Home Dialysis Treatment Choices
For more than 40 years, dialysis patients have had a choice in their home treatments. Peritoneal dialysis (PD) and home hemodialysis (HHD) have been available since the 1960s. Since then, PD has become a particularly popular home treatment, because of its ease of use. Now, new technology has made home hemodialysis more affordable and easier to learn and perform. A growing population of end stage renal disease (ESRD) patients prefer this type of home dialysis because of the clinical benefits and lifestyle advantages.
PD is the most common home dialysis treatment. Patients who opt for PD dialyze daily with little or no assistance from others.
Inside the abdominal cavity is the highly vascular peritoneal membrane which covers the internal organs. People on PD are able to use this internal membrane to filter wastes and excess fluid from the blood. The dialysis solution is instilled through a catheter into the abdomen where it dwells for several hours. Toxins and fluid pass from blood vessels in the peritoneal membrane into the dialysate solution. When the programmed dwell time is completed, the dialysate is drained, taking waste and extra fluid with it. Then fresh dialysis solution is instilled and the cleaning process begins. The three phases-- drain, fill and dwell-- are called an exchange. Exchanges can be done manually or with a machine called a cycler.
One of the forms of PD is continuous ambulatory peritoneal dialysis (CAPD), which patients do manually. Each exchange begins by draining existing fluid from the abdomen before fresh solution is placed. Draining is done by gravity into an empty bag that is placed onto the floor. Two liters of fluid should drain in 10-20 minutes. The abdomen is then filled with dialysate above the person’s head on an IV pole or a coat rack and attached to the catheter. The fill phase should take approximately 10 minutes for two liters of dialysate. The dwell phase lasts about 4-6 hours depending on the physician’s prescription. For people who work, manual exchanges can be performed in a clean area in the workplace.
The more common type of PD involves a machine called a cycler, also called automated peritoneal dialysis (APD), to perform the exchanges. This is the form of PD that most people choose since it tends to leave the days free for work, recreation, or other activities.The person connects to the cycler in the evening and the machine performs between three and five exchanges during sleep . Many people will carry some fluid in the abdomen during the day which is then drained out at night when reconnecting to the cycler machine. Some people will also need to perform an exchange during the day.
The home training nurse and nephrologist teaches the patient and/or a care partner how to perform PD safely at home. PD training usually takes about two weeks until people are comfortable with the procedure.
There are two types of home hemodialysis (HHD) currently available: conventional home hemodialysis and short daily home hemodialysis.
Conventional HHD is done three times a week for approximately 3-4 hours each session. This schedule is similar to hemodialysis done at a dialysis center. Some patients will do their treatment every other day, which works out to be three times a week the first week, and four times a week the second week. Many patients read, watch television or chat on the phone during treatment.
Short daily HHD consists of five or six treatments a week for a few hours each session depending on the patient’s weight, labs, access and other factors. Because their blood is cleaned on a daily basis, people often enjoy a more liberal diet and fluid intake, and experience less side effects such as low blood pressure, cramps and nausea than those on conventional hemodialysis.
Both types of HHD require a hemodialysis machine in the home. For safety reasons, HHD requires that a care partner is available to help the patient. The patient and care partner (who can be a spouse, family member, or any trusted individual) will be trained to set up, clean, operate and disinfect the machine. Training generally takes from a month to six weeks, or until both are comfortable and skilled enough to administering HHD.
Which home treatment is best for you?
Your choice of treatment depends on a variety of factors: your medical condition, lifestyle, and level of comfort in administering your treatment at home. Your doctor will recommend the best option suited for you based on these factors as well as your desired treatment method.
Because you will be responsible for treating yourself, you will be expected to monitor your condition and report any changes you see and feel to your doctor immediately. Always ask your doctor before you make any changes to your dialysis schedule or want to switch dialysis treatments. Remember, you will perform your treatment at home, but you will not be on your own. Before beginning any type of home dialysis, you will be trained by a professional. Once you start dialyzing at home, help is always available by phone if you have problems or questions.
Although home dialysis is not right for everyone, it could be right for you. Talk to your doctor and healthcare to learn if you could benefit from home treatment. From PD treatments while you sleep to short daily HHD sessions, home dialysis choices have come a long way and continue to gain popularity.
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