Home Dialysis: What is it and How Do I Sign Up?

By Dawn Foster, RN

Did you know that here at WDI we have a Home Dialysis program? Home Dialysis is a great alternative for many patients on dialysis. WDI offers both Home Hemo Dialysis and Peritoneal Dialysis. Currently there are four nurses that provide training and support for those patients that use Home Dialysis. Let's look into each type of home dialysis and what is involved.

Home Hemodialysis: Home hemo is done at home very similar to how it is done in center. There is a machine that you are connected to that pulls your blood through a filter using sterile dialysate or fluid to clean your blood and then return it to you. Patients perform their Home Hemo up to six days a week for a minimum of two hours a day. This helps them to feel better as the toxin and extra fluid are not allowed to build up with the more frequent dialysis. Thus, blood pressure and fluid balance are better controlled.

Training is a minimum of three weeks. Patients come five days a week for about 4-6 hours per day. Patients must have a willing and able partner that is present with them at home throughout their treatment because patients and their partners will perform all aspects of their treatment at home after completion of training. All the supplies required are provided to patients. Once training is completed patients are seen monthly in clinic at WDI. They are followed by a dietician, nurse, kidney doctor and a social worker at each visit. Visits are around one hour.

Peritoneal Dialysis: Peritoneal Dialysis is a daily therapy that is done using sterile fluid or dialysate that is introduced into the abdomen (belly) by using a flexible tube called a catheter. This catheter requires a minor surgery to have it placed in the abdomen. Once the catheter is placed patients come to the Home Dialysis clinic weekly for catheter care. Care consists of the home nurse flushing the catheter and applying a sterile dressing. This process is done until the catheter site is healed and the catheter is set in the abdomen ready to be used usually in about 2-4 weeks.

Training is done daily in the clinic for 4-6 hours per day for 6-8 days. More training will be given as needed. A partner is not required for someone to do PD at home but the patient must be able to independently perform all aspects of their treatment if there is no partner.

Peritoneal Dialysis can be done two different ways. CAPD or continuous ambulatory Peritoneal Dialysis requires 4- 5 manual exchanges be done spaced throughout the day. Fluid is left in the abdomen over night. Each exchange takes about 30-45 minutes and does not require a machine. The exchanges are portable so they can be done on the go as long as the area is clean and things can be kept sterile. CCPD or continuous cycling peritoneal dialysis is performed once a day usually at night while patients are sleeping. CCPD uses a machine called a cycler that performs the exchanges throughout the night. Once training is completed patients are seen monthly here at WDI. They are seen by a dietician, nurse, kidney doctor and social worker each visit. Visits are around one hour.

While all of this may sound great not everyone is a good candidate for Home Dialysis. If you are the type of person that is highly motivated, detail oriented, and love the freedom to set your own schedule, Home Dialysis may be for you.

The best way to determine this is to talk to your kidney doctor or nurse practitioner. If they feel that Home Dialysis may be a good option for you they can make a referral to the Home program. The Home team consisting of nurses, the kidney doctor, dietician and social worker will review records and meet with you. The Home Team will make a determination and will discuss this with you.
For many people Home Dialysis is a good option. Is it right for you? Talk with your team if you are interested.

Are there Costs Associated with Home Dialysis?

The freedom and control with home hemo (HD) and peritoneal dialysis (PD) is one of the hallmark features of these types of treatments. The ability to be within the comfort of your own home and administering your own care, with the help of a partner, can give a person a real sense of accomplishment and empowerment. However, there could be some costs associated with being a home dialysis (HD or PD) patient that you should consider, not to dissuade you, but rather, inform you.

  • Your utility, water or electity bill may increase.
  • You will need a storage area for your supplies. You may need furniture of shelving to accommodate the supplies
  • You may wish to purchase a comfortable chair
  • You will require a home helper
  • You may need a minor upgrade to an electrical outlet
  • You may see rise in telephone costs as you stay in touch with your home dialysis program nurse.
  • Your home dialysis nurse and social worker can assist with resource options. Although cost may be small, it is important to plan ahead rather than deal with unexpected expenses.

About the author: Dawn Foster has been a nurse for 17 years. She completed her seventh year as a Home Dialysis nurse and, in her words, "still loving it, I might add."