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According to the National Kidney Foundation, only 14% of patients on dialysis in the US are using at-home options, despite evidence showing that it may be a better option for some patients. Lack of information is a major barrier as many patients are unaware of options beyond the traditional in-center care. To spread awareness on home dialysis and whether it is compatible with your lifestyle, we’re taking this month to cover the ins and outs of the process and commonly asked questions by patients.
What is home dialysis and how does it work?
Dialysis is a process that essentially replaces how the kidneys operate for patients with kidney disease losing kidney function. Dialysis is a slow process that occurs over several hours each day as it works to constantly clean the toxins in your body.
There are two different modalities of dialysis – one that can be done in-center and two that can be done at home. In-center hemodialysis, a machine filters waste and removes extra fluid, balances electrolytes in your blood over 3-4 hours 3-4 times a week. Conversely, the two options for home dialysis are peritoneal dialysis (PD) – which uses the lining of the abdomen as a natural filter to remove waste, extra salt, and water from the body daily overnight – and home hemodialysis (HHD) – which provides the same treatment as a dialysis center, but at home over 2.5-3 hours 4-5 times a week.
What are the benefits of home dialysis vs. in-center options?
There are several benefits of home dialysis. Home dialysis modalities are slower dialysis and easier to tolerate. Peritoneal dialysis is done every night as you sleep and opens your day to other activities. It also gives patients the freedom to have a more flexible diet. Home hemodialysis is conducted 4-5 times a week. Although this is more frequent than in-center, it is slower and lessens the time on dialysis per session which can help alleviate fatigue and discomfort in patients.
In-center dialysis can wear on patients as it is done 3-4 times a week 3-4 hours per session. In-center dialysis tends to limit the range of what patients can eat/drink to garner the best clearance results of the procedure.
Organ stunning is a common concern with in-center vs home modalities. Secondary to the blood pressure variation, faster speed of clearance and water removal to achieve the targets, and rapid salt exchanges in in-center dialysis, several organ systems suffer even in the first year of starting dialysis.
C.W. Mclntyre, Journey of The American Society of Nephrology, Update on Hemodialysis-Induced Multiorgan Ischemia, Brains and Beyond, v. 35, p. 653-664, © 2024 by the American Society of Nephrology
So why may someone consider in-center dialysis over home dialysis? In-center dialysis can be incredibly beneficial to patients who require assistance administering their rounds of dialysis. It can also be helpful to have your dialysis nurses close by to monitor your performance and needs throughout the process. Ultimately, while both options serve their unique purpose, home is designed to mimic your kidneys’ clearance model – slow and frequent – which benefits patient health outcomes.
Additionally, the choice of modality is based on patient preference and medical needs based on their nephrology provider’s assessment. Often, detailed discussions of the patient's comorbid conditions, including cardiovascular diseases, are taken into account determining their candidacy for a certain dialysis modality.
Myth Busting: Misconceptions about home dialysis
“I need a partner”
A common misconception patients come in with is the impression they must have a partner to be eligible for home dialysis. This is untrue! While a partner or caretaker can make the process easier for some, it is by no means a requirement. Peritoneal dialysis can easily be done by yourself, for home hemodialysis, a care partner is helpful. If you are high-functioning, home hemodialysis can be done solo without a problem.
“I can no longer swim”
Another question people come in with is whether or not they’re able to swim while on home dialysis. For peritoneal dialysis, a catheter is required so keeping it clean and infection-free is important. To do so, swim in environments like swimming pools – avoid fresh lakes, hot tubs, and steam rooms – and perform catheter care right after. Be sure to consult with your kidney doctor about how to consider this safely.
“I won’t be able to travel”
This is not always the case! Peritoneal dialysis is a usual consideration for people who travel but patients on home hemodialysis can travel too! Nowadays, there are options for interim in-center dialysis or traveling with their machine with water bags.
“My catheter will get infected easily”
This is a complication that is feared a lot by patients. However, it is easily avoidable! With proper catheter care, infection can be avoided and is usually uncommon. In the case of infection, a PD catheter infection is treated with antibiotics instilled into the peritoneal cavity. Additionally, the infection does not cause a systemic or bloodstream infection!
Conclusion
Dialysis can seem like a daunting procedure to get acclimated to, but with the right guidance and information, the decision-making process can be much easier to navigate. There are a lot of resources like Kidney Smart education that can help gain more information about different modalities. Your provider can arrange an in-person education along with a dialysis unit visit to see the equipment and get acclimatized to the unit and staff. Be sure to stay updated this month as we cover all things home dialysis! As always, don’t forget to reach out to ANC with any of your kidney health concerns either through an appointment or by calling our office.
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