Debunking HHD Myths: Get the Facts

You’ve likely heard things about home hemodialysis (HHD) that may or may not be true for different patients. Here, DaVita’s Dr. Martin Schreiber debunks some common HHD myths.

First, what is HHD? 

HHD is a type of dialysis done at home. During HHD, blood is drawn from your body through your vascular access (which could be a catheter or from a site in your arm) and into a dialysis machine. The machine cleans the blood (removing waste and fluids), then sends it back into your body.

Now, let’s look at some common HHD myths.

Myth: “I must have a care partner to do HHD.”
Fact: While DaVita requires patients to have a care partner help with HHD, there are some rare exceptions where some people can do the process themselves (with their doctor’s approval). This is called solo HHD and has been approved to be carried out during the day without a partner. The patient is provided a couple of different devices to assist with treatment safety. Talk to your nephrologist to learn more about solo HHD.

Myth: “I cannot have pets if I do HHD.”
Fact: Pets just need to be kept out of the room where you dialyze and while you connect or disconnect from the machine. Pets should also be kept away from dialysis supplies. Sometimes pets can cause infectious complications and direct interference with the HHD procedure if in the room when dialyzing.

Myth: “HHD can only be done during the day.”
Fact: There have been a number of patients around the world who dialyze at night to achieve superior clinical results with lab data and improve how they feel. Nocturnal home hemodialysis (NHHD), when prescribed by a physician, is a form of home hemodialysis where patients can dialyze safely and effectively at home during the night. With training, support devices and resources, you can dialyze safely while you sleep.

Myth: “I cannot do HHD if I have a central venous catheter (CVC).”
Fact: You can perform HHD with a CVC, though it is advised to only use it temporarily. In general, CVCs have a higher risk of infection and complication rate than AVFs/AVGs. However, if your clinical situation calls for using a CVC, you may be prescribed a special cap by your treating nephrologist called the Clear Guard HD cap that fits on the CVC and kills many infection-causing bacteria inside a hemodialysis catheter hub to help reduce infections.

Myth: “I cannot do HHD if I can no longer do peritoneal dialysis (PD).”
Fact: PD and HHD are very different therapies for kidney failure. If you have been on PD and it is not an option any longer, you may be a candidate for HHD and continuing to dialyze at home. Check with your physician and Home nursing team to see if making a transition from PD to HHD is clinically appropriate.

Myth: “I need to have a medical background to do HHD.”
Fact: DaVita's highly skilled team of nurses and educators will teach you all you need to know about HHD. Patients who manage their kidney disease at home on hemodialysis (HHD) undergo a multi-week extensive training program to ensure they are comfortable and confident before they start treating at home. The treating registered nurse (RN) will only complete the training if and when the patient is ready to self-treat at home. Some patients may require more training days than others, but putting the patient in a position to be successful is DaVita’s primary goal. 

Myth: “I will have to modify my home electrical and plumbing to do HHD.”
Fact: It depends on the actual HHD device your physician prescribes. Some devices do require changes in the home electrical system. In certain circumstances, DaVita may cover the cost of reasonable and necessary home modifications. Patients are responsible for the cost of extensive home modifications.

You do not need to modify plumbing to do HHD with newer devices. Water is tested by a biomed team during training. From there, adjustments are made accordingly. If your water does not meet EPA standards, there are other options, including using pre-mixed hanging bags for treatment. Check with your physician, who can provide more information.

Myth: “HHD supplies take up a large room.”
Fact: HHD machines are smaller than in-center dialysis machines. If you live in a small space, we can arrange more frequent supply deliveries. Talk with your HHD team, who can do a home visit and evaluate the space needed for supplies.

Interested in exploring HHD? Talk to your doctor and care team about whether it could be a good treatment option for you. Every patient should be given an opportunity to manage their kidney disease at home if clinically appropriate.

Additional Resources
National Kidney Foundation: Home Hemodialysis: A Guide for Patients and Their Families
National Kidney Foundation: Home Hemodialysis
Home Dialysis Central: Patient Education

With nearly 40 years of experience in nephrology, Martin Schreiber, MD, serves as chief medical officer for DaVita Kidney Care's home modalities.

Service provider and modality choice are choices made between the patient and their nephrologist.