The Basics of Home Dialysis

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

The ability to dialyze at home can offer considerable health and lifestyle benefits. For many patients, home dialysis can provide a level of flexibility not possible at a dialysis center. Home dialysis allows patients to arrange their treatments around their own schedule. Additionally, research has shown that patients who perform home dialysis may experience better quality of life and better clinical results.

There are two main dialysis types that can be performed at home: peritoneal dialysis (PD) and home hemodialysis (HHD). Take a look at how each of these treatment options work.

Peritoneal dialysis

Peritoneal dialysis filters and cleans blood within the body rather than through an outside dialyzer. With PD, the patient's abdomen is filled with a special solution, called dialysate, that helps remove waste and extra fluids from the blood. During the process, known as an exchange, the solution is instilled into the abdomen, left there to dwell for several hours and then drained from the abdomen, taking the waste and excess fluid with it. Because PD effectively filters and cleans the blood without the use of a separate dialyzer, treatments can be done more easily from home or on the road.

To perform PD, a patient must first have a catheter placed in his or her abdomen to allow the fluid to enter and drain. The catheter is a small, flexible tube about the thickness of a pencil. It is inserted off to the side, below the belly button, and goes into the abdominal space called the peritoneal cavity. The catheter is placed into the body during an outpatient procedure by a surgeon or trained nephrologist. The catheter remains permanently in the abdomen, and its outer section is securely taped to the body to prevent accidental pulling and injury during  everyday activities such as work, exercise, recreation, showering or sexual activity.

After the catheter is in place and the exit site healed, the patient will visit a PD nurse and begin learning how to perform PD. There are several training sessions over a one- to two-week period for both the patient and the care partner (this can be a spouse, parent, child, professional caregiver or other responsible person who will provide support during treatments). In addition to learning how to do PD, information is given about diet, fluid management, good hygiene and medication management.

There are two types of PD that perform the same function but use different equipment and treatment schedules: continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD), also called automated peritoneal dialysis (APD).

CAPD is a manual exchange process usually performed 4-5 times per day without a machine. CCPD, or APD, involves an automated machine called a cycler and performs most exchanges at night while the patient sleeps. Although PD does not require a dialyzer, it still requires equipment, clean environment and aseptic procedure for performing regular treatments.

To perform CAPD, patients will need a supply of dialysate bags as well as empty bags for the solution to drain into at the end of each treatment.

For patients performing CCPD, a special cycler machine is needed to automate the exchange procedure, filling the abdomen with dialysate and then draining it at the end of the treatment. Larger bags of the dialysis solution are also needed for CCPD.

Home hemodialysis

Although similar to PD, home hemodialysis requires a care partner. Together, the patient and care partner develop a plan to perform regular dialysis treatments that fit their schedules and specific needs.

In order to begin treatment, a vascular access will have to be created. The access allows the patient's blood to travel to and from the dialysis machine so that toxins, waste and extra fluid can be removed from the body.

There are two types of HHD that use the same equipment and techniques but vary based upon the specific needs of the patient: short daily and traditional.

Short daily HHD is performed five or six times a week, typically for three to three and one half hours per session. Traditional HHD is performed three times per week, typically for about four hours per session. This is similar to the length of treatments received at a dialysis center.

There are various HHD equipment options available to accommodate and support the full range of treatment choices. The newest HHD machines are designed to take up less space and require fewer supplies to store. Some new equipment options are also designed to be mobile, allowing patients the ability to travel for work or leisure with their machines. Reliable and user-friendly, the machines and water treatment equipment are easy to use and maintain.

It is important to note that some homes might require plumbing and/or electrical modifications to accommodate traditional HHD equipment.

After a patient has decided with his or her doctor that HHD meets their treatment needs, the next step is to participate in a comprehensive training program to learn how to conduct HHD treatments safely and effectively. During training, patients and their care partners will learn all the skills and techniques needed to regularly perform treatments independently. Typically, a patient can learn to perform treatments within six to eight weeks.

Is home dialysis right for you?

Home dialysis benefits are numerous and help patients live a better quality of life. One of the greatest benefits of home dialysis is that it can be customized to accommodate your lifestyle and health needs. People considering home dialysis should talk with their doctor and decide if PD or HHD is right for them.