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 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 questions about the transition process.

Assembling your home dialysis health care team

If you're worried about losing touch with your health care professionals when you transition to 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 individuals will continue to play an integral role in your home dialysis treatment and will be there to answer questions you have along the way. You will also be scheduled 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 home dialysis health care 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 home dialysis provider will work closely with your nephrologist. If you do not currently have a nephrologist, your 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, help you create meal plans with foods you enjoy and review your lab results with you each month to determine where improvements can be made in your diet if necessary.
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 kidney diet tips, lend an ear when you need to talk and help with financial and insurance or Medicare concerns you may have.

Training for home hemodialysis

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

Depending on how fast you learn and the equipment you have chosen, home hemodialysis (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 the information you need to know about your particular choice of equipment and how to set it up, your list of medicine and prescriptions to be filled and your personal medical needs. The binder will also include a list of emergency phone numbers and more.

During your first week of home hemodialysis 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 home dialysis 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 you, your care partner and 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 hemodialysis treatment.

Modifying your home for home hemodialysis

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 time 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 hemodialysis

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 hemodialysis.

You can check with your nearby dialysis center to find out if in-center self care hemodialysis is available to you.

Patients who choose in-center self care do their own hemodialysis 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 on-site in case any problems arise.

In-center self care hemodialysis 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 in-center self care hemodialysis temporarily, you can make the move to home hemodialysis whenever you feel that you are ready.