What is nocturnal home hemodialysis?

Learn more about nocturnal HHD from our sponsors:

Any information you receive will come directly from our sponsors, not from Home Dialysis Central.

Nocturnal home HD benefits in brief:

Convenient - have your days free
Quality - get 2–5 times as much dialysis
Gentle - easy on your heart
Feel better - more energy, libido, and appetite
Less restrictive - easier diet, fewer drugs
Time - fewer trips to the clinic
Longer life - survival may be about the same as deceased donor transplant (3 times better than standard in-center HD).

How nocturnal home HD works

HD pumps your blood through a machine with a special filter to remove wastes and excess water. The filter is called a dialyzer. It is a plastic tube filled with hollow fibers. A needle connects to a tube that takes your blood to the dialyzer. A second needle connects to a tube that brings your blood back to you. Each time your blood goes through the dialyzer, it gets a little bit cleaner. The machine pushes your blood through the dialyzer and keeps track of time, temperature, blood flow speed, and pressure.

For nocturnal home HD, you and a partner train for a few weeks and learn to do your treatments at home, 3–6 nights a week. You start the treatment, go to sleep, and get off of the machine in the morning when you wake up. Your blood moves through the dialyzer very slowly. This gives wastes and fluid much more time to move into your bloodstream where they can be removed. Nocturnal home HD removes more water and wastes than any other type of dialysis. More dialysis is better.

In-center nocturnal HD

Some clinics now offer in-center nocturnal HD. This is most often done 3 nights a week, from about 8pm to about 4am. While in-center nocturnal is not a “home” treatment, it is much better dialysis than standard in-center treatment. It may be a good option if you don’t have a partner or can’t have a machine in your home. With twice as much treatment, you can feel better and studies show that you may live longer, too. Find a center near you.

See how dialysis works. Reused with permission from Kidney School™.

Preparing for nocturnal home HD: Vascular access

To do any type of HD, you need a way to get blood to the dialyzer. This is done by using one of three types of vascular access:

Fistula - for this “gold standard”, a surgeon links an artery and vein, most often in your arm. A fistula is all your own tissue, and is under your skin. This makes it far less likely to get blood clots or infection than any other access. A well cared for fistula can last for years—even decades. The best chance for a long fistula life is if you (or a partner) are the only ones who put needles in it.
Graft - A graft links an artery and vein with a piece of man-made vein. Grafts are more likely than fistulas to get infections and blood clots. They often need “tune-ups” to declot or replace them. Grafts may last up to a few years.
Catheter - A plastic tube can be placed into a central vein in the neck or chest. Catheters can let germs into your body that can cause sepsis (blood poisoning). Sepsis is a frequent cause of death in people on dialysis. It is best to avoid HD catheters as much as you can.

You are asleep during nocturnal home HD treatments, so your needles must be taped very well. Placing one alarm that can detect even a drop of blood under your access arm, and one under the dialyzer, can help assure safety. (In New York state, treatments must be monitored remotely, but this has not been shown to be any safer.)

TIP: You can learn more about vascular accesses and how to care for them in Kidney School Module 8 - Vascular Access: A Lifeline for Dialysis, at Kidney School™.

Training

After your access is ready for 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

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 if you need help.

Availability

In the late 1960s and early 1970s when dialysis first started in the U.S., home HD was the most common type of treatment—and long, slow, gentle treatments were the norm! But once many dialysis clinics began to open, home HD faded away. In-center dialysis treatments are usually shorter and harder on your body. Now, with new, easy-to-use machines on the market (and more improvements on the way), slow nocturnal home HD is making a comeback.

Thanks to demand from people like you, there are more nocturnal 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. Of the 5,600 dialysis clinics in the U.S., about 1 in 10 now train people to do nocturnal home HD. Nocturnal home HD is offered in 48 of the 50 states. Find a center near you.

Cost

In the U.S., a large part of the cost of HD is paid for by the Medicare ESRD Program. Most Americans (93%) qualify for these Medicare benefits, no matter how old they are. But, Medicare only routinely pays for 3 treatments per week—not 4 or 5 or 6. Your doctor must write you a letter of medical justification to get Medicare to pay for a 4th treatment (the most Medicare will cover). A health plan may or may not pay for more than 3 treatments per week.

Cost for you: Do you have a job with a health plan? If you do, your health plan will pay first for your first 30 months of treatment. Medicare, if you choose it, will be secondary. That means it will pay some or all of the balance left over after your health plan pays (if the charge is something Medicare pays for).

When you don’t have a health plan through an employer, home HD can really help you. Why? Most people under age 65 can’t get Medicare until the 1st day of their 3rd month of treatment. Those 3 months of treatment can cost tens of thousands of dollars. Some people go bankrupt. But if you do home HD, Medicare will start to pay on day 1.

Your water and electricity bills will go up a bit, but you won’t have to pay for gas to drive to and from a clinic 3 times a week.

As hard as it can be, read your health insurance policy. Some health plans will not pay for more frequent HD at home. This may limit you to three treatments per week or every other night. You can avoid plans like these if you read the fine print. Talk to your dialysis clinic—they may know which plans are best for the type of treatment you want to do.

TIP: Life Options offers a free 108-page booklet called A Kidney Patient’s Guide to Working and Paying for Treatment. Download it here.

Cost for your clinic: Medicare pays for dialysis with a set fee per treatment, called a bundled payment. If you only have Medicare and want to do nocturnal home HD, you may be limited to 3 treatments per week, or every other night. If you want to do nocturnal treatments more often, your doctor may be able to write a letter of medical justification for a 4th treatment (the most Medicare will cover). Clinics do best if people who want to do nocturnal HD more than 3 times a week have an employer group health plan (EGHP). EGHPs may pay many times what Medicare will for a treatment, and they may pay for more than 3 treatments.

Because the clinic must use a machine just for you with nocturnal home HD and must take the time to train you, you will need to show a real commitment for them to say yes.

Time

Nocturnal home hemodialysis takes about 7–9 hours each night that treatment is done—but since you are asleep, it takes very little time out of your day. You decide when to start and finish the treatments.

It takes time to set up the machine for each run and to clean it afterward. How much time this will take depends on the machine. To learn about HHD machines, check out our section on home hemo equipment.

Once you’re trained, you’ll need to return to the clinic once a month to have your labs checked 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 prepare dialysate, depending on the machine you use. Your machine may need repair sometimes, too.

Even with the time it takes to do nocturnal home HD, you may gain time if you do it. Why? Because 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 nocturnal home HD feel well just 10 minutes or so after a treatment. So, it can give you a lot of your life back.

Space needed

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

Helper tasks

Most—but not all—clinics require a helper for nocturnal home HD. Some people do their treatments alone, sometimes with a “life alert” type of personal alarm that can call 911. Since the longer treatments are more gentle and problems are very rare, the lack of a partner has not been as great a concern. It also means that a partner should not have to take on much of the work 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 placing the needles. It’s your treatment.

Your dialysis helper may place one or both of your needles, fetch things you can’t reach when you’re hooked up to the machine, give you medications or saline, or be ready to call 911.

Most often, a family member or friend trains to be a helper. Sometimes people hire dialysis nurses or techs to be helpers. Medicare does not pay for home HD helpers. A few clinics pay for them—but this is very rare. In most cases people who hire a dialysis helper have to pay themselves. Some pay an hourly fee per hour, others offer free rent in a spare room in exchange for help, or even trade helping tasks with another person on home HD.

If you work, you may be able to write off the cost of a helper as a medical deduction on your taxes. If you work and get Social Security disability income, home helper payments may count as an “impairment-related work expense.” This lets you earn more and still keep a disability check.

Nocturnal home HD pluses

You can dialyze at night and keep your days free. Nocturnal home HD is a work-friendly treatment.
With 24 to 60 hours of blood cleaning—instead of about 14 hours with standard in-center HD—people sleep and eat better, and have better libido and more energy.
The slow, gentle treatment is easier on your heart, and is less likely to cause cramping and ups-and-downs than standard in-center HD.
The diet and fluids may be near-normal with more treatment.
You will need fewer drugs, or lower doses of some drugs. Some people need phosphate supplements instead of binders.
When you (or a partner) are the only ones putting needles in your access, a fistula (if you use one) is likely to last longer with fewer problems or trips to the hospital.
You’ll save time not having to travel to and from the clinic three times a week.
Nocturnal home HD controls blood pressure very well, which can help protect your heart from damage.
Studies have found that people who do nocturnal home HD may live about as long as those who get a kidney transplant from a deceased donor. This is about three times longer than standard in-center HD.
Research shows that the more you know about your treatment and the more you do for yourself, the longer you are likely to live.

Nocturnal Home HD Minuses

Needing a partner to be there for each treatment can strain your relationship, or cost you money to hire someone. (NOTE: Strong relationships tend to get stronger with home HD.)
Training can take a few weeks, and you may need to take time off work to do it.
You and a partner will need to learn to keep your cool and deal with problems that may arise.
If you use a fistula for access, two needle sticks are needed for each treatment, and you or your partner will need to learn to place them. (You can use a cream to numb the sites so it doesn’t hurt.)
If you dialyze with a catheter, you’ll need to take care to avoid infection, and your activities (swimming, etc.) may be limited.
Machine alarms or noises may disturb your sleep.
It can be hard on you to travel and get in-center HD when you are used to more frequent treatments. You can look for in-center nocturnal, or take your machine with you (if it’s small) when you travel.

Who is best suited for nocturnal home HD?

The most important factor in whether you are suited for nocturnal home HD is how much you want to do it. As long as you or a partner can pass the training and learn to place your needles, you should be able to succeed. Each program that offers nocturnal home HD has its own screening methods to be sure that people understand what they are getting into and are willing to commit to the training and the treatment.

Interested? Learn about how to choose a home dialysis clinic.

Compare the different types of dialysis

We've developed this chart to show you the pluses and minuses for each of the dialysis types and in-center hemodialysis so you can weigh your options.

Dialysis Modality Comparison Chart

What is daily home hemodialysis?

Learn more about daily HHD from our sponsors:

Sign up to receive more information directly from DaVita » Sign up to receive more information directly from Fresenius » Sign up to receive more information directly from NxStage »

Any information you receive will come directly from our sponsors, not from Home Dialysis Central.

Daily HD benefits in brief:

Flexible - plan your own schedule, keep your job
Quality - get more dialysis to feel better
Control - eat, drink, and have visitors during treatments
Access - lasts longest when you put in your own needles
Less restrictive - easier diet
Time - fewer trips to the clinic
Longer life - survival may be about the same as deceased donor transplant (3 times better than standard in-center HD)

How short daily HD works

For short daily HD, you and (most often) a partner train for 2–6 weeks and learn to do your treatments at home, 5–7 times a week. More dialysis is better.

See how dialysis works. Reused with permission from Kidney School™.

Preparing for HD: Vascular access

To do any type of HD, you need a way to get blood to the dialyzer. This is done by using one of three types of vascular access:

Fistula - for this “gold standard”, a surgeon links an artery and vein, most often in your arm. A fistula is all your own tissue, and is under your skin. This makes it far less likely to get blood clots or infection than any other access. A well cared for fistula can last for years—even decades. The best chance for a long fistula life is if you (or a partner) are the only ones who put needles in it.
Graft - A graft links an artery and vein with a piece of man-made vein. Grafts are more likely than fistulas to get infections and blood clots. They often need “tune-ups” to declot or replace them. Grafts may last up to a few years.
Catheter - A plastic tube can be placed into a central vein in the neck or chest. Catheters can let germs into your body that can cause sepsis (blood poisoning). Sepsis is a frequent cause of death in people on dialysis. It is best to avoid HD catheters as much as you can.

TIP: You can learn more about vascular accesses and how to care for them in Kidney School Module 8 - Vascular Access: A Lifeline for Dialysis, at Kidney School™.

Training

After your access is ready for 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 will be on call if you need help.

Availability

In the late 1960s and early 1970s when dialysis first started in the U.S., home HD was the most common type of dialysis treatment! Once many clinics started to open, home HD faded away. Now, with new, easy-to-use machines on the market (and more improvements on the way), home HD of all types is making a comeback. Short daily 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. Of the 5,600 dialysis clinics in the U.S., about 14% train people to do short daily HD. Find a center near you.

Cost

In the U.S., a large part of the cost of HD is paid for by the Medicare ESRD Program. Most Americans (93%) qualify for these Medicare benefits, no matter how old they are. But Medicare only routinely pays for 3 treatments per week—not 4 or 5 or 6. Your doctor must write you a letter of medical justification to get Medicare to pay for a 4th treatment (the most Medicare will cover). A health plan may or may not pay for more than 3 treatments per week.

Cost for you: Do you have a job with a health plan? If you do, your health plan will pay first for your first 30 months of dialysis treatment. Medicare, if you choose it, will be secondary. That means it will pay all or some of the balance left over after your health plan pays (if the charge is something Medicare pays for). Find out if your clinic is in your health plan’s network. If not, the costs to your health plan (and the hit to your lifetime benefit, if there is one) can be much higher.

When you don’t have a health plan through an employer, short daily home HD can really help you. Why? Most people under age 65 can’t get Medicare payments for dialysis until the 1st day of their 3rd month of treatment. Those 3 months of treatment can cost tens of thousands of dollars. Some people go bankrupt. But if you do any type of home treatment, Medicare will start to pay on day 1.

Your water and electricity bills will go up a bit, but you won’t have to pay for gas to drive to and from a clinic 3 times a week.

As hard as it can be, read your health insurance policy. Some health plans will not pay for more frequent HD at home. You can avoid plans like these if you read the fine print. Talk to your dialysis clinic—they may know which plans are best for the type of treatment you want to do.

TIP: Life Options offers a free 108-page booklet called A Kidney Patient’s Guide to Working and Paying for Treatment. Download it here.

Cost for your clinic: Medicare pays for dialysis with a set fee per treatment, called a bundled payment. Most clinics can make ends meet with Medicare-only payments for short daily home HD if a doctor writes a letter of medical justification for a 4th treatment each week. But, clinics do best if people who want to do this treatment have an employer group health plan (EGHP). EGHPs may pay many times what Medicare will for a treatment.

Because the clinic must use a machine just for you with short daily home HD and must take time to train you, you will need to show a real commitment to home hemodialysis for them to say yes.

Time

Short daily home HD takes a few hours each day that treatment is done. 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, either.

It takes time to set up the machine for each run, and to clean it afterward. How much time this will take depends on the machine. To learn about HHD machines, check out our section on home hemo equipment.

Keep in mind, even with the extra time it takes to do short daily HD, you may gain time if you do it. 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 short daily HD feel well just half an hour after treatment. So, it can give you a lot of your life back.

Space needed

Helper tasks

Most—but not all—clinics require a helper for short daily home HD. Some people do short daily HD alone, sometimes with a “life alert” type of personal alarm that can call 911. Since the frequent treatments are more gentle and problems are very rare, the lack of a partner is not as great a concern. It also means that a partner should not have to take on much of the work 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 placing the needles. It’s your treatment.

Your dialysis helper may place one or both of your needles, fetch things you can’t reach when you’re hooked up to the machine, give you medications or saline, or be ready to call 911.

Most often, a family member or friend trains to be a helper. Sometimes, people hire dialysis nurses or techs to be helpers. Medicare does not pay for home HD helpers. A few clinics pay for them—but this is very rare. In most cases people who hire a dialysis helper have to pay themselves. Some pay an hourly fee, others offer free rent in a spare room in exchange for help, or even trade helping tasks with another person on home HD.

Short daily HD pluses

You can choose your own treatment days and times—and shorter treatments are easier to fit into your life. Short daily HD is a work-friendly treatment.
With more frequent treatments, people feel much better and have more energy.
You’ll have fewer (or no) diet and fluid limits with more treatment.
Since you (or a partner) are the only ones putting needles in your access, it is likely to last longer with fewer problems or trips to the hospital.
You can follow your own house rules for eating, drinking, or visitors during treatments.
You’ll save time not having to drive to and from the clinic three times a week.
You can do short daily HD while you travel. Supplies can be shipped to you for free in the continental US. You can take your machine along in a car, on a cruise, or, even on an airplane.
Short daily HD controls blood pressure very well, which can help protect your heart from damage.
Studies have found that people who do short daily HD may live about as long as those who get a kidney transplant from a deceased donor. This is about three times longer than standard in-center HD.
Research shows that the more you know about your treatment and the more you do for yourself, the longer you are likely to live.

Short daily HD minuses

Needing a partner to be there for each treatment can strain your relationship, or cost you money to hire someone. (NOTE: Strong relationships tend to get stronger with home HD.)
Training can take a few weeks, and you may need to take time off work to do it.
You’ll need room to store the machine and supplies, and time to set up the machine, clean it, and order what you need.
You and a partner will need to learn to keep your cool and deal with problems that may arise.
Two needle sticks are needed for each treatment, and you (or your partner) will need to learn to place them. (You can use medication to numb the sites so it doesn’t hurt.)
Short daily HD takes a few hours out of your day each day you do treatments.

Who is best suited for short daily HD?

The most important factor in whether you are suited for short daily HD is how much you want to do it. As long as you or a partner can pass the training and learn to place your needles, you should be able to succeed. Each program that offers short daily home HD has its own screening methods to be sure that people understand what they are getting into and are willing to commit to the training and the treatment.

Interested? Learn about how to choose a home dialysis clinic.

Compare the different types of dialysis

We've developed this chart to show you the pluses and minuses for each of the dialysis types and in-center hemodialysis so you can weigh your options.

Dialysis Modality Comparison Chart

Daily home hemodialysis

Learn more about daily HHD from our sponsors:

Sign up to receive more information directly from DaVita » Sign up to receive more information directly from Fresenius » Sign up to receive more information directly from NxStage »

Any information you receive will come directly from our sponsors, not from Home Dialysis Central.

Daily home hemodialysis (daily HHD) is done at home during your own treatment days and times. With shorter treatments more often, it’s easier to fit into your life.

Learn more about daily home hemodialysis

Compare the different types of dialysis

We've developed this chart to show you the pluses and minuses for each of the dialysis types and in-center hemodialysis so you can weigh your options.

Dialysis Modality Comparison Chart

Nocturnal home hemodialysis

Learn more about nocturnal HHD from our sponsors:

Any information you receive will come directly from our sponsors, not from Home Dialysis Central.

Nocturnal home hemodialysis (nocturnal HHD) is done for 6–8 hours, overnight. It can be done daily, providing 24–45 hours of dialysis per week (instead of just 14 hours with in-center HD).

Learn more about nocturnal home hemodialysis

Compare the different types of dialysis

We've developed this chart to show you the pluses and minuses for each of the dialysis types and in-center hemodialysis so you can weigh your options.

Dialysis Modality Comparison Chart

Standard home hemodialysis

Learn more about standard HD from our sponsors:

Sign up to receive more information directly from DaVita » Sign up to receive more information directly from Fresenius » Sign up to receive more information directly from NxStage »

Any information you receive will come directly from our sponsors, not from Home Dialysis Central.

Standard home hemodialysis (standard HHD) is standard, three-times-a-week dialysis treatment done at home. You can choose your treatment days and times, and even do longer or more-frequent treatments to help you feel better.

Learn more about standard home hemodialysis

Compare the different types of dialysis

We've developed this chart to show you the pluses and minuses for each of the dialysis types and in-center hemodialysis so you can weigh your options.

Dialysis Modality Comparison Chart

What is peritoneal dialysis?

Learn more about PD from our sponsors:

Sign up to receive more information directly from DaVita » Sign up to receive more information directly from Fresenius » Sign up to receive more information directly from Satellite WellBound »

Any information you receive will come directly from our sponsors, not from Home Dialysis Central.

Peritoneal dialysis (PD) benefits in brief:

Portable - take it with you
Flexible - choose treatment times that suit your schedule
Saves time - make fewer trips to the clinic
Easy - learn it in a week or two
No needles - avoid needle sticks
Fewer limits - eat a more-normal diet

How PD works

PD uses the inner lining of your abdomen (the peritoneum) as a dialysis filter. The peritoneum is lined with tiny blood vessels. Wastes and extra water in your blood can flow out of these blood vessels, through the peritoneum, and into special fluid that you put into your abdomen. Then you drain the fluid, and the wastes, out of your body.

PD catheter

To do PD, you’ll have a soft plastic tube, called a catheter, placed in your abdomen or chest by a surgeon (read more about catheter placement and bathtub catheters). You’ll learn how to use the catheter to fill your abdomen with a sterile fluid called dialysate. Most people use about 2 liters of dialysate for each treatment.

PD exchanges

After you put the dialysate into your abdomen, it stays there for a few hours. The period between putting fresh fluid in and taking used fluid out is called dwell time. While you go about your day, the fluid will collect all the wastes and water it can hold. Then you drain out the used fluid and put in clean fluid. This process is called an exchange. There are two types of exchanges:

Exchanges by hand - Some people do exchanges by hand, usually four each day: one when you wake up, one at lunch time, one at dinner time, and one at bedtime. Each takes about 20–30 minutes. This is called continuous ambulatory (walking around) PD, or CAPD.
Exchanges with a machine - most people who do PD use a cycler machine. The cycler does a few exchanges for you at night while you sleep. Your days may be free, or you might need to do one exchange during the day by hand. Your cycler prescription can be adjusted to fit your life. This is called automated PD (APD), or continuous cycling PD (CCPD).

See how PD works. Reused with permission from Kidney School™.

Getting ready for PD

Catheter placement can be done as outpatient surgery so you won’t need to stay in the hospital. Some people have little or no pain afterwards; others have pain for a few days.

Ask the surgeon who puts in your catheter to put a “transfer set” onto your catheter at the same time. A transfer set is a tubing extension with a valve that will open and close the catheter. Having a transfer set will make it easier for you to get started with PD. You should also ask the surgeon to make sure the catheter won’t exit your body at your belt-line or under a skin fold. This will make your catheter much more comfortable and easy to live with, as well as to keep clean.

After surgery, your PD training nurse will check your catheter, flush it with fluid, and teach you how to change the dressings until it heals (usually about a week or so).

Training

Once your catheter is placed, you’ll have one to two weeks of training. Your PD training nurse will teach you how to:

Set up a good place to do exchanges
Wash your hands
Take care of your catheter and exit site
Do an exchange
Learn what kind of dialysate to use and when to do an exchange
Use your cycler (if you do APD or CCPD)
Store and order your supplies
Keep treatment logs
Take your blood pressure
Follow your diet and fluid limits
Recognize and report any problems

A PD nurse will be on call 24 hours a day if you need help.

When you first begin to put fluid in, you are likely to feel very full and even stretched. After a week or two, you’ll get used to the fluid and it won’t bother you.

Availability

PD is the most common type of home dialysis. It is offered in every state. There are about 5,600 dialysis clinics in the U.S., and about 40% train people to do PD. Find a center near you.

Cost

In the U.S., a large part of the cost of PD is paid for by the Medicare ESRD Program. Most Americans (93%) qualify for these Medicare benefits, no matter how old they are.

Cost for you: Do you have a job with a health plan? If you do, your health plan will pay first for your first 30 months of dialysis treatments. Medicare, if you choose it, will be secondary. That means it will pay all or some of the balance left over after your health plan pays (if the charge is something Medicare pays for). Depending on your insurance plan, you will most likely have some co-pays.

If you don’t have a health plan through an employer, PD can really help you cut the costs you have to pay for dialysis. Why? Most people under age 65 can’t get Medicare until the 1st day of their 3rd month of dialysis. Those 3 months of treatments can cost tens of thousands of dollars! But if you choose PD, Medicare will start to pay on day 1 of treatment. If the timing is right, Medicare may even pay for your catheter surgery.

Even though it is not easy, read your health insurance policy. Some health plans charge co-pays per day for PD. You may be able to avoid plans like these if you read the fine print.

TIP: Life Options offers a free 108-page booklet called A Kidney Patient’s Guide to Working and Paying for Treatment. Download it here.

Cost for your clinic: Medicare pays your clinic a fee for each dialysis treatment it provides. The fee covers the cost of treatment plus the cost of the medications and supplies you use during the treatment. Because the fee covers all of those things at once, it’s called a bundled payment. The bundled-payment system may help more people choose PD for treatment, because clinics are able to make more money when people feel better and use fewer meds. Both of these tend to be true on PD.

Time

You can do PD at home, at work, or when you travel. Manual PD exchanges do take time each day, but you can choose the time to fit your schedule. PD with a cycler at night lets you do your treatments while you sleep so that you can leave your days free. Once you’re trained, you’ll only have to go to the clinic once a month to check your lab tests and treatment logs. You’ll also need to allow time to check your supply levels, order supplies each month, and receive the shipment.

Space needed

Supplies for PD will be brought to your home once a month. You will need to be able to store about 30 boxes that are about 1 foot by 2 feet, plus a couple of smaller boxes with other supplies.

The boxes are heavy, since they hold bags of fluid. They must stay dry. If you keep them in a basement, use shelves or a pallet—not the floor. A closet will do. Or, just line up the boxes against a wall in a room where they are easy to reach.

Helper tasks

You can do PD without a helper. Even blind people can do PD with assist devices. If you have someone who can help you, he or she may train with you. They can also help you gather supplies, move boxes, set up the cycler (if you use one), or in some cases, do your exchanges.

PD pluses:

PD is done all day, or each night—not just 3 days a week. This means no ups and downs in how you feel. You won’t feel wiped out or tired after exchanges.
You choose your schedule. Fit your exchanges in around your day or do them at night. PD is work-friendly.
You can have a more-normal diet than standard in-center HD.
PD uses no needles and the exchanges are painless.
Your own body—not a dialyzer—cleans your blood. Your blood does not leave your body.
You can do PD at home, at work, in a car, or while you travel. Supplies can be shipped to you for free in the continental US. A cycler can go with you, even on an airplane.
You won’t be around other patients, except at clinic visits. And, you may be more likely to think of yourself as mostly healthy.
Research shows that the more you know about your treatment and the more you do for yourself, the longer you are likely to live. PD puts you in the driver’s seat.

PD minuses:

Having fluid—and a catheter—in your belly can how you look and how you feel about your body.
Dialysate has sugar in it, which can cause weight gain.
The catheter is a doorway into your body. Infection (peritonitis) can occur at any exchange, so you need to follow the PD steps just as you are taught.
Due to the risk of infection, your care team may want you to avoid tub baths, or swimming in lakes or ponds. (If your PD catheter is in your chest, you can take baths, but swimming is still not advised.)
There are no days off from CAPD. It must be done a few times each and every day.
Supply delivery times may not be convenient (you may have to miss work), and the boxes are heavy.

Who is best suited for PD?

The most important factor in whether you are suited for PD is how much you want to do it. If you have had many or complex abdominal surgeries, you may not be able to do PD. If you are a large person, it may be hard to get enough dialysis with PD. Have a hernia? It must be fixed before you start PD. Sometimes PD can cause a hernia. If so, there is a way for you to keep doing PD while it is fixed.

Interested? Learn about how to choose a home dialysis clinic.

Compare the different types of dialysis

We've developed this chart to show you the pluses and minuses for each of the dialysis types and in-center hemodialysis so you can weigh your options.

Dialysis Modality Comparison Chart

Peritoneal dialysis

Learn more about PD from our sponsors:

Sign up to receive more information directly from DaVita » Sign up to receive more information directly from Fresenius » Sign up to receive more information directly from Satellite WellBound »

Any information you receive will come directly from our sponsors, not from Home Dialysis Central.

Peritoneal dialysis (PD) is a treatment with few ups and downs, so you won’t feel wiped out or tired after exchanges. With fewer diet and fluid limits and a flexible schedule, you can fit dialysis into your day.

Learn more about PD

Compare the different types of dialysis

We've developed this chart to show you the pluses and minuses for each of the dialysis types and in-center hemodialysis so you can weigh your options.

Dialysis Modality Comparison Chart

Standard home hemodialysis: Patient stories

{exp:channel:entries channel=“patient_stories” status=“Homepage”}
Why I chose home dialysis: {title}'s Story

Why I chose home dialysis

{patient_story_excerpt}

Continue »

{/exp:channel:entries}

Compare the different types of dialysis

We've developed this chart to show you the pluses and minuses for each of the dialysis types and in-center hemodialysis so you can weigh your options.

Dialysis Modality Comparison Chart

What is standard home hemodialysis?

Learn more about standard HD from our sponsors:

Sign up to receive more information directly from DaVita » Sign up to receive more information directly from Fresenius » Sign up to receive more information directly from NxStage »

Any information you receive will come directly from our sponsors, not from Home Dialysis Central.

Standard home HD benefits in brief:

Flexible - plan your own schedule, keep your job
Quality - dialyze longer to feel better
Control - eat, drink, and have visitors during treatments
Access - lasts longest when you put needles in
Time - fewer trips to the clinic
Longer life - about twice as long as standard in-center HD

How standard home HD works

In standard home HD, you and a partner train for a few weeks and learn to do your treatments at home, three times a week—the “standard” schedule that is used in most dialysis clinics. At home, you can choose to do longer treatments, or—much better—a treatment every other day. More dialysis is better. Standard home HD is also referred to as conventional home HD.

See how dialysis works. Reused with permission from Kidney School™.

Preparing for HD: Vascular access

To do any type of HD, you need a way to get blood to the dialyzer. This is done by using one of three types of vascular access:

Fistula - for this “gold standard”, a surgeon links an artery and vein, most often in your arm. A fistula is all your own tissue, and is under your skin. This makes it far less likely to get blood clots or infection than any other access. A well cared for fistula can last for years—even decades. The best chance for a long fistula life is if you (or a partner) are the only ones who put needles in it.
Graft - A graft links an artery and vein with a piece of man-made vein. Grafts are more likely than fistulas to get infections and blood clots. They often need “tune-ups” to declot or replace them. Grafts may last up to a few years.
Catheter - A plastic tube can be placed into a central vein in the neck or chest. Catheters can let germs into your body that can cause sepsis (blood poisoning). Sepsis is a frequent cause of death in people on dialysis. It is best to avoid HD catheters as much as you can.

TIP: You can learn more about vascular accesses and how to care for them in Kidney School Module 8 - Vascular Access: A Lifeline for Dialysis, at Kidney School™.

Training

After your access is ready for 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 will be on call if you need help.

Availability

In the late 1960s and early 1970s when dialysis first started in the U.S., standard home HD was the most common type of dialysis treatment! Once many clinics started to open, home HD faded away. Now, with new, easy-to-use machines on the market (and more improvements on the way), home HD of all types is making a comeback.

Thanks to demand from people like you, there are more home HD options every day. Some people even move to be closer to a clinic that will train them to do the kind of treatment they want. Of the 5,600 dialysis clinics in the U.S., nearly 1 in 6 trains people to do standard home HD. Find a center near you.

Cost

In the U.S., a large part of the cost of HD is paid for by the Medicare ESRD Program. Most Americans (93%) qualify for these Medicare benefits, no matter how old they are.

Your water and electricity bills will go up a bit, but you won’t have to pay for gas to drive to and from a clinic 3 times a week.

TIP: Life Options offers a free 108-page booklet called A Kidney Patient’s Guide to Working and Paying for Treatment. Download it here.

Cost for your clinic: Medicare pays for dialysis with a set fee per treatment, called a bundled payment. This bundle may help even more people to use home HD, because clinics will be able to make more money when people feel better and use fewer meds. Both of these tend to be true on home HD.

Because the clinic must use a machine just for you and must take the time to train you, you will need to show a real commitment to home hemodialysis for them to say yes.

Time

When you dialyze at home, you can do longer treatments. Some people run as long as 6 hours, because they find they feel so much better. Or, you may be able to dialyze every other day. Since the machine is in your home, you can do treatments early in the morning, late at night, or any time in between. It doesn’t have to be the same time each day, either. You can choose what works best for you and your partner.

It takes time to set up the machine for each run, and to clean it afterward. How much time this will take depends on the machine. To learn about home HD machines, view our section on dialysis equipment.

Once you’re trained, you’ll need to return to the clinic once a month to have your labs checked and go over your treatment logs. You’ll also need to allow time to check your supply levels, order supplies each month, and receive the shipment. Your machine may need repair sometimes, too.

Space needed

You will need a place where a chair, machine and water treatment tanks (some machines) can be placed with access to water and a drain. You’ll also need space to store dialyzers, bottles of dialysate, bleach and disinfectant, syringes, needles, meds, blood tubes, water test kits, etc.

Helper tasks

Most clinics require a helper for standard home HD. A helper can do a little or a lot. Some dialysis partners are just on hand to call 911 if there’s an emergency. Others do small tasks—like fetching things you can’t reach when you’re hooked up to the machine. If you need more assistance, your partner might give you meds or saline, and help with machine set-up and clean up. Each patient-partner team is unique, but in most cases it’s best if you do as much of your own treatment as you can—especially putting in the needles. It’s your treatment.

Most often, a family member or friend trains to be a helper. Sometimes, people hire dialysis nurses or techs to be helpers. Medicare does not pay for home HD helpers. A few clinics pay for them—but this is very rare. In most cases, people who hire a dialysis helper must pay themselves. Some pay an hourly fee, others offer free rent in a spare room in exchange for help, or even trade helping tasks with another person on home HD.

Standard home HD pluses

You can fit your treatment times into your schedule. Standard home HD is a work-friendly treatment.
When you or a partner are the only ones who put needles in your access, it may last longer, with fewer problems or trips to the hospital.
You can do longer or more frequent treatments to feel your best.
You can make your own rules for eating, drinking, or visitors during treatments.
You’ll save time not having to travel to and from the clinic three times a week.
Research shows that the more you know about your treatment and the more you do for yourself, the longer you are likely to live.

Standard home HD minuses

Needing a partner to be there for each treatment can strain your relationship, or cost you money to hire someone. (NOTE: Strong relationships tend to get stronger with home HD.)
Only doing 3 treatments per week can raise your risk of heart damage, unless the treatments are longer.
Training can take weeks, and you may need to take time off work to do it.
You’ll need room to store the machine and supplies, and time to set up the machine, clean it, and order what you need.
You and a partner will need to learn to keep your cool and deal with problems that may come up.
Two needle sticks are needed for each treatment, and you (or your partner) will need to learn to place them. (You can use medication to numb the sites so it doesn’t hurt.)

Who is best suited for standard home HD?

The most important factor in whether you are suited for standard home HD is how much you want to do it. As long as you or a partner can pass the training and learn to place your needles, you should be able to succeed.

Interested? Learn about how to choose a home dialysis clinic.

Compare the different types of dialysis

We've developed this chart to show you the pluses and minuses for each of the dialysis types and in-center hemodialysis so you can weigh your options.

Dialysis Modality Comparison Chart

Our sponsors

Home Dialysis Central is made possible through the generous annual contributions of our Corporate Sponsors. Learn more about becoming a Corporate Sponsor.