Is At Home Dialysis Right For Your Loved One?

Dialysis is an important treatment for many patients with chronic kidney disease. These patients have reached the last stage, also known as kidney failure. This is when kidney function is too low to sustain life. End stage kidney disease requires either kidney transplantation or dialysis. Many patients undergo dialysis while waiting for a kidney transplant. 

If you care for a loved one with kidney disease, you might have to help them choose between in-center and home dialysis. In this article, we’ll:

• Outline the types of dialysis that can be done at home for end stage renal disease
• Discuss the pros and cons of at home and clinic dialysis
• Provide tips for making the decision 

Looking for more information about caring for someone with chronic kidney disease? Check if you have free access to Trualta. 

What Types Of Dialysis Can Be Done At Home? 

There are two primary types of dialysis: hemodialysis and peritoneal dialysis. Both can be done at home, but home peritoneal dialysis is more common. 

Home Hemodialysis

Hemodialysis uses a machine that functions like an artificial kidney to filter the blood. Blood moves from the patient into the machine, where it’s filtered. The machine returns clean blood to the patient. 

These are the subtypes of home hemodialysis: 

• Conventional. Conventional home hemodialysis is similar to center dialysis. The patient undergoes three treatments per week that last about three to four hours. 
• Short and daily. Newer dialysis machines allow patients to do shorter sessions of home hemodialysis more frequently, often once a day. 
• Nocturnal. Nocturnal home hemodialysis takes place overnight. It’s a long and slow treatment done approximately every other night. 

Home Peritoneal Dialysis

Peritoneal dialysis uses the patient’s abdominal tissue, called the peritoneum, to filter the blood as a healthy kidney would. It also uses a dialysis fluid called dialysate. Peritoneal dialysis is rarely done at a dialysis facility and almost always done as home dialysis. 

There are two types: 

• Continuous Ambulatory Peritoneal Dialysis (CAPD). CAPD doesn’t require a machine. A dialysate solution flows into the patient’s abdomen through a catheter. The body and the solution filter the blood, and the waste and solution flow back out. It’s done a few times a day.  
• Automated Peritoneal Dialysis (APD). APD is also called continuous cycling peritoneal dialysis. It filters the blood in the same way as CAPD, but with the use of a machine. It’s usually done every night while the patient sleeps. 

What Are The Benefits Of At Home Dialysis? 

If your loved one is a good candidate for peritoneal dialysis, they may prefer home care. Many patients prefer peritoneal dialysis to in-center or home hemodialysis. 

There are several benefits to peritoneal dialysis: 

• Peritoneal dialysis allows for better control of fluid because treatment is more frequent and continuous than hemodialysis. 
• More frequent fluid removal takes pressure and stress off the heart and blood vessels.
• The patient’s diet is less restrictive compared to those on hemodialysis.  
• The kidneys decline more slowly on peritoneal dialysis compared to hemodialysis. 
• Peritoneal dialysis is simpler and doesn’t require a home hemodialysis machine.
• Patients and care partners can travel with supplies and perform the treatment from anywhere, allowing for more flexibility. 
• In-home peritoneal dialysis is less expensive for most patients. 

Unfortunately, not all kidney patients are good candidates for peritoneal dialysis. Certain abdominal issues, for example, make the treatment difficult. However, this doesn’t mean these patients cannot receive dialysis at home. Another option is home hemodialysis as opposed to in-center hemodialysis. 

Some of the benefits of doing hemodialysis at home include: 

• According to studies, patients undergoing home hemodialysis compared to center hemodialysis have better outcomes and live longer. They generally have fewer kidney problems and greater kidney health because home hemodialysis patients undergo treatment more frequently. 
• Many patients prefer to do treatments in the comfort of their home. 
• There is no need to travel to a dialysis clinic with in-home treatment. This benefits patients with limited access to transportation or who cannot afford transportation costs. 
• Home hemodialysis is more flexible, allowing patients and care recipients to choose their treatment days and times. 
• Many patients appreciate the independence and greater sense of control that comes with home treatment in which they participate. 

What Are The Benefits Of A Dialysis Center? 

Home dialysis is not for everyone. While the benefits of home hemodialysis are significant, there are many reasons patients choose in-center care. 

For many, dialysis at home simply isn’t feasible. Unless you have a home healthcare worker available several times a week, the patient and their caregiver must perform the treatment, which requires extensive training for both you and your loved one. 

In-center dialysis may be a better option if you don’t have the time or are unwilling to do it, or if your loved one is unable to participate in the treatment. With in-center care, healthcare professionals perform all aspects of the dialysis treatment. 

Another potential issue is dialysis equipment. Both home hemodialysis and center hemodialysis require a machine. If your loved one wants to do it at home, you’ll need to look into home hemodialysis machines. This could be an issue if you don’t have room for the equipment and supplies or if the costs are too high. 

Finally, some patients enjoy socializing with other patients and healthcare workers at a dialysis center. Kidney patients who feel isolated and lonely at home benefit from the social aspect of in-center treatment. 

How To Help Someone Choose

The first step in deciding which type of dialysis is right for your loved one is to talk to their doctors. They can clarify which options might be better and any kinds of dialysis or locations that are not possible for your loved one. You may be able to eliminate one option before making your choice. 

Once you have a list of options, talk with your loved one about their preferences. Consider these six important factors as you come to a decision: 

1. Leaving The Home

For some patients, going to a hemodialysis center several times a week is difficult or impossible. Transportation may be an issue, and as the caregiver, you might not have time to take them. 

On the other hand, if center dialysis access is easy, some patients prefer the social aspect of leaving the home and visiting with other patients for dialysis. 

Talk to your care recipient about what is possible and what they prefer. 

2. Costs

The cost of care is another important consideration. Evaluate your loved one’s insurance options, including Medicare or Medicaid, and compare what they can afford based on coverage and the costs of different dialysis options. 

3. Care Partners

Kidney patients cannot do dialysis alone, even if they feel capable of doing so. They need a care partner. This means you, or another caregiver, must be with them at every dialysis session. For peritoneal dialysis, this can be several times a day or overnight. Home dialysis requires that a care partner be available, which might not be possible for all patients. 

4. Training

Before they can begin home dialysis, the patient and care partner must undergo training with healthcare professionals. If you choose home dialysis, be sure you are both available for and willing to undergo the training. 

5. Scheduling

Flexibility and scheduling are important considerations when choosing among dialysis types. Patients with more active or busy lifestyles benefit from the flexibility of home hemodialysis. They can choose the treatment schedule. In-center care is much more rigid. They must adhere to the schedule, which includes set times for several hours of treatment per week. 

6. Privacy

If your loved one is a private person, they may struggle with in-center care. Some patients prefer to do treatments at home with more privacy. Others are fine with going to a center and undergoing treatment in front of others. 

Key Takeaways

• Dialysis is essential for patients with end-stage kidney disease, and choosing between in-center and at-home treatment is a major decision for caregivers and patients.
• Two types of dialysis can be done at home: home hemodialysis and peritoneal dialysis. Peritoneal dialysis is more common and often easier to manage.
• Benefits of at-home dialysis include greater flexibility, improved quality of life, fewer dietary restrictions, and reduced stress on the heart.
• Home dialysis may not be suitable for everyone. It requires training, space for equipment, and a dedicated care partner.
• In-center dialysis provides full medical support, may be easier for those without caregiving help, and offers social interaction that some patients value.
• Key factors to consider when choosing a dialysis type include: ability to travel, cost, caregiver availability, training requirements, scheduling needs, and personal preferences for privacy or socialization.
• Always consult with your care recipient’s medical team to understand what options are medically appropriate and realistic for your care situation.

Don’t forget to check if you have free access to Trualta for more information about caring for someone with chronic kidney disease. 

References

1. François, K., & Bargman, J. M. (2014). Evaluating the benefits of home-based peritoneal dialysis. International journal of nephrology and renovascular disease, 447-455.
2. Kidney.org. (n.d.-a). Home hemodialysis. National Kidney Foundation. 
3. Kidney.org. (n.d.-b). Choosing dialysis: Which type is right for me? National Kidney Foundation.