Home Treatments: Home Hemodialysis and Peritoneal Dialysis

For decades, home dialysis has been recognized by patients and physicians as a safe and effective alternative to in-center treatment. More than 300,000 Americans currently undergo regular dialysis treatments, a number that has roughly doubled in the past decade and is expected to grow significantly over the next few years. In my practice, approximately one quarter of my patients are now using some form of at-home dialysis. As more and more people discover the flexibility and freedom home dialysis can bring, I consistently hear many common questions from patients wanting to know more about their dialysis treatment options, how these treatments compare and which one is better.

Anyone considering home dialysis should talk with their doctor and learn about the various treatment choices that are available. Every patient is unique and dialysis treatment programs should always be designed to fit the patient’s specific clinical and lifestyle needs. As a result, no single treatment option can be characterized as better than another – what is best for one patient might not be the best fit for another. Only you and your doctor can make that decision.

There are two main categories of home dialysis treatments -- home hemodialysis (HHD) and peritoneal dialysis (PD). Although they differ in how they work, both types safely and effectively provide the same basic function: removing waste and fluids from the body when your kidneys no longer work well enough to keep the body healthy. When talking with my patients about choosing a dialysis treatment that is right for them, we discuss a range of issues, including potential complications from other existing medical conditions, lifestyle needs and desires, available resources for physical and mental support, and the specific benefits each form of treatment can provide.

Understanding the Differences between PD and HHD

During home hemodialysis (HHD), the blood is cleaned of waste products and extra fluids as it is pumped by a machine through a dialyzer or filter. In order for the blood to be carried to the dialyzer, a vascular access is needed. A vascular access is normally created under the skin using a person's own blood vessels.

Before beginning home dialysis, the patient and their dialysis partner (if needed) will learn everything they need to perform regular treatments by participating in a comprehensive safety and training program. One of the greatest benefits of at home hemodialysis is that it can be customized to accommodate the specific treatment program determined by doctors. Every patient is unique and with at home hemodialysis, so is every treatment. Today, there is a range of home hemodialysis treatment options available. There are also various home hemodialysis equipment options available to accommodate and support the full range of treatment choices. Some new equipment options are even designed to be mobile, allowing patients the ability to travel for work or leisure with their machines. It is important to note that some homes might require plumbing and/or electrical modifications to accommodate home hemodialysis equipment.

Peritoneal Dialysis (PD) differs from home hemodialysis by filtering and cleaning blood within the body rather than through an outside dialyzer. With peritoneal dialysis, the patient's abdomen is filled with a special solution called dialysate that helps remove waste and extra fluids from the blood. Since the lining of the abdomen takes the place of the dialyzer used in HHD, there is no need for needles in peritoneal dialysis treatments.

During the process known as an exchange, the solution is then drained from the abdomen, taking the waste with it. Since peritoneal dialysis uses simple equipment, many patients perform peritoneal dialysis at home with no assistance and have an easier time traveling. There are two types of peritoneal dialysis that perform the same function but use different equipment and treatment schedules. Although peritoneal dialysis does not require a dialyzer, it still requires equipment and a sanitary environment for performing regular treatments.

Making the Choice between PD and HHD

Your choice of treatment depends on a variety of factors: your medical condition, your lifestyle, and your level of comfort in administering your treatment at home. Both types of treatments are effective for many end stage renal disease (ESRD) patients.

When helping my patients make an informed choice about their at home dialysis treatment, I provide a detailed explanation of how PD and HHD work along with the unique attributes of each. I also like to have my patients meet my home dialysis nurse, who can show them the different types of equipment and supplies they would need for both options so they get a firsthand perspective of what to expect. Learning about your treatment options can seem overwhelming at first. I tell my patients to ask me every question they can imagine. Reviewing websites and forums and hearing stories from others who have already gone through the process is also a good way to learn more.

Regardless of whether you choose PD or HHD, the ability to dialyze at home can offer considerable clinical and lifestyle benefits. Research has shown that patients who perform home hemodialysis (HHD) may experience increased diet flexibility, better blood pressure control, improved sleep, reduced fatigue and nausea, reduced need for medications and a reduced frequency of hospitalization - especially those who take advantage of their home setting to have more frequent or extended dialysis. And for many patients, at-home dialysis can provide a level of flexibility not possible at a dialysis center. Whether it's additional time spent working, with family or fulfilling other obligations or interests, at-home dialysis allows patients to arrange their treatments around their own schedule. At-home dialysis also saves time because there is no need to drive back and forth to a dialysis center three days per week.

About Dr. Glickman

Joel D. Glickman, M.D., F.A.C.P., is Director of the Home Dialysis Program at the DaVita-Franklin Dialysis Center in Philadelphia and maintains a private practice with Pennsylvania Nephrology Associates in Philadelphia. He also serves as National Medical Consultant for at-home hemodialysis for DaVita and is Clinical Associate Professor of Medicine at the University of Pennsylvania School of Medicine.