What is home hemodialysis?
Home hemodialysis is blood dialysis done in your own home with a user-friendly machine.
Who is it for?
Home hemodialysis is for just about any dialysis patient who wants to:
- Take more control over their care
- Be free of a rigid dialysis schedule that is set by someone else
- Get back to work but can't because they feel to "drained" after dialysis
- Have more energy to do the things in life they haven't been able to do because they're too tired
- Be less careful with their fluid intake
- Spend more time at home with their family and friends
- Spend less time and money on travel for their treatments.
What makes a good candidate?
- You must be able to see and hear the machine, and to move your fingers easily (i.e., button your own shirt) or have a loved one who can consistently help you.
- You must have a well-functioning vascular access (e.g., fistula, graft or permcath).
- The water in your home must pass Saskatchewan Drinking Water Standards. If you are interested in pursuing home hemodialysis, our technicians will take a sample of the water in your home.
- You must have the space in your home to store the machine and supplies.
- Owning your own home is not a requirement, but if you rent we require a landlord agreement in order to make the necessary plumbing and electrical changes.
How do I do it?
A technician from Fresenius Medical Care will come to your home to collect a water sample and inquire about the amount of water available in your home. They will look at the plumbing and electrical for changes that are needed for the dialysis and reverse osmosis water machine.
If the water supply and quality are appropriate, a home hemodialysis nurse and social worker will come to your home to discuss the training process and home hemodialysis requirements.
Next, a plumber/electrician will come to your home to get a detailed estimate of the work required. Saskatoon Health Region will provide up to $1,500 to help cover the cost of renovations.
Finally, training begins. It is Monday to Friday for about seven hours per day. It usually takes about six weeks, but it can be more or less depending on the person. When your patient educator and yourself feel that you are safe to do home hemodialysis, and your plumbing and electrical renovations are complete, you will have your first treatment at home. The trainer will be with you for the first treatment to ease you into your new life.
When do I do it?
Nocturnal dialysis is done for seven to eight hours while you sleep, five to six nights per week. It doesn't matter the time of day you sleep, just that you perform your dialysis according to the orders written by your nephrologist (kidney specialist). This is the most effective form of home hemodialysis because it is a long, gentle dialysis.
Some people may be on short daily dialysis, which is usually two to three hours per day, five to six days per week.
Where do I do it?
If nocturnal dialysis, it is done while you sleep. If on short daily treatments, you will pick a room in your home that best suits your needs.
What do I need?
- An acceptable water quality and supply
- A water softener (Note: The cost of the softener is your responsibility)
- A well functioning access point – the preferred access is a fistula but a graft or permcath may be used
- A time commitment of at least six weeks for training (Note: Assistance may be available for those who require accommodation while training)
- Heated storage space for supplies (approx. 4x4x8 feet)
- A dialysis machine, reverse osmosis water machine and treatment supplies
What is the cost of the machines required?
The cost of all machines listed above are covered by Saskatoon Health Region – there is no cost to the patient.
How difficult will it be to use the machine?
The machine (the Fresenius 2008K@home) is a very user-friendly machine. It provides on screen, step-by-step instructions, as well as colour coded diagrams as you work your way through machine preparation, hook up and take off. It has an on-screen trouble shooting guide, and you receive lots of practice with the machine during your training.
What are the benefits of home hemodialysis?
- Increased energy and better heart health because you are dialyzing more often and for longer periods
- More independence and control over your health and flexibility
- Less travel
- Minimal, if any, diet and fluid restrictions
- Fewer hospital admissions
- Fewer medications
- Better blood pressure control
- More control over your schedule
- Better quality of life
Are there any disadvantages?
- Training is six to eight weeks, Monday to Friday, in Saskatoon (you have your dialysis while you train)
- Increased water and power bills (approx. $200/month)
- Adequate space is required for supplies – they take up the space of a queen-sized bed but can be stacked vertically on shelving)
- Plumping and electrical renovations are required in your home (Saskatoon Health Region will provide up to $1,500 to help cover the cost - you are required to have a water softerner at your own cost)
- You are responsible for ordering the necessary supplies
- The machine takes time to get ready before and after treatment, and requires regular maintenance
What will I learn during the training?
You will learn how to:
- Program, dress, prime and recirculate the machine, as well as hook up and take yourself off treatment
- Draw your own lab work
- Manage the reverse osmosis water machine and maintain both machines
- Deal with alarms and work through different scenarios that can occur while on dialysis
- Give yourself a needle.
What if I'm afraid to give myself a needle?
We have trained numerous people with needle phobias on home hemodialysis, and they all manage very well. Now they actually prefer to needle themselves. We use the buttonhole technique for needling fistulas (a surgically made passage between a hollow or tubular organ and the body surface). With this technique, a tunnel is created that becomes like a pierced earring track. There is minimal to no pain using this method once developed and there is less incidence of aneurysms (big bumps) on your fistula.
Can I do it on my own?
Everyone's situation is different. It is not a requirement that each home hemodialysis patient have a partner's help. There are people of all ages who live alone and do their own home hemodialysis. However, if you have trouble seeing and/or hearing the machine, or if your finger strength is poor, you may need a support person to help you.
For more information, contact us.