Deciding Which Home Dialysis Treatment Is Right for You

Is there one type of at-home dialysis treatment that is better than another? No, not necessarily. However, one treatment type may be better for you in particular. This article is designed to help you decide on an at-home dialysis modality.

Is home dialysis right for me?

Before you choose an at-home dialysis modality, you first need to decide if dialyzing at home is right for you. Here are some preliminary questions to ask yourself when making this decision:

  • Am I good at setting a schedule and sticking to it?
  • Am I motivated enough to stay on top of my health condition?
  • Can I read and write? If not, do I have a care partner that can?
  • Do I follow directions well?
  • Am I confident enough to do my own dialysis treatments?
  • Do I have basic dexterity?
  • Am I attentive enough to know when something is going wrong with my body?
  • Am I comfortable asking questions if I am unsure about something?
  • Am I free of the following: psychiatric disease(s), chronic use of sedatives, drug abuse, neurologic disorders, dementia, recurrent hepatic encephalopathy?
  • Am I looking to have an active lifestyle?
  • Do I like learning about my health condition so I can better maintain it?
  • Do I dislike traveling to and from the dialysis clinic?
  • Am I comfortable doing dialysis without the help of a nurse once I am trained?

If you answered yes to most of these questions, at-home dialysis may be an option you want to consider. Now, read on to explore which at-home modality will be the best fit for your health and lifestyle.

There are two types of at-home dialysis treatment: peritoneal dialysis and home hemodialysis. Both peritoneal dialysis and home hemodialysis are effective in treating end stage renal disease (ESRD), but they are very different from one another. Each type requires a different kind of access to the body, relies upon different equipment and allows for different treatment schedules.

Is peritoneal dialysis right for me?

Peritoneal dialysis (PD) is the most common form of at-home dialysis. PD is needle-free, but requires the surgical insertion of a soft, plastic tube called a catheter into your abdomen. PD uses the thin membrane that lines the abdomen called the peritoneum to perform dialysis treatments. A fluid called dialysate fills the abdomen and pulls wastes from the blood using the peritoneal membrane as a filter. Once the wastes have been absorbed, the dialysate is drained and the abdomen is filled with fresh dialysate.

If you are considering peritoneal dialysis (PD), here are some preliminary questions to ask yourself to help decide if this treatment type is right for you:

  • Do I have a functional peritoneal membrane?
  • Do I or my care partner have adequate vision and manual dexterity to connect pieces of tubing together?
  • Do I have space in my home to store supplies?
  • Would I be fine with having a catheter surgically placed into my abdomen?
  • Can I provide a sanitary environment in which to perform treatments?
  • Does my home have running water?
  • Does my home have electricity?

If you answered yes to these questions, PD may be the right choice for you. If you decide to go with peritoneal dialysis (PD), you will have two forms of PD to choose from: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).

Which form of peritoneal dialysis is right for me?

  • Continuous ambulatory peritoneal dialysis
    Continuous ambulatory peritoneal dialysis (CAPD) is done manually by placing a bag of dialysate on an IV pole or coat rack above your head and connecting it to your catheter. Once your abdomen is filled with dialysate, the dialysate remains, or dwells, in your abdomen for an amount of time specified by your doctor. After the determined amount of dwell time, your abdomen is drained and refilled with fresh dialysate. CAPD is a good choice for you if you do not sleep well while dialyzing or you are not comfortable doing dialysis at night because CAPD allows for a daytime treatment schedule. CAPD is also a good treatment choice if you maintain a full-time job since exchanges can be done in a sterile environment within the workplace.
  • Automated peritoneal dialysis
    Automated peritoneal dialysis (APD)--commonly referred to as continuous cycling peritoneal dialysis (CCPD)--requires a machine called a cycler to automate the fill and drain process. Cyclers are programmed to fill and drain your abdomen at night while you sleep. Two to four automated exchanges are performed while you sleep, and you may need to do an additional manual exchange during the day. CCPD is a good choice for you if you have a career or are in school, lead a busy life during the day or like to travel.

Is home hemodialysis right for me?

Home hemodialysis (HHD) is a treatment type that is very similar to in-center hemodialysis.  However, home hemodialysis can be safely and effectively performed at home. HHD requires vascular access, needle sticks and the accommodation of a dialysis machine in your home. During home hemodialysis treatments, blood flows through your vascular access, usually on your forearm, to the dialyzer where it is cleansed. The cleansed blood then flows from the machine back into your body.

If you are considering HHD, here are some questions to ask yourself to help decide if it is right for you:

  • Does my home have running water?
  • Does my home have electricity?
  • Am I willing to make plumbing and/or electrical modifications to my home if needed?
  • If I do not own my home, will my landlord permit me to make modifications if needed?
  • Am I willing to have vascular access surgery?
  • Am I comfortable sticking myself with needles?  If not, do I have a care partner that is?

If you answered yes to these questions, home hemodialysis (HHD) may be the right choice for you. If you decide to go with HHD, you will have two types to choose from: conventional home hemodialysis and short daily home hemodialysis. Because of the different types of HHD treatment available, you should take a close look at your lifestyle and decide which type will fit into your daily routine the best.

Which form of home hemodialysis is right for me?

  • Conventional home hemodialysis
    Conventional home hemodialysis treatments are very similar to in-center hemodialysis treatments and are usually performed three times a week for about four hours a session. Conventional HHD is a good choice for you if you would like to dialyze more frequently in order to eliminate a second day of fluid build up. It is also a good choice if you are looking for more flexibility in regard to the time of day your treatments are performed.
  • Short daily home hemodialysis
    Short daily home hemodialysis treatments are performed five to seven times a week for two-and-a-half to three hours each session. Short daily HHD is a good choice if you are seeking the benefits that come with more frequent dialysis, such as fewer peaks and valleys, fewer negative side effects, greater dietary freedom, a quicker recovery time and less weight gain.

Summary

If you are interested in either peritoneal dialysis or home hemodialysis, set up an appointment to talk with your doctor today.  Your doctor will be able to give you more information about at-home dialysis and the treatment modality you are most interested in.  Your health care professional can also guide you on how to transition from in-center to at-home dialysis.


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