients proactively explain the process to family and close friends to help put them at ease.
Depending on the type of home dialysis they choose, some patients like to have a partner assist them with their treatments. Many patients perform peritoneal dialysis at home with no assistance. In general, most home hemodialysis patients prefer to have a partner. Dialysis partners often play a key role in providing both emotional and physical support for home dialysis patients.
If you have a dialysis partner, I always recommend being sensitive to the needs and schedules of the family member or friend fulfilling this role. Sometimes adhering to a regular treatment schedule might create stress for you and your dialysis partner, so it’s especially important to find a balance for your respective roles and responsibilities related to your treatment that works for both of you.
About Courtney Mawhinney
Courtney Mawhinney is a Registered Nurse and has worked with Davita for the last 8 years. She has worked in the home dialysis field for the last 6 years and started one of the first DaVita home hemodialysis programs in Philadelphia, PA. This home location has trained over 100 home hemodialysis patients. She is now working as the director of clinical marketing for DaVita at Home.
© 2004-2008 DaVita Inc. All rights reserved.