Home Hemodialysis

Home Hemodialysis

Hemodialysis is when blood is cleaned outside of the body using a machine and artificial kidney filter. Home hemodialysis is done by the patient in their home. 

Benefits of Home Hemodialysis versus In-Centre Hemodialysis

Patients set their own dialysis schedule which is either overnight while sleeping or during the day. People who use home hemodialysis can do dialysis more often and for longer times than in hospital, often leading to improved health. Once training is complete, patients only need to visit the home dialysis clinic once every one to two months for assessment by health-care team members.

  • Independence & personal control
  • Less travel for health care to and from dialysis
  • Flexible schedule/ability to work
  • Less exposure to infections
  • Better blood pressure control*
  • Improved phosphate control*
  • More dietary freedom*
  • Less fluid restrictions*
  • Less medications

*For Nocturnal Hemodialysis and Short Daily Hemodialysis

Where to Start

Assessment:

An assessment appointment is the first step to finding out if home hemodialysis (HHD) is a good fit for you. During the appointment different care team members may ask questions and:

  • review the entire process of home hemodialysis with you
  • answer any questions or concerns you may have
  • ask you questions about your home and life

With this option, a patient and a partner (a partner may be optional based on assessment) are trained to perform hemodialysis treatments themselves.

How Hemodialysis Works

Hemodialysis is a treatment that takes a small amount of blood and cleans it outside the body using a machine. Blood leaves the body through a vascular access (a way to access to the bloodstream) and is filtered through a dialyzer on the machine that acts like an artificial kidney. The clean blood is then returned to the body.

The most important part of a hemodialysis treatment is a dialyzer. The dialyzer is a circular tube filled with hundreds and hundreds of tiny hollow “strings”. Each of these strings are like a straw. Along the sides of the straw are even smaller holes, or pores, which allow the patients’ wastes to be filtered out. Blood passes through the inside of these straws. On the outside of the straws is fluid. The fluid (bath) is made specifically for each patient. The bath is what draws, or pulls, the waste products away from the blood. It is this action that cleans the blood.

What is Vascular Access?

Blood is pulled away from the patient and returned to the patient at a very fast rate. In order to accomplish this, a vascular access is required. Vascular accesses are created by physicians, most often vascular surgeons.

The different types of vascular accesses are:

Fistulas: created surgically by attaching an artery directly to a vein. The artery then enlarges the vein so that needles can be placed in the vein (see diagram above)

Grafts: created surgically by attaching an artery to a vein using a piece of specially created tubing under the skin. The tubing portion is where needles are usually placed for each treatment

Central Venous Catheters: a soft type of tubing that is inserted directly into the patients’ blood stream. This tubing stays in place from treatment to treatment. Once inserted, no further needles are needed to provide hemodialysis treatment

Home Hemodialysis Treatment Schedules

The main difference between types of home hemodialysis is how often and for how long a patient dialyzes. Your health-care team will discuss all the different options with you.

Nocturnal (Night) Home Hemodialysis
With this type of dialysis, the patient has their dialysis treatment during the night while they are sleeping. It is a slower, longer and gentler form of dialysis done five to seven nights a week for six to eight hours. A benefit for this type of dialysis is that dialyzing at night leaves the days free. There can also be benefits such as better blood pressure control, better phosphate levels, more dietary freedom and less fluid restriction as well as less medication.

Short Daily Home Hemodialysis
This type of dialysis is when the patient has dialysis treatment five to six days a week for two-and-a-half to three hours each time. Since this is a shorter session, it’s usually done during the day at a time chosen by the patients. Benefits include ability to schedule one’s own treatment, better blood pressure control, better phosphate levels, more dietary freedom, less fluid restriction and less medication.

Conventional Home Hemodialysis (Three Times a Week)
With this type of dialysis the patient has their dialysis treatment three days a week for four hours each time, similar to an in-centre schedule. While this option offers less time, it does not offer all the same benefits as short daily or nocturnal home hemodialysis. It does, however, allow the patient to be at home and independent.

What You Will Need

The home will be outfitted with a hemodialysis machine and water filtration system at no cost to the patient. A technologist will visit your home to assess it. The patient will need to have the following in order to have the best possible environment for home hemodialysis:

  • Suitable water, plumbing and electricity as determined by MRP technologists
  • Telephone
  • Clean work area
  • Storage space for supplies
  • Space for the dialysis machine

Home requirements may include:

  • 260 square feet for dialysis treatment, circulation space, water treatment, supplies and biohazard waste storage area
  • Devoted 120 vac 20 amp standard electrical circuit with receptacle
  • Seamless vinyl flooring in space dedicated to dialysis
  • Fluorescent treatment lighting with separate switch
  • Adequate temperature, humidity and ventilation control
  • Adequate municipal or well water
  • Adequate sewage or septic system
  • Telephone land line in treatment room

All of this will be discussed with you in more detail during your home hemodialysis assessment appointment.

Training & Clinic Visits

Home hemodialysis training takes six to eight weeks and happens daily (during weekdays). Training is provided by home hemodialysis nurses at the hospital in Winnipeg. Some rural patients may choose to relocate to Winnipeg during training. Once training is complete, home hemodialysis program staff are available to answer questions and there is technical support available to help with equipment concerns and issues.

Clinic appointments for home hemodialysis patients are every one to two months once the patient is independent at home.

Getting There
Talk with the health-care team if the patient plans on driving to training or if you need help arranging transportation.

Responsibilities

Being on home hemodialysis means managing one’s own care. While this is a responsibility, it also allows the patient freedom to set their own schedule. The patient will have to ensure that they are willing and able to:

  • Complete the training
  • Manage their own care
  • Order supplies
  • Attend clinic appointments
  • Have home plumbing and electrical adjustments to accommodate the machine (arranged and paid for by MRP)

Eating & Drinking

Short daily and nocturnal home hemodialysis offers the benefit of more freedom in the diet and fluid intake than conventional (three days a week) dialysis. Because the patient is dialyzing more often, their body is better able to eliminate certain waste products and excess fluid. Though these types of dialysis offer more dietary freedom, there are still certain restrictions.

A renal dietitian will talk to patients about a customized diet for the patient’s specific needs. Always talk to the dietitian if there are concerns about nutritional needs. Click the button below for more nutrition information for those on home hemodialysis.

Home Hemodialysis Utility Reimbursement Program

The HHURP is administrated by Manitoba Health, Seniors & Active Living (MHSAL) and reimburses patients for the cost of water and electricity used by their home hemodialysis machines. Reimbursements amounts depend on the schedule of treatments, machine used and current utility rates. After completing training for home hemodialysis, participants can consent to join the program. Their dialysis use information is then shared with MHSAL for MHSAL to calculate and generate payment to the home dialysis user.

Update: June 2019

As of May 26, 2019 the Home Hemodialysis Utility Reimbursement Program (HHURP) is now administrated by Manitoba Health, Seniors & Active Living (MHSAL). Previous to this date the program was administrated by the Kidney Foundation of Canada Manitoba Branch. Current users of the program will need to sign a new consent form to continue participating. This consent is to allow MRP to share patient dialysis use information with Manitoba Health, Seniors & Active Living. Your home hemodialysis care team will provide you with this form.

Manitoba Renal Program is waiting for MHSAL to confirm if there are any changes to the program or if payment schedules will remain the same. Once we have this information we will provide it as soon as possible.

In the meantime contact information for the program is now as follows:
Ancillary Programs
300 Carlton Street
Winnipeg, Manitoba R3B 3M9
Phone: 204-786-7365 or 204-786-7366
Toll free: 1-800-297-8099 ext 7365 or 7366
FAX: 204-786-6634
TTY/TDD Relay Service: 204-774-8618 outside Winnipeg: 711 or 1-800-855-0511
Email: insuredben@gov.mb.ca

You can also find information of their website here.

Frequently Asked Questions

If someone lives in a rental property they must obtain legal written consent from the property owner for any renovations required. A consent form will be provided to the patient and must be signed by the property owner and witnessed before any training will begin. The MRP will return the rental unit to its original state if the patient move or choose to come off home hemodialysis. The MRP will only pay for this service once. If the patient decides to move they are required to pay for the new renovations.

In addition to the dialysis machine, there may be a reverse osmosis (R.O.) water purification unit. This unit sits on floor behind the machine. There is also a water softener and a board with carbon filters that clean the water before it goes through the R.O. and is used for dialysis. All equipment is provided and installed by MRP.

Enough space will be needed to store tubing, dialyzers and dialysate solution. There are also other smaller supplies like medications, gauze, syringes and needles. The patient will be responsible for ordering supplies as needed.

It is recommended that dialysis equipment and supplies be kept in the room that will be used for dialyzing for convenience. Supplies can be stored in any warm, dry space. This will all be determined on a home visit prior to starting home dialysis. Ideally, no more space than a large linen closet will be needed to store supplies in.

A home hemodialysis technologist will visit the home if the patient decides to do home hemodialysis. The technologist will assess water quality and the septic system to determine if home dialysis is possible. The technologist will work together with patients in determining the best location for the dialysis equipment. The dialysis technologist will also arrange for a plumber and electrician to come in and make any changes needed in order to house the equipment.

Once the dialysis location/room in the patient’s home is determined, the plumber will connect the required municipal water feed and the appropriate sanitary drain for your specific dialysis machine to operate.

The electrician will install an electrical wire from the main electrical power source to the room in which the dialysis equipment is located. The electrical wire will be dedicated to the dialysis machine only.

If the patient decides to discontinue home hemodialysis, they will return to the in-centre hemodialysis unit for treatments. The dialysis machine (and if applicable the R.O. unit, water board, chair) and carts will be removed from the home. The patient will be responsible for disposing of other dialysis supplies. Any repairs needed as a result of home hemodialysis will be done and expenses for these repairs will be covered by the MRP.