In the U.S., home dialysis (PD or home hemo) training is set up through a dialysis center. The center will train you and a partner. You don’t have to buy the machine yourself—you just have to find a center that will support you.

Once you choose a center, you have two options for your equipment, supplies and staff support. The center can provide these for you (Method I), or you can get staff support from the center and your equipment and supplies from a supply company (Method II). Most people use Method I.

Location, location, location

When you have to go to a center three times a week, having it close to your home can help reduce your travel time. But when you do treatments at home, after you finish training you only need to go to the center once a month for clinic visits. (You will also have to arrange to get IV iron, if you need it.) So, a home center can be as far away as you are willing to drive once a month.

This is a key point, because home hemo is only offered by about one of every 12 centers in the U.S. (PD is offered by about one of every 3 centers). So, if you insist that a center be around the corner or even in your town, you may not be able to get the treatment you want.

“Find a center” database

To help people locate a home dialysis center, Home Dialysis Central staff built a find-a-center database of every center in the United States that offers home training. You can use this list in two ways:

1. Find all the centers in the U.S. that offer a treatment. You can do this by checking only the box for the treatment(s) you are looking for. To find out how many U.S. centers offer nocturnal home hemo, check only that box, and click “Search”.
2. Find all the centers near you that offer a certain treatment. First, choose your state from the drop-down menu. Then see if your city is in our list. If it is, select it and check the boxes for the treatment(s) you are looking for.

If you don’t get results—or if your city is not listed—re-do your search by state only. Leave the city blank and see what comes up. You may need to look on Mapquest or Google Maps for driving directions to see which centers are closest to you.

Coverage maps

Besides the “Find a Center” database, we also created coverage maps for Home Dialysis Central. You may find these maps helpful if you live near a state border. In some cases, the closest home program to you may be in the next state—and the maps can give you ideas for where to look.

There are separate maps for PD, conventional home hemo, daily home hemo, nocturnal home hemo, and all home hemo. Each dot on the map stands for a 120-mile radius around a program site—about a 2-hour drive. Below are the maps (you can see them larger or download them here.

PD coverage	Conventional home hemo coverage
Nocturnal home hemo coverage	Daily home hemo coverage

No luck yet? Don’t give up!

As you can see from the coverage maps, some parts of the U.S.— especially the East coast—are very well-supplied with home centers of all types. Other parts, like the West, are not. If you live in a region with poor coverage, you may need to get creative.

• Are you looking for daily or nocturnal home hemo and not finding them? Try contacting a center near you that offers PD or conventional (3 times per week) home hemo and see if they might expand their program to include the treatment you want. Be persistent—you may have to follow up for a while to convince the center of your interest.
• If you are not tied to where you live now, you might want to think about moving somewhere that will let you do the treatment you prefer.
• Check around to see if others in your area are also interested in home treatments. Approach your center or nephrologist as a group. Consumer demand has been successful in getting new programs started in a number of places—why not yours?
• Contact a center that is farther away from your home to see if they can train you. For example, a nonprofit dialysis corporation, Northwest Kidney Centers in Seattle, trains and follows home patients as far away as Alaska. Once you are trained, your local center or doctor may be able to do your monthly checks. Some centers want you to live close enough for their technician to maintain and repair your machine. But, some machines can be shipped back to the company if there are problems. Ask if this is possible if you live far away.
• Contact DaVita at Home (800-244-0582) or Fresenius Medical Care (866-434-2597) to see if they may be starting a new program in your area.
• Write a letter to the editor of your local paper about the benefits of home dialysis—and the trouble you are having finding it nearby. Sometimes public attention can help bring about a solution.

Copyright © 2006 Medical Education Institute, Inc. All rights reserved.