Is Home Hemodialysis Right For You?

Dialysis is the most common treatment for patients with advanced kidney failure. The function of dialysis is to help your body by filtering out waste and excess fluid the way your kidneys would if they were working properly.

There are two common types of dialysis: peritoneal dialysis and hemodialysis.

Peritoneal dialysis refers to a method where the patient’s abdomen is filled with a solution that draws waste and excess fluid through a catheter. Peritoneal dialysis is a treatment that can be completed at home by the patient if he or she has the ability and manual dexterity. Often, peritoneal dialysis comes with fewer dietary restrictions and medications.

Hemodialysis is a more advanced method where the patient’s blood is filtered through a machine that removes waste, salt, and excess fluids. Hemodialysis requires a stricter schedule for treatment and medications, and often requires dietary restrictions.

Both treatments are effective for treating kidney disease. Hemodialysis, however, is often the preferred treatment for advanced kidney failure. If your kidneys are not performing effectively or if they are not working at all, your doctor may suggest hemodialysis.

Hemodialysis can be done in a treatment center or at home with the help of a nurse or trained loved one, but a strict schedule must be maintained.  

Often, hemodialysis is completed at a dialysis treatment center. Patients must travel to the center three times a week for treatments that can last 3 to 4 or more hours. Completing treatments in a dialysis center requires a very strict schedule, as they often have many patients coming in and out for their dialysis treatments. Sometimes having your treatments done in a treatment facility can mean long waits, and long treatments keep you out for extended periods of time. It is sometimes hard to get to and from treatment facilities.

Home hemodialysis can offer you many advantages, including the ability to complete your treatments in the comfort of your own home. Home treatment offers you more flexibility.

The biggest advantage of home hemodialysis is certainly a greater quality of life and control over your own treatments. Home hemodialysis, while still requiring a strict schedule, allows the patient a little more freedom and comfort.

With their doctor’s permission, patients can choose to do long treatments three times a week like they would in a treatment center, or they can choose to break up their treatments into more frequent but shorter shifts.

At home, hemodialysis can even be done during the night when the patient is sleeping. Because the patient is able to control the treatment schedule, a custom treatment schedule is possible.

Home hemodialysis is also becoming more and more popular, so smaller machines and easier set ups are available. A home hemodialysis setup may or may not be covered by your insurance provider, your doctor and the distributor of the machines will be able to help you determine the costs.

Home hemodialysis offers many advantages to patients, but also comes with risks. You will need to weigh these risks with the benefits to decide if home hemodialysis is right for you.

There are serious risks associated with home hemodialysis. A lot of these risks are the same as the risks associated with receiving treatment in a dialysis center, but are heightened by the expertise and training of your caretaker.

Training of a nurse or loved one can often take anywhere from 3 to 8 weeks. Your caretaker will need to be vigilant and ready if any complications arise such as blood pressure emergencies or infection. The most common complications involve air embolisms when air gets trapped in the catheter and is accidentally injected into the blood stream. Most of these complications are the same as in-center treatment but require a level of training to be able to prevent, detect, and act quickly if problems occur.

Worksheet:  Is home hemodialysis right for you?

Ask yourself and then discuss with your doctor:

1.    Do you dislike or are you often unable to make it to an in-center treatment facility?

2.    Are you and a loved one or friend willing and able to complete training for use and operation of a home hemodialysis machine?

3.    Are you and that loved one or friend willing and able to complete training for the detection and subsequent action that might be necessary if any complications should occur? Or if not, would you be willing and able to hire a nurse to administer your home treatments?

4.    Do you and/or your chosen partner have the visual and manual dexterity to complete the tasks as shown to you by your trainer? This includes but is not limited to the handling and insertion of needles and catheters, reading directions and paperwork, and filling out order forms.

5.     Are you willing and able to abide by a strict schedule for treatments?

6.    Are you able to follow directions closely?

7.    Are you comfortable asking for help when needed or when you have questions?

8.    Do you have any mental disorders such as dementia or depression that would ever deter you from being able to complete treatments as scheduled?

9.     Are you aware enough to know if something is different or wrong with your body, and are you willing and able to call a doctor if such an occasion should arise?

10.    Are you confident and motivated to maintain a strict schedule and follow all directions handed to you by your doctors and trainers?

If you answered “no” or are not sure about any of the questions listed above, talk to your doctor.
Home hemodialysis can offer you a level of freedom and quality of living that could be more comfortable than a treatment facility; however it comes with its own risks and responsibilities. Your doctor is the best person to discuss these risks and advantages with. He or she may be able to help you determine if home hemodialysis is right for you. Your doctors are the best people to discuss any reservations or questions you have about your dialysis treatment.

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