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

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.

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.

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 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.

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.

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.

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