Daily Home Hemodialysis
A nurse will teach you how to do 2.5–4 hour HD treatments, 5 or 6 days a week. You won't have a 2-day "killer gap" without any blood cleaning. While you are still in training, you may be able to stop taking blood pressure pills. You'll also have fewer limits on what you eat and drink than if you did standard in-center treatments. You may be able to take fewer phosphate binders, too, based on your blood tests.
You will have to fit the treatments into your day—any time that works for you and your partner. So, you can change treatment times from one day to the next. It will take a few months to get into a new routine. Expect to feel overwhelmed at first. Hang in there! The end result will be worth it. And, studies show that people who do more frequent HD treatments may live about three times as long as those who do standard HD in a clinic.
Daily Home HD benefits in brief:
- Portable – Take it with you
- Flexible – Choose treatment times that fit into your life
- Energy – Get more dialysis to feel better
- Control – Eat, drink, and have visitors during treatments
- Access – Lasts longest when you put in your own needles
- Freedom – Eat and drink more of what you like and make fewer trips to the clinic
- Survival – You may live about as long as if you get a deceased donor kidney transplant (3 times better than with standard in-center HD)
Getting ready for daily home HD
To do HD you will need a surgeon to make you a vascular access (a way to reach your blood to clean it).
When your access is ready to use, you'll have a few weeks of training. Your training nurse will teach you and your partner how to:
- Set up a treatment room
- Take care of your access and put in the needles
- Figure out how much fluid to remove
- Run and care for the dialysis machine
- Store and order your supplies
- Keep treatment logs
- Take your blood pressure
- Follow your diet and fluid limits
- Recognize and report any problems
A nurse may come to your home for your first treatment to watch you and be sure that you feel confident. Once you are home, a nurse will be on call 24 hours a day, 7 days a week to help you and answer your questions.
Where can you get daily home HD?
In the late 1960s and early 1970s when dialysis first started in the U.S., home HD was the most common type of dialysis! Once many clinics started to open, home HD faded away. Now, with new, easy to use machines (and more on the way), home HD is making a comeback. Daily home HD is growing fastest of all, and can now be found in every state.
Thanks to demand from people like you, there are more home HD options every day. Some people even move to be closer to a center that will let them do the kind of treatment they want. Or, you only have to go to the clinic once a month after training is done. So, you can choose a clinic that is farther away from your home. Of the 5,000 or so dialysis clinics in the U.S., about 14% train people to do daily home HD. Find a center near you.
Daily home HD takes a few hours on each treatment day. Since the machine is in your home, you can do treatments early in the morning, late at night, or any time that works best for you and your partner. It does not have to be the same time each day.
It takes about 30 minutes to set up the machine for each treatment, and about 15 minutes to clean up when you're done. To learn about home HD machines, check out our section on home HD equipment.
Once you're trained, you'll need to go to the clinic once a month to have your labs checked and look at your treatment logs. You'll need time to order and receive supplies each month. You may also need to make fluid (dialysate) for some machines or use water treatment for others. Your machine may need repair at times, too.
Even with the extra time it takes to do daily home HD, you may gain time in your week. Why? With standard in-center HD, you may feel washed out, weak, or tired for as long as 7 hours after each treatment. But, people who do daily home HD feel well just half an hour after treatment. So, it can give you a lot of your life back.
You will need a place for a dialysis chair and the machine. Why do you need a special chair? Since you can't get up during the treatment, you will want to be comfy. HD involves blood, and you won't want to get blood on your other furniture. And, dialysis chairs can lay flat and tip you back in case you feel faint. Your clinic must provide you with a basic chair as part of your care—and you should not have to pay for it. You can pay for upgrades, like heat or massage, if you want those. Read more about coverage of home equipment
You'll also need space to store cartridges or dialyzers, bleach and disinfectant, syringes, needles, medicines, blood tubes, water test kits, etc., based on the machine.
Care Partner tasks
Most, but not all, clinics require a care partner for daily home HD. It is safe enough that some people go it alone, sometimes with a "Life Alert" type of alarm that can call a neighbor or 911. The frequent treatments are gentle, and problems are very rare. So, lack of a partner is not the same concern as it would be with standard HD.
A partner should not have to do much if you are in good health (apart from kidney failure).
It's best if you do as much of your own treatment as you can—especially putting in the needles. After all, it's your treatment.
Your care partner may fetch things you can't reach when you're hooked up to the machine, and give you medicines or saline. Some care partners move supplies around or even set up the machine.
Most often, a family member or friend trains to be a care partner. Sometimes, people hire nurses or techs to be care partners. Medicare does not pay for home HD care partners. A few clinics pay for them—but this is rare. In most cases, people who hire a care partner must pay for it themselves. Some pay hourly. Others trade free rent in a spare room for help, or even trade helping tasks with someone else on home HD (not at the same time, of course!).
If you work, you may be able to write off the cost of a care partner on your taxes. If you work and get Social Security disability income, home care partner payments may count as an "impairment-related work expense." This lets you earn more and still keep a disability check.
Daily home HD may be a good choice for you if you want to:
- Feel well all the time. With 5–6 treatments a week, you'll feel well half an hour after a treatment.
- Keep your job. Fit your HD into your day. Daily home HD is work-friendly.
- Eat and drink more normally. You won't have the strict limits on fluid, potassium, sodium, and phosphorus that you would have with standard in-center HD.
- Travel. You can take your machine with you in a car, RV, or on a boat or plane. Supplies can be shipped to you for free in the continental U.S.
- Swim or take tub baths. If you have a fistula or graft for access, you can swim and bathe after the needle sites scab over after a treatment.
- Spend more time with your loved ones. You won't be need to spend much time at the dialysis clinic, except for monthly visits. And, you may be more likely to think of yourself as mostly healthy.
- Feel in control! Research shows that the more you know about your treatment and do for yourself, the longer you may live. Daily home HD puts you in the driver's seat.
- Protect your heart. Blood pressure is more likely to stay at a safe level when you do daily home HD than with standard HD. Daily home HD is also gentler on your heart.
- Have a healthy sex life. People who get more HD say that their sex lives improve.
- Have a baby. There are not many studies on this. But, women who get at least 20 hours of dialysis a week seem to have a better chance of carrying a baby to term.
- Stay out of the hospital. People who do daily home HD are less likely to have hospital stays.
- Live as long as you can. Studies have found that people who dialyze 5–6 times a week may live as long as those who get a deceased donor kidney transplant. People who do daily home HD may live 3 times longer than those who do standard in-center HD.
Daily home HD may not be as good of a choice for you if you want to:
- Spend time with others on dialysis. You'll go to the clinic once a month for a visit with your care team, but may not see others who use daily home HD. You can find them online, though.
- Keep dialysis out of your home. Since this is a home treatment, you would need to have a machine and supplies there. Although, we do know of at least one person who has a cabin near his home that he uses for dialysis.
- Dialyze by yourself. Most clinics will require you to have a partner.
- Avoid needles. All HD requires needles (unless you use a catheter, which is risky).
- Have your days free of dialysis. Daily home HD treatments are most often done during the day, but they can be any time you like—from early morning to late evening.
- Avoid missing work time for training. Most clinics do home HD training during work hours. Some may be willing to work with your schedule. For most people, daily home HD training takes 3–4 weeks or so. Training can be shorter if you learn to put in your own needles before you start. Once you are trained, you are likely to miss less work time than if you did standard HD in a center.
Who is best suited for daily home HD?
The most vital factor in whether you are suited for daily home HD is how much you want to do it. As long as you and a partner can pass the training and learn to place your needles, you can succeed. Each program has its own way to be sure that you know what you are getting into and will commit to the training and the treatment.
Tip: Bringing daily HD into your home is a bit like bringing home a new baby. There is a machine and supplies to find space for, and new roles for you and your care partner to take on. The "baby" affects your home and your schedule. Planning out who you think will do what is wise—but plans may need to change in real life. Talk with your partner. Be kind to each other. Show appreciation for any help you get from your partner. You are a team, on the same side in all of this.
Try to clear your calendar when you go through training so you can focus. Make meals ahead and freeze them, if you can. When you start to do treatments at home, expect to feel overwhelmed for the first 3 months or so—that's very normal. Hang in there. You'll get into a routine, and the treatments will get much easier. You'll be so proud of yourselves when you succeed!
Thinking about daily home HD? Learn how to choose a home dialysis clinic.