What is home hemodialysis (Home HD)?
Hemodialysis (HD) is a type of dialysis that filters your blood outside your body using a machine and a dialyzer, which is a manufactured filter that acts like an artificial kidney.
During hemodialysis (HD), the dialysis machine removes a small amount of your blood from your body through a needle or catheter. The dialyzer then cleans your blood, removing waste, toxins, and excess fluid. Finally, your clean blood is returned to your body. Hemodialysis (HD) can be done at home, ideally with the assistance of a caregiver, giving you the flexibility to adjust your treatment schedule around your daily activities and the time to carry on a normal life. This is called home hemodialysis (Home HD).
How Do I Perform Home Hemodialysis (Home HD)?
If home hemodialysis (Home HD) is the right treatment option for you, your healthcare team will train you to set up your dialysis machine and other equipment, insert needles properly, and how to perform your treatments successfully.
You may be able to perform daily home hemodialysis (Home HD) treatments between 3 and 6 times a week for time periods of 2.5-4 hours. Your clinician may also advise you to do longer therapy sessions, but fewer times per week. It is important that you still pay regular visits to your hospital or clinic throughout your treatment to make sure that everything is running according to your plan.
Home hemodialysis (Home HD) Can Give You More Freedom
Compared to having dialysis in a clinic or hospital, home hemodialysis (Home HD) gives you more flexibility to plan treatments around the activities you know and love. You may even be able to travel while on home hemodialysis (Home HD). You should speak with your clinician before planning activities and trips, as they can give you more information on how to stay safe and healthy while pursuing a full and active life.
Compared to in-center hemodialysis (In-Center HD), you may save the time you would have spent on transportation to the hospital or clinic and enjoy the convenience and comfort of your own space while completing therapy. With an on-call nurse available to help you if needed, you can feel comfortable performing home hemodialysis (Home HD).
Despite these benefits, home hemodialysis (Home HD) does have some special considerations, and you should keep these in mind when discussing with your clinician whether home hemodialysis (Home HD) is right for you.
If you perform home hemodialysis (Home HD), you will need space in your house for a hemodialysis (HD) machine, in addition to your regular dialysis supplies. You might need to have adjustments made to your plumbing and electrical systems to accommodate the amount of water the dialysis machine uses during treatment. Also, two needles will need to be inserted, either by you or your caregiver, each time you do dialysis. You should talk to your clinician about how to prepare yourself, mentally and physically, for this process.
Because of these and other special considerations, the training for home hemodialysis (Home HD) is longer than the training for peritoneal dialysis (PD) – usually lasting about 4-6 weeks.
In terms of how the therapy feels, you should expect to feel some mild pain during the needle insertion phase, and you may feel tired or experience uncomfortable leg cramps or nausea after therapy. The therapy itself should not be painful.
Preparing Your Body for Home Hemodialysis (Home HD)
Before you begin home hemodialysis (Home HD), you will need to complete the 4-6 weeks of training required to perform treatment safely and successfully. You will typically also need a caregiver helping you with your home hemodialysis (Home HD) treatments, so he or she will also need to be trained.
Before treatments start, you will also need to have a surgical procedure that creates a dialysis access site under your skin called a fistula. This dialysis fistula lets unfiltered blood flow from your blood vessels through the dialysis machine and lets clean blood flow back into your blood vessels. Access to this fistula is created by inserting two needles into the blood vessels in the fistula.
There are three different types of hemodialysis (HD) access: fistula, graft and hemodialysis (HD) catheter. Each has its own benefits and drawbacks, and you should discuss these with your healthcare team in order to determine which will be the safest and most effective access option for you. Typically, a fistula is considered the standard of care in most dialysis centers.
- A fistula is often the best choice for hemodialysis (HD) because it uses your own blood vessels, allowing for good blood flow during therapy, and has the lowest chance of infection.
- Your surgeon will connect one of your arteries to a vein under the skin of your upper or lower arm.
- This surgery should be done at least 2-3 months in advance of your dialysis start date.
- During dialysis, unfiltered blood will flow from your blood vessels through one needle, connected to your fistula, and clean blood will flow back into your body through a second needle, also connected to your fistula.
- To create a graft, your surgeon will use a piece of medical tubing to connect one of your arteries to one of your veins. This graft will be placed under the skin either on your arm or your leg.
- During dialysis, unfiltered blood will flow from your blood vessels through one needle, connected to your graft, and clean blood will flow back into your body through a second needle, also connected to your graft.
- Catheters are usually temporary and are only used while you’re waiting to receive a dialysis fistula or a graft.
- A catheter will be placed inside a vein, either in your neck or your chest. The other end of the tube will exit your skin and be attached to the dialysis machine tubing.
- Catheters are not recommended for long-term use because they can put you at higher risk of blood clotting and infection and provide a slower blood-flow rate.
Depending on the strength of your veins and your overall health, your clinician will be able to decide what type of access option is best suited to you. If your clinician decides that you need a dialysis fistula or graft, they will need to schedule the surgery in advance of your dialysis start date.
No matter which kind of access type you choose, you’ll have to protect your access site from excess pressure, germs and infection. Remember to clean your hands before touching your access site and consistently check it for signs of swelling and irritation. If you suspect these issues, contact your nurse immediately. This is true for all dialysis treatment options.
Preparing Your Home for Home Hemodialysis (Home HD)
To perform safe and effective home hemodialysis (Home HD), you will need to have a dedicated clean area where you can conduct your daily treatments. You will also need a chair or bed that is comfortable for you to sit or lie in during treatment and a telephone with which you can make any necessary calls to your healthcare team. Your clean area will need to be adapted for dialysis with the type of electrical outlet needed for your dialysis machine, a water source that can be accessed easily during treatment, and a plumbing system for draining away any waste water. These adjustments will be organized by your clinic or hospital.
A member of your healthcare team will usually visit you at home and help you decide on the best place to set up your treatment area and store your supplies.
Benefits of Home Hemodialysis (Home HD)
Home hemodialysis (Home HD) may be the right treatment option for you if it is well-suited to your medical and physical condition, and lifestyle choices. Home hemodialysis (Home HD) gives you the opportunity to enjoy the comfort and freedom that comes with performing dialysis in a space that feels familiar and safe, while having telephone access to professional help if you need it. Doing your treatments at home may also increase your flexibility by allowing you to avoid frequent trips to the hospital or clinic.
You will have some control over your treatment, choosing a schedule that fits your social and professional life. If your clinician prescribes it, you may be allowed to do dialysis more frequently and for longer periods of time than you can in-center. If you can, having longer, slower treatments more often may be gentler on your body because it more closely mimics your natural kidney function, which works 24 hours per day. This may decrease negative side effects and help you feel better and more energized, and even provide you more dietary freedom.
In addition to the benefits of home hemodialysis (Home HD), you should be aware of some of the special considerations of this treatment, such as:
- Needles must be inserted during each treatment, which may be uncomfortable for you if you are afraid of needles.
- Almost all home hemodialysis (Home HD) patients require the help of a caregiver.
- Your treatments will be performed away from your healthcare team.
- You will need to store up to 6 weeks' worth of dialysis equipment and supplies in your home.
All these benefits and considerations should be discussed with your clinician so that you can make a decision that suits your medical and lifestyle needs.
Where to go next?
Peritoneal Dialysis (PD) at Home
There are other types of dialysis that can be done at home. Learn more about peritoneal dialysis (PD).
In-Center Hemodialysis (In-Center HD)
You may prefer to receive dialysis at a hospital or treatment center near you. Learn more about in-center hemodialysis (In-Center HD).
Other Treatment Options
If you and your clinician decide dialysis isn’t right for you, there are other treatment options you may consider. Learn more about other options for treating chronic kidney disease (CKD).