Home Hemodialysis

Home Hemodialysis

(Click for French Version)

Home hemodialysis is the same as in-centre hemodialysis, but is done by the patient in their home. With this option, a patient and a partner (a partner may be optional based on assessment) are trained to perform hemodialysis at home. The home will be outfitted with a hemodialysis machine and water filtration system at no cost to the patient. Patients set their own dialysis schedule which is either overnight while sleeping or during the day. Patients choosing this option 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.

Where to Start

An assessment session will be required prior to your training. There will be a nurse, home hemodialysis physician, social worker, psych liaison nurse, clinical pharmacist and technician available to explain the entire process of home hemodialysis in detail, and answer any questions or concerns you may have.

Benefits of Home Hemodialysis versus In-Centre Hemodialysis

  • 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

 

What’s Involved – An Overview

Hemodialysis is a treatment that takes a small amount of blood (250ml) 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.

Hemodialysis is often done in hospital but can be done at home using similar equipment. The difference is the patient learns how to do their own hemodialysis and manage their own treatments and schedule.

Types of Home Hemodialysis
The main difference between types of home hemodialysis is how often and for how long a patient dialyzes.

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 the Patient Will Need

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 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)

Vascular Access
“Vascular access” is how your bloodstream will be accessed so that dialysis can be performed. The health-care team will talk about all the access options available and inform patients about which option is best for them.

Often the vascular access has to be created and stable for a period of time (sometimes weeks) before it can be used for dialysis.

Patients are taught how to care for the vascular access by keeping it clean and monitoring it for sign of infection. It is very important that patients report any concerns to the health-care team.

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. As well, MRP has kidney friendly cookbooks available through the main office or the renal dietitian.

 

Home Hemodialysis Utility Reimbursement Program

As of 2015, the Manitoba Government implemented a Home Hemodialysis Utility Reimbursement Program. The reimbursement amount is calculated on set up time, frequency/length of hemodialysis treatments, & which type of hemodialysis machine is used. The first claim is filed at the 3 month follow-up clinic visit with the HHD nurse then submitted quarterly thereafter. The Kidney Foundation of Canada Manitoba Manitoba Chapter processes the claim & sends the reimbursement directly to the patient. No receipts are required to be submitted by the patient.

 

FREQUENTLY ASKED QUESTIONS

Can people who live in apartments do hemodialysis at home?

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.

What equipment is needed in the home?

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.

What other supplies will be kept in the home?

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.

Where should my dialysis supplies and equipment be kept?

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.

Do any changes have to be made to the home in order to accommodate the dialysis equipment?

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.

What will the plumber do in the home?

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.

What will the electrician do in the home?

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.

What happens if the patient decides to stop home hemodialysis?

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.

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