A Brief Overview of Home Hemodialysis

Home hemodialysis (HHD) is the modality of hemodialysis done in the home. During home hemodialysis, blood flows from the patient's vascular access through a dialysis machine. The dialysis machine cleanses the blood of extra waste and fluids and sends the clean blood back into the body. Patients on home hemodialysis have the option of performing more frequent or longer dialysis treatments, which may contribute to better clinical outcomes and an overall improved quality of life.

History

Dr. Belding Scribner, a doctor at the University of Washington, can be credited with developing dialysis as a way to treat end stage renal disease (ESRD) in the 1960s. Scribner’s dialysis developments eventually led to the creation of the Seattle Artificial Kidney Center (SAKC), the first outpatient dialysis center. At the time that the SAKC was created, though, there were not enough resources to treat everyone who needed dialysis. It was this circumstance that led medical professionals to consider bringing hemodialysis into patients' homes.

When home hemodialysis (HHD) was first attempted, it was difficult because the equipment was large and complicated. However, Scribner worked to make the process easier for patients, and by the 1970s, nearly 40% of the dialysis patient population in the United States was doing HHD. The percentage of patients on HHD dropped over the following 20 years as peritoneal dialysis (PD) began to grow in popularity, but in the 1990s, HHD began to gain favor in the dialysis community once again. Today, home hemodialysis (HHD) is growing in popularity due to developments in equipment, self-cannulation and training programs.

Treatment choices

There are two types of home hemodialysis (HHD): short daily and traditional. One of the major benefits of HHD is that treatment schedules can be tailored to a patient’s specific health condition and lifestyle.

  • Short daily home hemodialysis
    Short daily home hemodialysis is generally performed five or six times a week for two to three hours per session.
  • Traditional home hemodialysis
    Traditional home hemodialysis is very similar to in-center hemodialysis. Traditional HHD treatments are generally performed three times a week for four hours per session, but patients have the option of dialyzing more frequently to achieve more favorable clinical results.

Care partners

Every home hemodialysis (HHD) patient must have a care partner to assist him or her with the dialysis process. A care partner could be a spouse, family member, friend, neighbor or professional care giver. The role of a care partner could include setting up the machine and supplies, inserting the dialysis needles into the patient's vascular access, recording the patient’s medical information on a chart and/or disconnecting and cleaning the machine after dialysis treatments. The role of a care partner will vary depending on the needs of the patient. Care partners go through the same training as patients so that they are prepared to assist in any way.

Self-cannulation

Self-cannulation is a term that refers to the patient inserting his or her own dialysis needles. Home hemodialysis (HHD) requires that two needles be inserted into the patient's vascular access to allow the blood to flow from the body to the machine and back into the body. Patients on HHD are trained to insert their own needles or to have their care partners insert the needles. While learning to self-cannulate may seem a little daunting at first, new techniques, such as the buttonhole technique, have made self-cannulation much easier and more comfortable.

Patients using the buttonhole technique insert their needles into the same spot each time they do dialysis. This causes the insertion points to form scar tissue and creates a hole much like the hole in a pierced ear. With this method, patients are able to use blunt needles instead of sharp needles, which are more comfortable and safer for the patient. It's important to note, though, that the buttonhole technique requires that a patient have a fistula, which is created by connecting an artery to a vein using your own tissue.

Patients who self-cannulate generally have a better chance of keeping their vascular access healthy and functioning for a long period of time. Patients who learn to self-cannulate often report that inserting their needles is not as difficult as they expected. In addition, once they learn to self-cannulate, most patients rarely want anyone else to cannulate for them.

Training

Home hemodialysis (HHD) patients and their care partners will go through a comprehensive safety and training program at a local dialysis center. During the training program, they will learn everything they need to know about performing hemodialysis treatments safely and effectively in their homes. Patients and their care partners will learn how to self-cannulate, operate the dialysis equipment, create a clean environment, record treatments on a log and handle needles and other supplies.

Training usually takes from four to eight weeks and is conducted individually by a home training nurse. The training material is customized to the patient's medical needs and equipment choice. Patients and their care partners start out by observing the training nurse during the dialysis process. As they learn more about the process, patients and care partners will begin assisting the training nurse, and they will continue to take on more responsibility until they are doing it on their own.

Equipment

The newest home hemodialysis machines on the market are designed to be user-friendly, making home dialysis easier than ever before. In addition, the new machines are designed to require fewer supplies and less storage space within the patient's home. One of the new machines is also small and portable, making it possible for dialysis patients to travel while on dialysis. Your doctor can help you decide which machine is right for you.

Summary

Home hemodialysis is a safe and effective option for end stage renal disease (ESRD) patients who want to receive the care they need while maintaining the freedom they value. It is an at-home option that gives patients control over when and how they dialyze, which can dramatically improve their overall quality of life. In addition, patients who dialyze at home have the ability to achieve improved clinical outcomes. Talk with your doctor today to see if home hemodialysis is right for you.

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