Even though the great majority of kidney patients choose to visit a dialysis center three days a week for dialysis, more doctors today are recommending home dialysis for eligible patients.
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If you are interested in home dialysis, here’s what you need to know. With home dialysis, you have two options:
- Filtering your own blood. Hemodialysis requires the removal, filtering and return of blood to your body. Patients also can do this process at home, says nephrologist Sheru Kansal, MD. “Generally, they can do what we call ‘short daily,’ which is hemodialysis five to six times a week, but for shorter sessions than they generally do at the center,” Dr. Kansal says. Patients also can do overnight dialysis, anywhere from every other day to five days a week. Dr. Kansal says patient training for hemodialysis usually takes about a month at a dialysis center. Patients learn how to do the home procedure, including how to insert the needles themselves.
- Using clean fluid to absorb toxins. With a process called peritoneal dialysis, you place clean fluid in the abdomen and let that fluid sit and absorb toxins from the blood. Then, you drain the fluid away. “We teach patients how to do it, and they do that process at home several times a day,” Dr. Kansal says. “That’s how they get their dialysis.” The training usually takes between three and five days. Once the process is underway, patients see their doctor once a month to review how they are doing and check their blood pressure, blood work and so on.
What the studies say about home dialysis
Dr. Kansal says a significant amount of observational evidence and one randomized control trial suggest that hemodialysis done more than three times a week is better for the patient’s survival.
As to whether peritoneal dialysis is superior to standard hemodialysis 3X/week, the results are inconclusive.
“There are some studies that indicate that it’s worse, while some studies show that it’s better,” Dr. Kansal says. “Most of the recent studies suggest that peritoneal dialysis is superior to standard hemodialysis, but I generally tell patients it’s about the same as three-times-a-week hemodialysis, assuming the patient does not have to start with an IV.”
Caveats involving both types of home dialysis
Patients new to the three-times-a-week hemodialysis would ideally start with a fistula, or a connection between an artery and a vein, which is created in the arm through a minor surgical procedure. This allows access to the blood without the use of synthetic material, but it takes time to develop.
In situations where patients with kidney disease have not had this placed in advance of needing dialysis, an IV is needed to get access to the blood stream. These IVs are associated with infections, recurrent hospitalizations, and death. Unfortunately, almost 80 percent of patients that start dialysis in the U.S. start with an IV.
“We can’t repeatedly stick a needle into an artery, and a vein is too small,” Dr. Kansal says. “So the connection between the artery and vein strengthens the vein, and after a while, that connection matures, so we can repeatedly insert needles into that vein without problems to gain access to the patient’s bloodstream.”
If you compare to peritoneal dialysis, which does not involve an IV, there are other risks to consider. Peritoneal dialysis involves sugar exposure. The fluid placed in your abdomen contains sugar to draw out salt and water, and patients can absorb some of that sugar. This can lead to other problems for some patients. Overall, the risks associated with an IV for hemodialysis far outweigh any possible risk associated with peritoneal dialysis
In weighing these risks, it’s important to talk to your doctor. He or she will be able to consider your individual health history in making recommendations about whether you are a good candidate for at-home dialysis, and if so, what type is the most appropriate.
Advantages of home dialysis
The most obvious benefit of home dialysis is being at home, which is much more comfortable and relaxing than a dialysis center. It also reduces the typical post-dialysis symptoms that result from having fluid removed and returned to your body.
“People often feel pretty badly after dialysis,” Dr. Kansal says. “So, when they’re doing a little bit less dialysis more frequently, you don’t feel as bad.”
Why you need support
While home dialysis is very safe, the thought of doing it yourself or with someone’s help at home can be intimidating. When it comes to the overall safety of in-home dialysis versus the use of a dialysis center, experts say the overall risks are similar but it’s important to have support.
“There’s not a lot of evidence that patients are at an increased risk of complications any more than in the in-center unit,” Dr. Kansal says. However, you should always have someone available, in case you do need help.