If you are considering or have chosen home hemodialysis as opposed to in-center hemodialysis, there will be a lot to learn. This article will walk you through questions you might have, give you insight into what to expect and offer tips and resources to help you during this transition.
What is home hemodialysis?
Simply put, home hemodialysis is hemodialysis done at home rather than in a dialysis center. When done at home, hemodialysis is performed by you and/or your care partner instead of a nurse and dialysis technician.
If you do not have access to a care partner and you qualify, you can be trained for solo home hemodialysis. With solo home hemodialysis, you will be trained to handle your home hemodialysis sessions on your own. Your dialysis team including your nephrologist will work with you to determine if you qualify for this particular type of dialysis.
Regardless of whether you have a care partner or not, you will need a permanent access site for home hemodialysis. A fistula is usually recommended. Your nephrologist will discuss your options with you.
Pros and cons of home hemodialysis
Pros:
Flexibility
No commuting to dialysis centers
Autonomy over treatments
Possibility of better health outcomes
Comfort
Privacy
Dialysis access may last longer
Less treatment time daily because it can be done more frequently
Cons:
Fear of being responsible for the machines
Some difficulty finding training/length of training
Space needed for home dialysate, hemodialysis equipment and other supplies
The need for a care partner
Slight increase in utility bills
The need to find dialysis center support when traveling
Lack of social interaction
Different types of home hemodialysis schedules:
There are four types of schedules for home hemodialysis:
Conventional – three to four times per week for three to four hours or more each time
Short daily – five to seven times per week for two hours each time
Nocturnal or nighttime – three to six nights per week for six to eight hours
Combination – done daily and nightly depending on needs, health and machine
What training will be involved?
It usually takes three to eight weeks or longer to complete. The sessions are generally three- to five-hour training sessions each week. These are generally done during your in-center dialysis sessions. You will need to determine if your dialysis center offers training, if they do not, you can visit www.medicare.gov to find a dialysis center near you that trains for home hemodialysis.
Depending on the type of home hemodialysis you choose, you will likely need a care partner who can go through the training with you as well. You and your care partner will have to pass the training before you are allowed to change over to home hemodialysis, unless you qualify for solo home hemodialysis in which case you will be the one carrying out your dialysis at home alone.
You and your care partner if required will be trained on the following:
Equipment setup
Accessing your dialysis site properly
Determining the amount of fluid to remove
Using and caring for the machine
Water system if needed
Type of medical/equipment issues and how to handle them
Storing and ordering of supplies
Monitoring blood pressure
Keeping treatment logs
Following your diet and fluid limits
Dialysis solution options
Will I still need to go to my dialysis center?
The answer is yes. Regardless of your home hemodialysis schedule, you will still need monthly checkups at your local dialysis center to perform lab work and evaluate your current treatment plan to ensure it is effective. Your visits will be scheduled per your dialysis team’s recommendations.
You may also have questions from time to time. Staying in touch with your center keeps an open line between you and your dialysis team to ensure your success with home hemodialysis.
How will I pay for home hemodialysis?
Medicare Part B will cover your equipment and many supplies. However, you will still be responsible for your premium and deductible.
If you do not already have Medicare, end-stage renal disease (ESRD) will automatically qualify you for Medicare.
According to Medicare.gov, Medicare usually starts on the first day of the fourth month of your dialysis treatments. So, it is important to enroll as soon as you know you will need dialysis if you are not already on Medicare.
Medicare will pay for the training for home hemodialysis for you and your care partner, dialysis machine, water treatment if needed, basic recliner, alcohol, wipes, sterile drapes, glove and scissors.
If you have private insurance, you will need to check with your insurance provider to determine what is covered until Medicare kicks in.
Please see the helpful numbers and links section below to contact Medicare directly.
What will I need at home?
You will need a designated treatment room with very good lighting and enough space for a chair, supplies, and your dialysis machine. Put some thought into what you want to be doing while you are receiving your treatment. This will help you best set up your treatment room.
You will want a small table or overbed table so things are within arm’s reach during dialysis. There will be a lot of supplies, especially the dialysate solution, so you will need a good size supply closet for these.
Supplies you will need in addition to a dialysis chair and machine include:
Alcohol wipes
Blood pressure cuff
Dialysis solution
Dialyzers
Forceps
Gauze
Gloves
Scale
Scissors
Sharps container
Sterile drapes
Stethoscope
Syringes
Tape
Topical anesthetics
This list may not be all inclusive, but your dialysis training nurse will educate you on any other equipment or supplies that you may need based on your treatment plan.
Maintain your home atmosphere!
You don’t have to let home hemodialysis take over your home. Maintain your home atmosphere so it feels less like a dialysis center.
Think outside the box when setting up your equipment. You can use closets for things that you do not need during your actual treatment sessions, like the extra dialysate. Use a popup screen to hide the machine so it’s not visible to visitors when not in use.
For things you need during dialysis, place a bookshelf near your chair and camouflage the front with decorative drapes or curtains if you want. You could also have a small end table or shelf with drawers to stock things you need during your treatment sessions. Create the space you want and are comfortable in and keep it clean.
What to expect the first week of home hemodialysis
Once you have your home hemodialysis room set up and ready to go AND you have completed the necessary training, take a deep breath and get ready for the freedom and benefits home hemodialysis offers!
Make sure you do a test run prior to your actual dialysis treatment. Go through the motions so if you forget something or need to make changes, you can do so during this time.
Maybe you do not have your chair in the best place to watch TV during your dialysis session? Maybe you need an extra table on the other side of your chair for your drink or TV remote? Maybe you need to have an overbed table for your laptop if you’re going to be surfing the internet during treatments? What about a phone charger? This is the time to work out all the little kinks before the real deal!
Typically your dialysis training nurse will be there for your first home hemodialysis session, if this is not automatically offered to you, ask your nurse to be present. You and your care partner should feel completely comfortable and confident in your ability to perform your dialysis treatments. You will also have access to a nurse 24/7 should any questions or concerns arise.
A few safety tips for solo home hemodialysis:
You will need a designated treatment room with very good lighting and enough space for a chair, supplies, and your machine that has very good lighting. Put some thought into what you want to be doing while you are receiving your treatment. This will help you best set up your treatment room.m.
Ask what remote monitoring options your dialysis clinic has available
Check in with someone before and after you start your treatment
Consider obtaining a medical alert device
Remember, at this point, you have been trained well, and serious issues should not be a regular occurrence, but it’s best to be prepared and have your key contact numbers easily accessible. The more sessions you do, the better you will get at performing your own hemodialysis treatments. And you will have more flexibility than if you were going to a dialysis center three days a week, so enjoy your new freedom!
Helpful numbers and links
To sign up for Medicare, call the Social Security office at 1-800-772-1213. The teletypewriter (TTY) number is: 1-800-325-0778
For assistance locating a Medicare-certified dialysis center call 1-800-633-4227
For Medicare Telehealth visit medicare.gov/coverage/telehealth
For assistance with other coverages to help with home hemodialysis, such as Medigap and Medicare health plan choices, contact your State Health Insurance Assistance Program (SHIP) at shiphelp.org
Resources:
Home Hemodialysis: A Guide for Patients and Their Families. National Kidney Foundation. (2022).
Help I need dialysis? How to have a good future with kidney disease. Chapter 8 (2012).
Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis: a matched cohort study. BMC Nephrology volume 20, Article number: 52 (2019). You can search for additional articles on this topic if you want at Pubmed.gov and discuss the articles conclusions with your nephrologist to ensure you understand the context and how it applies to you.
