Home hemodialysis

Transitioning from in-center to home hemodialysis

If you are thinking of switching from in-center to home hemodialysis (HHD), you may have some questions about the transition. How long will the transition take? Will you have a healthcare team to support you? What is the training process like? Is there a way to ease into at-home dialysis slowly? What if you're not ready to do your own treatments when your training is completed? Read on to find out the answers to your most pressing questions about the transition process.

Assembling your healthcare team

If you're worried about losing touch with your health care professionals when you transition to at-home dialysis, don't be. Choosing home dialysis does not mean you’ll need to say good-bye to your doctors and healthcare team. On the contrary, these important individuals will continue to play an integral role in your treatment and will be there to answer any questions you have along the way. You will also need to have monthly in-center check ups to make sure everything is going according to plan.

When you begin training for home hemodialysis (HHD), you will be supported by a professional healthcare team made up of your nephrologist, a home training nurse, a renal dietitian, and a social worker.

• A nephrologist will prescribe your dialysis treatment, diet and medication, as well as manage your ongoing medical care. Your at-home dialysis provider will work closely with your current nephrologist. If you do not currently have a nephrologist, your at-home dialysis provider can help you choose one.
• A home training nurse will train and guide you. Your nurse will plan, coordinate and oversee all aspects of your dialysis care in keeping with your doctor's orders.
• A renal dietitian will guide you on what to eat and review your lab results with you each month to determine where improvements can be made in your diet.
• A social worker will counsel you regarding the emotional aspects and adjustment of dialysis and insurance issues.

These people will be dedicated to and focused on your care. It will be their job to monitor your lab values to make sure that you are getting the most out of your dialysis treatments, train you on all aspects of home dialysis, provide you with dietary tips and advice, lend an ear when you need to talk and help you through any insurance or Medicare concerns you may have.

Training

Before you begin training, your training nurse will explain the training process to you. Because training requires such a high level of commitment, both you and your training nurse will sign a document declaring your dedication to the training process prior to beginning training.

Depending on how fast you learn and the equipment you have chosen, HHD training can take anywhere from three to six weeks. Your training nurse will work with you and your care partner to devise a training schedule that will fit into everyone's daily routine. Your care partner must come with you to all training sessions so that he or she will learn how to assist you. The majority of home hemodialysis training is done in a dialysis center.

When you begin training, you will be given a customized educational binder with all of the information you need to know about your particular choice of equipment, your prescriptions and your personal medical needs. The binder will also include a list of emergency phone numbers, lists of medications, instructions for setting up your equipment and much more.

During your first week of training, your HHD training nurse will set up your dialysis equipment, explaining everything as he or she goes along. As you become familiar with the process, you will gradually begin assisting with the set-up of the machine. When you are ready, you and/or your care partner will insert the needles needed for your treatment into your vascular access. Once you learn how everything works, you and your care partner will orchestrate the entire treatment process from set-up to clean-up while your training nurse stands by and observes.

When both you and your training nurse feel that you are ready to take your machine home and begin your at-home treatments, your training will be complete. Your training nurse will come to your house to support you during your first at-home treatment.

Modifying your home

During the training process, you will need to create space in your home to store your dialysis supplies. A closet or large cabinet works well. You will also need to decide where you want to dialyze each day and make space for your dialyzer on a table next to a comfortable chair or your bed. You may need to make some minor plumbing and electrical modifications to your home depending upon your equipment choice. Your healthcare team will go over the changes that need to be made to your home (if any) and will help you arrange for these changes if you need assistance.

In-center self care

When your training is complete and your home is ready, you will have the knowledge, understanding and physical set-up needed to perform your home hemodialysis treatments. However, if you find that you don't have the confidence just yet, you may want to consider in-center self care.

It's important to note, though, that in-center self care is currently only available at a small number of centers. You can check with your dialysis center to find out if self care is available to you.

Patients who choose in-center self care do their own dialysis treatments in a dialysis center. They go into the center, set up the dialysis machine themselves, self-cannulate and perform their own dialysis treatments. However, because they are in a dialysis center, they have the support of a team of professionals in case any problems arise.

Self care helps you get a feel for doing your own dialysis treatments while remaining confident that assistance is only a few feet away. The timing of self care treatments is more flexible, although it is still done three times a week. In-center self care patients can come in for more than the standard amount of treatments during the week if a dialysis chair is available at the center, although these extra treatments may not be covered by insurance.  If you choose self care, you can make the move to your home whenever you feel that you are ready.

Related articles on DaVita.com

• Getting started on home dialysis