Learn more about home hemodialysis and whether it's right for you
Home hemodialysis overview
Home hemodialysis is similar to in-center hemodialysis, but it can be done in the comfort of the your own home. This can mean greater independence and flexibility in your dialysis treatment schedule. Even though you are performing treatment at home, you are always supported by a dialysis healthcare team that includes your nephrologist, nurse, dietitian, and social worker.
Home hemodialysis can be done in more than one way:
Standard Hemodialysis is performed using a standard hemodialysis machine—similar to what is used in an in-center facility. Standard treatments are usually performed 3 – 4 times per week. At home, you can have treatments that last longer than in-center treatments. Or, you can do treatments every other day,so you don't go two consecutive days without treatment. Either—or both—can help you feel better and live longer. A standard hemodialysis machine is usually prescribed by your kidney doctor.
Short Daily Hemodialysis: Short daily treatments are done with a dialysis machine that is made to use at home. Treatments are usually performed 5–6 times per week, and can vary in length from 2—4 hours of treatment time. When you do 5 or 6 treatments a week, treatment is more gentle, so cramps and problems can be rare. A short daily hemodialysis machine is usually prescribed by your kidney doctor.
What to Expect with Home Hemodialysis
For blood to flow through the dialysis machine, the patient needs an entrance to their bloodstream—this is called an access site. The patient’s access site is their lifeline; it’s a way to reach and clean their blood. There are three access types for hemodialysis treatments: fistula, graft or catheter.
Timing is critical. A fistula should be placed six months to a year before a patient begins dialysis if possible, to allow time for the fistula to heal and develop. (However, the surgeon and/or kidney doctor will provide direction on the placement timing of a patient’s fistula.)
Fistula access: considered the best access choice for hemodialysis
- A fistula is the most natural access because it is made with your own blood vessels, it provides the best dialysis blood flow, and it has the lowest chance of infection
- A surgeon connects one of your arteries to the vein under the skin of your arm. The surgery is commonly done in the outpatient operating room
- Fistula access should be placed 6 months to a year before you begin dialysis (if possible) to allow time for the fistula to heal and develop (mature). Your surgeon and/or kidney doctor will provide direction on the recommended timing of fistula placement.
- During treatment, two needles are placed in your fistula. These needles connect to the dialysis machine tubing so you can receive hemodialysis treatment.
Graft access: considered a good access choice, second best to Fistula access
- Surgeon connects your artery to a piece of soft, man-made plastic that acts like a vein. It’s placed under the skin of your upper arm
- Graft surgery is typically performed in an outpatient operating room
- A graft can be used several weeks after graft surgery
- During treatment, two needles are placed in the graft and connect to the dialysis machine tubing.
Catheter access (hemodialysis): considered the poorest access option, it should be avoided if possible
Most catheters are temporary, and used only until a graft or fistula is ready. The hemodialysis catheter is considered the poorest access option and should be avoided, if possible, because of the higher risk of clotting, higher chance of infection and because it can have a slower blood flow rate during dialysis.
However, there may be conditions that prevent a patient from having a fistula or graft (for example, patients whose blood vessels are not strong enough for a fistula or graft).
“Hemo” means blood, and “dialysis” means filter. Hemodialysis is how blood is filtered outside the body. In hemodialysis, a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean the patient’s blood.
During hemodialysis treatment, wastes and fluid are removed from the blood:
The patient’s blood flows into the dialyzer (a plastic tube full of filters, with each filter being as thin as a hair).
Wastes in the patient’s blood flow through the filters and into a fluid called dialysate.
Once cleaned, the blood flows back into the patient.
Pressure from a pump squeezes water out of the patient’s blood and into the dialysate.
Only about a coffee cup of blood is out of the patient’s body at any one time.
Benefits of home hemodialysis
- You can choose to stay on the machine longer, which can contribute to feeling better. Studies show that with more frequent and longer treatments, a patient has a better chance to live longer --about as long as those who get a deceased donor transplant.
- You can choose their time for treatments, allowing more flexibility for work or school or other social or physical activities.
- You do not need to leave home for treatment, which will save travel time and transportation costs.
- You or your care partner will put in your own needles, which some people prefer.
Considerations of home hemodialysis
- No treatment is perfect. Home hemodialysis treatments take time to set up, do and clean up after
- You will need a dependable care partner (family member or friend) to participate in your home hemodialysis treatment process
- Space must be set aside in your home to store supplies and equipment
Getting started with home hemodialysis
Before choosing home hemodialysis treatment, it may be helpful to learn what you can expect with performing hemodialysis in the home.
What to Expect with Home Hemodialysis
Before beginning home hemodialysis
Before you begin home hemodialysis, you need to make sure your home is ready to serve as your treatment area.
A member of your home hemodialysis team will visit your home and review the room where treatments will be performed. Requirements include:
- Access to a plumbing drain and electrical outlets
- Room for water treatment equipment and hemodialysis supplies
Your water quality will be tested and you may need to make plumbing and wiring changes in the treatment area. While these changes are usually minor, they may require an out-of-pocket cost.
Training for home hemodialysis
You won’t start hemodialysis at home until you are well trained and very comfortable with the process of performing treatment. Until then, you will receive dialysis treatment at an in-center facility with your training nurse to guide you.
The training program can last from 4–8 weeks and requires that you and a care partner (a family member or friend) attend. It is important to have your care partner fully trained as they are required to stay and assist you during home hemodialysis treatments to ensure your health and safety.
During training, you and your care partner will learn everything you need to know. This includes how to:
- Use and care for the home dialysis and water machines
- Care for your access sites
- Take your blood pressure and record it
- Place and remove needles in a fistula or graft access; or place and remove hemodialysis catheter tubing
- Set your fluid removal goal based on your weight and blood
- Order hemodialysis supplies
- Recognize problems to report to your home dialysis nurse or doctor
- Safely dispose of medical wastes
Once you have successfully completed home hemodialysis training in a facility, a training nurse will visit you at home and help you and your care partner with your first treatment.
There are a number of steps you will go through to begin a safe, effective home hemodialysis treatment session.
During the treatment process, you will follow a series of steps that include:
- You will record your vital signs (blood pressure, pulse)
- You will check, clean and prepare the access site for dialysis treatment
- You or your care partner will place two needles in your access site and connect to the dialyisis machine tubing
- Setting the hemodialysis machine to the fluid removal goal and setting the timer
- You or your care partner will draw a blood sample.
Once the dialysis machine has indicated that treatment is complete, the blood will be rinsed back into the body. Now you can remove needles or tubing from the access site.
To complete the treatment, you will take and record blood pressure again and weigh yourself. This will provide a record of how much fluid has been removed during treatment. You can now clean the dialysis machine so that it is ready for the next treatment.
Get your full treatment
Most hemodialysis treatments take at least four hours; overnight treatment can last twice as long. Your prescribed length of treatment time is not a suggestion. All of this time is needed to help you feel better! Missing even part of a treatment can lead to more illness, hospital stays and a shorter life.