Home Hemodialysis

During hemodialysis (HD), the dialysis machine removes a small amount of your blood from your body through a needle or catheter. The dialyser 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).

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.

Compared to in-centre hemodialysis (In-Centre 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.

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 centres.

Fistula

• 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. 

Graft

• 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.

Catheter

• 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.

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-centre. 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.