When diabetes damages your kidneys, you face some major decisions about dialysis. If you also have vision loss, your situation may seem even more complicated, as you may think reliable transportation is essential for getting to your hemodialysis treatment. This used to be so, but nowadays a lesser-known option called home hemodialysis is growing in popularity. This is not a new option, but proponents claim that new machines make home hemodialysis easier and more convenient than ever before.
There are two kinds of dialysis: Hemodialysis and Peritoneal Dialysis. Each process does some of the work your own kidneys can no longer do, such as filtering, clearing waste, and removing excess fluids from your blood. Hemodialysis requires a dialyzer or artificial kidney machine. Peritoneal dialysis cleans the blood by pushing a special fluid into the abdomen through a small, flexible tube called a PD catheter.
Most people receive hemodialysis in a dialysis center or clinic, where a nurse or technician connects patients and operates the dialysis machine. This is usually done on a fixed, pre-scheduled basis, three days a week for three to four hours each session. Others do peritoneal dialysis at home, often while they sleep.
Imagine getting your dialysis treatments in the comfort of your own home, and on your own schedule. Home dialysis users are not locked into a rigid clinic schedule and do not have to fight traffic or bad weather in order to have their blood cleaned.
This added flexibility brings with it added responsibility but can make all the difference when it comes to managing your dialysis schedule and fitting it into your personal and professional life.
Flexibility and Health Benefits as well
According to the National Kidney Foundation, reports conclude that people using short daily and nocturnal home hemodialysis enjoy a number of added health benefits. These include:
• Less need for medication to control blood pressure, anemia, and the phosphorus levels in the blood
• Reductions in neuropathy pain and restless leg syndrome
• Added comfort during dialysis and less severe “washed out” feeling after treatment
• More energy for daily tasks
• Better sleep
• Fewer and shorter hospital stays
• Better quality of life
• Longer lives
How Home Hemodialysis Works
With home hemodialysis, the process is the same as clinic-based hemodialysis except that you are in charge of your treatment. Most programs also require you to have a care partner who is willing and able to be with you during each treatment. This care partner can be a family member or friend and does not need a medical background. You and your partner are trained to do the dialysis safely and to handle any problems that may come up. Training may take from several weeks to a few months. Together, you and your care partner connect your needles and control your machine.
Even if you are blind, you have a right to home dialysis. Be sure to participate fully in your training. Use your hands to examine the equipment and supplies, and do not be afraid to ask for clarifications, this is your health and you have a responsibility to participate fully. With the proper training, you should be as effective with this treatment as your sighted counterparts.
Of course, the treatment center is only a phone call away. And even if you treat at home, you will need to stay in touch with your dialysis team to make sure that you are getting the regular blood tests and the right amount of dialysis. Some centers even monitor your home treatments by connecting your home dialysis machine to a staffed location via telephone modem or
Three Approaches to Home Hemodialysis
Three types of hemodialysis can be performed at home. They are:
1. Conventional home hemodialysis:
Three times a week for three to four hours each treatment
2. Shorter daily home hemodialysis:
Five to seven times a week, about two hours each. (With more frequent dialysis, less fluid accumulates between treatments reducing side effects like headaches, nausea, cramping and the washed-out feeling often reported after longer, less frequent treatments.)
3. Nocturnal home hemodialysis:
Overnight, six nights a week or every other night for about six to eight hours. (The additional hours of dialysis allow for more waste removal and reduce side effects.)
Note on expenses: Insurers do not always cover the additional cost of supplies for more frequent dialysis, so work with your dialysis team to advocate with your insurance company for the treatment that best meets your needs. Also, check to see if you will need to update the electrical or plumbing systems in your home so they will support your dialysis machine.
Is Home Hemodialysis Right for you?
Home hemodialysis is not a good fit for everyone. But if you are willing to invest the time and energy to learn and are willing to take responsibility for your own care, you can enjoy the added health benefits, personal flexibility and independence which this option offers.
Finding A Home Hemodialysis Center
Finding a home hemodialysis provider can be challenging. The web resources below can help.
The National Kidney Foundation Kidney Learning System (KLS) ™—Get information about chronic kidney disease and its treatment.
Dialysis Facility Compare—Find information about dialysis centers that offer home hemodialysis training programs. www.medicare.gov
Home Dialysis Central—Learn about home dialysis options, talk to other patients, find out if a dialysis center near you offers a home hemodialysis program. www.homedialysis.org
Seek the advice and support of those who have gone before.
Interview the center’s medical team and ask them to introduce you to others who have chosen to dialyze at home.
Remember, you are still in control, even though your kidneys are not.
According to the National Kidney Foundation (kidney.org) the more you know and the more you do on your own, the better you are likely to do on dialysis.
About the Author
Thomas Ley has had type 1 diabetes since he was seven and has been blind since he was 17. He is a manager and senior software support analyst for UPS and has a strong background in the field of accessible technology for the blind. He is the technology writer for Voice of the Diabetic.