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

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 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.

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.

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

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 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.

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.

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