Extended (Nocturnal) Home Hemodialysis

Getting 8-hours of HD at a time means that the treatments can be very slow and gentle, and easy on your heart. You'll train during the day but most people do the long treatments at night while they sleep once they go home. Studies show that people sleep better with HD treatments at night than with standard HD. The longer treatments help you to have more-normal levels of a sleep hormone (melatonin). Some people do take some time to get used to sleeping with the machine on. You will have alarms to wake you up if even a drop of blood leaks at night. Knowing that the alarm will protect you can help you relax and sleep.

Research finds that people who do longer HD treatments at home may live about three times as long as those who do standard HD in a clinic.

Most people who do extended home HD dialyze every other day, or 4, 5, or 6 times per week. They don't have a 2-day gap with no blood cleaning.

Extended home HD benefits in brief:

Getting ready for extended home HD:

To do any type of HD, you will need a surgeon to make you a vascular access (a way to get blood to the dialyzer).

If you sleep during your extended home HD treatments, you will:

These steps can help assure your safety. (In the state of New York, treatments must be monitored remotely, but this has not been shown to be any safer.)

Tip: Learn more in Kidney School Module 8— Vascular Access: A Lifeline for Dialysis .

Training

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:

Often, your first treatments at home will be during the day. A nurse may come to your home 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 extended home HD?

Dialysis first started in the U.S. in the late 1960s and early 1970s. Back then, home HD was the most common type of treatment. Long, slow, gentle treatments were the norm! But, in 1973, Medicare started to pay for dialysis. Many clinics began to open and extended home HD faded away. In-center HD treatments are shorter and harder on your body. Today, with more evidence that supports the benefits of longer treatments, this option is making a comeback.

Thanks to demand from people like you, there are more extended home HD options. Some people even move to be closer to a center that will let them do the kind of treatment they want. Of the more than 5,000 dialysis clinics in the U.S., about 8% now train people to do extended home HD. Once you finish training, you only have to go to the clinic once a month. So, you can choose a clinic that is farther away from your home. Extended home HD is offered in every state except South Dakota and Wyoming. Find a center near you.

Time

Extended home HD takes about half an hour each night for set up. The 7–9 hour treatments can be done while you sleep, so this option can give you the most blood cleaning—but take the least time out of your day! You decide when to start and finish the treatments. In the morning, clean up takes another 15 minutes or so. 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, meet with your care team, and go over your treatment logs. You'll also need time to check your supply levels, order supplies each month, and receive the shipment. You may also need to make dialysate, depending on the machine you use. Your machine may need repair at times, too.

People who do extended home HD feel well just 10 minutes or so after a treatment. So, this option can give you a lot of your life back.

Space needed

You will need a place for the machine. You'll also need space to store dialyzers, bottles of dialysate, bleach and disinfectant, syringes, needles, medicines, blood tubes, water test kits, etc.—depending on the machine.

Most people use a bed for extended HD, so they can sleep. Since you can lie flat in a bed, your clinic does not have to provide a chair for this option. You may want to use a mattress cover in case of blood leaks. Chux or other absorbent pads can be used under your arm when you put the needles in to keep your sheets clean.

Care partner tasks

Most, but not all, clinics require a care partner for extended home HD. This option 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 very rare. In most cases, people who hire a care partner must pay for it themselves. Some pay an hourly fee, others trade free rent in a spare room for help, or even trade helping tasks with someone else on home HD.

If you work, you may be able to write off the cost of a care partner as a deduction 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.

Extended home HD may be a good choice for you if you want to:

Extended home HD may not be a good choice for you if you want to:

Who is best suited for extended home HD?

The most vital factor in whether you are suited for extended 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 that offers extended home HD has its own screening methods to be sure that you know what you are getting into and will commit to the training and the treatment.

Tip: Bringing 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 extended home HD? Learn how to choose a home dialysis clinic.