Dialysis removes waste products and excess fluid from the blood when kidneys can no longer function effectively. Normally, substances like urea and creatinine are filtered out through urine. When kidney function declines, these can build to harmful levels, requiring dialysis to maintain the body’s balance. Dialysis can be done at home, offering increased flexibility and control over treatment schedules.
Types of Home Dialysis
Two primary methods of dialysis can be performed at home: peritoneal dialysis (PD) and hemodialysis (HHD). Each method filters blood differently, offering options tailored to individual needs.
Home Peritoneal Dialysis (PD)
Peritoneal dialysis uses the abdominal lining, the peritoneum, as a natural filter. A catheter is surgically placed into the abdominal cavity. Cleansing fluid, called dialysate, flows through this catheter into the peritoneal cavity, remaining for a “dwell time.” During this period, waste products and excess fluid from blood vessels in the peritoneum pass into the dialysate. After the dwell time, the fluid containing filtered waste is drained and discarded.
There are two main forms of home peritoneal dialysis. Continuous Ambulatory Peritoneal Dialysis (CAPD) involves manual exchanges, where the patient or caregiver connects dialysate bags to the catheter, allows the fluid to dwell, and then drains it. This process occurs three to five times daily, each exchange taking 30 to 40 minutes. Automated Peritoneal Dialysis (APD), also known as Continuous Cycler-Assisted Peritoneal Dialysis (CCPD), uses a cycler machine to automate exchanges, usually overnight while the patient sleeps. The cycler performs three to five exchanges over about nine hours, allowing for daytime freedom.
Home Hemodialysis (HHD)
Home hemodialysis uses a machine to filter blood outside the body, similar to in-center treatment. This method requires vascular access, such as a fistula or graft, typically created in the arm. Blood flows from the patient’s vascular access through tubing to a dialyzer, or artificial kidney. Inside the dialyzer, waste products and excess fluid are removed from the blood before it returns to the patient. The machine controls blood flow, treatment time, and fluid removal.
Home hemodialysis schedules vary in frequency and duration. Conventional home hemodialysis is typically three times a week for three to five hours per session. Short daily home hemodialysis involves more frequent treatments, usually five to seven times a week, each lasting two to four hours. Nocturnal home hemodialysis is performed overnight while the patient sleeps, for six to ten hours, typically three to seven nights a week. More frequent or longer sessions can lead to fewer symptoms and better health outcomes.
Patient Suitability and Home Setup
Determining if home dialysis is suitable involves evaluating a patient’s health, personal capabilities, and living environment. These factors ensure safe and effective treatment outside a clinical setting.
Medical suitability for home dialysis requires a stable health status. For home hemodialysis, adequate vascular access, such as a well-functioning fistula or graft, is necessary. For peritoneal dialysis, the abdominal cavity’s health is important, as it serves as the filtering membrane.
Personal suitability also plays a significant role. Patients need motivation and the ability to learn treatment procedures and take responsibility for their care. Good vision and manual dexterity are needed to operate equipment and handle supplies. While some home dialysis can be performed independently, a supportive caregiver, such as a family member or friend, is often beneficial and sometimes required, especially for home hemodialysis.
The home environment must meet specific requirements for safe and effective dialysis. A clean, dedicated area or room that can be closed off, free from distractions, is important to maintain a sterile setting and reduce infection risk. Adequate space is needed for the dialysis machine, cycler, and substantial supplies, often requiring a closet-sized storage area. Reliable electricity, a water source, and appropriate drainage are also necessary.
Living with Home Dialysis
Performing dialysis at home integrates treatment into daily life, offering both a structured routine and enhanced flexibility. This involves setting up equipment, managing supplies, and adapting daily activities around treatment schedules.
A typical home dialysis routine varies by therapy. CAPD involves manual exchanges throughout the day, while APD uses a cycler for overnight exchanges. Home hemodialysis sessions require setting up the machine, connecting to vascular access, and then disconnecting and cleaning equipment. Time commitment ranges from a few hours daily to longer sessions several times a week, depending on the prescribed schedule.
Home dialysis requires specialized equipment and a consistent supply of materials. This includes the dialysis machine or cycler, dialysate solutions, and sterile supplies. These are typically delivered to the patient’s home, requiring sufficient clean, dry, and organized storage space.
A primary advantage of home dialysis is increased flexibility and independence. Patients can schedule treatments to fit personal routines, allowing them to continue working, traveling, or engaging in hobbies. This contrasts with in-center treatments, which follow fixed schedules. Managing treatment at home can lead to improved quality of life and better health outcomes, as it allows for more frequent and often gentler dialysis.
Training and Ongoing Support
Home dialysis requires comprehensive training and continuous support from a dedicated healthcare team. This ensures patients and their caregivers can confidently and safely manage treatment.
Dialysis centers provide training programs, equipping patients and care partners with necessary skills. This training covers dialysis procedures, machine operation, and hygiene practices to prevent infection. Patients also learn to troubleshoot common issues and respond to emergencies. Training durations vary, typically one to two weeks for peritoneal dialysis and four to six weeks for home hemodialysis, with hands-on practice until competence is achieved.
Patients receive ongoing support from a multidisciplinary healthcare team. This team includes nephrologists, who oversee the treatment plan, and nurses, who provide guidance and monitor progress. Dietitians offer nutritional advice, while social workers provide emotional support and help with lifestyle adjustments. This continuous support ensures patients receive comprehensive assistance throughout their home dialysis journey.