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Home Hemodialysis

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What is home hemodialysis?

Home hemodialysis is hemodialysis that a person can do at home using a special machine. A nurse from a dialysis clinic can teach a person how to do hemodialysis at home. The person does not have to buy the machine. A person can choose the schedule for home hemodialysis. The three types of home hemodialysis are

  • standard home hemodialysis—three times a week or every other day for 3 to 5 hours at a time
  • short daily hemodialysis—5 to 7 days per week for 2.5 to 4 hours at a time
  • extended hours hemodialysis—three to six times per week, most often while sleeping

Lady sitting in chair hooked up to a dialysis machine
A person can choose their home hemodialysis schedule.

More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Hemodialysis.

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How do people do hemodialysis at home?

At home, people use hemodialysis machines that are often smaller than the machines in a dialysis clinic. Some machines are about the size of a large microwave oven. Medicare, the federal health insurance program that pays most dialysis expenses and sets rules for dialysis providers, requires clinics that offer home hemodialysis to provide a machine, chair, blood pressure monitor, and scale for use at home. A person may also choose to deal directly with the medical supply company for this equipment. Under either method, a medical supply company will send supplies such as dialyzers, tubing, masks, gauze, and gloves to the person’s home once or twice a month. The clinic will bill Medicare and other health plans.

Most dialysis clinics require a person to train with a partner who will be in the home while the person receives treatment. A partner should be a responsible family member or friend. The clinic’s home training nurse will teach important safety techniques. The person on dialysis should do as many of the tasks as possible. Many partners find it hard to have to place needles, for example. With practice, people on hemodialysis can learn how to place their own needles with ease.

During training, the person and partner will learn to

  • set up the machine
  • take steps to prevent infection
  • place needles into the vascular access
  • respond to any alarms from the machine
  • check the person’s weight, temperature, blood pressure, and pulse
  • record details about the treatments for the clinic
  • clean the machine
  • throw out used supplies safely
  • track supplies used and order new ones

Home hemodialysis training may take from 3 to 8 weeks. For people who already know how to place the needles into their access, the training period may be shorter. Some types of machines make training even easier. The home training nurse will make sure the person and the partner feel confident before going home and may visit during the first treatment. The clinic will give 24-hour support for questions or problems. Some clinics monitor home hemodialysis using the Internet.

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What are the benefits of home hemodialysis?

The benefits of home hemodialysis include the convenience of a more flexible schedule and better health.

More Flexible Schedule

A person can choose the schedule for home hemodialysis instead of following the clinic’s schedule. Home hemodialysis is work and travel friendly. A person can do short daily hemodialysis in the evenings, after work, for example. Extended treatments at night during sleep leave a person’s days free. Some hemodialysis machines are small enough to take in a car, a boat, an RV, or a plane. A person doesn’t have to drive to a clinic three times each week; instead, the person will only have to go to the clinic about once a month. During clinic visits, the person will see the home training nurse, dietitian, social worker, and nephrologist—a doctor who specializes in treating people with kidney disease.

More Thoroughly Filtered Blood

Since a person does home hemodialysis treatments more often or longer, home hemodialysis filters a person’s blood more thoroughly than standard hemodialysis. Healthy kidneys work 24 hours a day, 7 days a week. Getting more hemodialysis feels more like having healthy kidneys, so a person has much less risk of common standard hemodialysis problems such as

  • painful muscle cramps from removing too much fluid too quickly
  • high blood pressure, which can cause a headache or stroke
  • low blood pressure, which can make a person feel nauseous, faint, and more likely to fall
  • high phosphate levels, which can weaken bones and make skin itchy

A study done between 2006 and 20101 compared standard hemodialysis treatments with six short hemodialysis treatments per week. All hemodialysis treatment sessions took place in a dialysis clinic. Those who did six treatments had

  • better blood pressure control with fewer medications
  • a reversal of some heart damage due to high blood pressure
  • better control of phosphate levels in their blood

A second recent study comparing frequent home hemodialysis with standard hemodialysis in a clinic found the same things—and one more benefit: Those who did more frequent hemodialysis were 13 percent less likely to die from any cause.2

Better Quality of Life

Standard hemodialysis can make people feel tired or washed out for several hours after each treatment. People who have switched from standard hemodialysis to longer or more frequent hemodialysis report they feel better, with more energy, less nausea, and better sleep. They do better on tests that measure their quality of life.3

1The Frequent Hemodialysis Network. In-clinic hemodialysis six times per week versus three times per week. New England Journal of Medicine. 2010;363(24):2287–2300.

2Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-clinic hemodialysis patients. Journal of the American Society of Nephrology. 2012;23(5):895–904.

3Hall YN, Larive B, Painter P, et al. Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials. Clinical Journal of the American Society of Nephrology. 2012;7(5):782–794.

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Eating, Diet, and Nutrition

With standard hemodialysis, a person should strictly limit intake of salt, phosphorus, and potassium. Also, a person should limit liquids to prevent taking in more than standard hemodialysis can safely remove. Having too much fluid in the blood can raise blood pressure and stress the heart. Removing too much fluid too fast during standard hemodialysis can also stress the heart. More frequent hemodialysis means that fluid does not have as much time to build up in the body between sessions.

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What are some things to think about with home hemodialysis?

A person should research home hemodialysis thoroughly before deciding if it is the best treatment approach. A person should consider access to training, treatment costs, and resources available in the home before deciding to start home hemodialysis.

Access to Training

Not all clinics offer training for home hemodialysis, although more do each year. The nearest clinic that offers training may be an hour or more away. Medicare’s Dialysis Facility Compare page at http://medicare.gov/DialysisFacilityCompare/search.html and Home Dialysis Central’s Find a Home Dialysis Clinic page at http://homedialysis.org/clinics/search list clinics that offer home hemodialysis training.

Treatment Costs

Most health plans pay for home hemodialysis training and treatments. However, if a person has Medicare, coverage often includes just three hemodialysis treatments a week, whether in a clinic or at home. If a nephrologist writes a letter of “medical justification,” Medicare may pay for more home hemodialysis treatments. Other health plans may cover extra treatments, too. People considering home hemodialysis should talk with their health plan’s or clinic’s billing staff about requesting coverage for extra home hemodialysis treatments. More information is provided in the NIDDK health topic, Financial Help for Treatment of Kidney Failure.

Home Resources

A home hemodialysis machine needs a grounded electrical outlet, which a person may not have in the home. Most machines also need a special water treatment system and a drain. Some machines operate with bagged dialysate—the liquid that takes filtered wastes away from the machine—so the home does not need a water hookup. If a person needs minor electrical or plumbing changes for the machine to work in the home, the dialysis clinic will pay for them.

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What are the risks of home hemodialysis?

Home hemodialysis has some of the same risks as standard hemodialysis, including low blood pressure and infection. Low blood pressure is much less common when a person does hemodialysis longer or more often. Infection risk is lower with good infection control practices and fewer people placing needles into the access. The most severe risks of hemodialysis are

  • an air embolism—if air gets into the bloodstream. An alarm on the machine prevents air embolisms.
  • blood loss—if a needle comes out of the access or a tube comes out of the dialyzer. A person can use a blood leak detector that sets off an alert in the event of blood loss.

If a problem occurs at the clinic, a nurse or technician is on hand to act. With home hemodialysis, the person and partner should watch for problems and act quickly if they arise. Training for home hemodialysis prepares a person to deal with problems that might occur.

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A Comparison of Home and In-center Hemodialysis

A person may find this chart helpful in comparing hemodialysis in a clinic or at home.

  Dialysis Center and Home Hemodialysis Comparison Chart
Dialysis Center Home
Schedule Three treatments a week for 3 to 5 hours or more. Monday, Wednesday, Friday or Tuesday, Thursday, Saturday. Flexible. Three to seven short or long treatments per week at times that work best for the person.
Availability Available in most communities; may require travel in some rural areas Becoming more widely available as smaller equipment is developed
Machine/Supplies The clinic has the machine and supplies. The machine and 2 to 4 weeks’ worth of supplies are in the home. A person may need minor changes in the home to connect the machine to electricity and water properly.
Training The clinic teaches about treatments, diet, fluid, medications, lab tests, etc. A person and a partner should attend 3 to 8 weeks of home hemodialysis training.
Diet and Liquids Strict limits on liquids, phosphorus, sodium, and potassium Fewer limits on liquids or diet based on the amount of hemodialysis and on lab tests
Level of Freedom Less freedom on treatment days. May feel washed out and tired for hours after each treatment. A person sets the treatment schedule, fitting in all prescribed treatments. Work and travel are much easier.
Amount of Work Center staff do hemodialysis tasks. They can teach a person to do some tasks. A person and partner must set up, run, and clean the machine; check vital signs; track the treatments and send in forms; and order supplies.
Payment Medicare and most other health plans cover three hemodialysis treatments a week. Medicare covers three hemodialysis treatments a week and may cover more for medical reasons; other health plans may cover all hemodialysis treatments.

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Points to Remember

  • The three types of home hemodialysis are
    • standard home hemodialysis—three times a week or every other day for 3 to 5 hours at a time
    • short daily hemodialysis—5 to 7 days per week for 2.5 to 4 hours at a time
    • extended hours hemodialysis—three to six times per week, most often while sleeping
  • At home, people use hemodialysis machines that are often smaller than the machines in a dialysis clinic.
  • Home hemodialysis training may take from 3 to 8 weeks. For people who already know how to place the needles into their access, the training period may be shorter. Some types of machines make training even easier.
  • Healthy kidneys work 24 hours a day, 7 days a week. Getting more hemodialysis feels more like having healthy kidneys, so a person has much less risk of common standard-hemodialysis problems.
  • People who have switched from standard hemodialysis to longer or more frequent hemodialysis report they feel better, with more energy, less nausea, and better sleep.
  • People considering home hemodialysis should talk with their health plan’s or clinic’s billing staff about requesting coverage for extra home hemodialysis treatments.
  • A home hemodialysis machine needs a grounded electrical outlet, which a person may not have in the home. Most machines also need a special water treatment system and a drain.

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Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.


The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

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About the Kidney Failure Series

You and your doctor will work together to choose a treatment that's best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.

Booklets

Fact Sheets

Learning as much as you can about your treatment will help make you an important member of your health care team.

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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

This information is not copyrighted. The NIDDK encourages people to share this content freely.


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December 2015

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