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

Dialyze at home
Control your schedule
Ability to work
No travel to a dialysis unit
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

Interested in learning more about peritoneal dialysis? Our Transition Coordinator can visit with you or talk to you on the phone about dialysis options. Call 204-631-3022 to talk to the Transition Coordinator or email kidneyhealth@wrha.mb.ca. This is an easy way to learn more about your options before taking any next steps.

Assessment:

An assessment appointment is a great way to find 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
Show you home hemodialysis equipment
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.

It is recommended to bring a partner or support person to the assessment meeting if possible. After the HHD assessment, if the patient and health-care team agree HHD is a good option for the patient, planning will begin for a transition to HHD.

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 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?

During hemodialysis blood is pulled away from and returned to the body at a fast rate. This requires a vascular access. The health-care team will talk about all the access options available and which option may be best for you.

You are taught how to care for the vascular access by keeping it clean and monitoring it for sign of infection.

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

You and your health-care provider will determine what schedule works best for you.

Nocturnal (Night) Home Hemodialysis

Done at night while sleeping
Slower, longer and gentler
5 – 7 nights a week for 6 – 8 hours
Days are free
Health benefits such as blood pressure and phosphate control
More dietary freedom, less fluid restriction

Short Daily Home Hemodialysis

4 – 6 days a week for 3 – 5 hours
Patient picks time of day
Health benefits such as blood pressure and phosphate control
More dietary freedom, less fluid restriction

Conventional Home Hemodialysis (Three Times a Week)

3 days a week for 4 hours
Less time on dialysis

What You Will Need

MRP technologists will assess your home and help you understand what your home may need in order to use home hemodialysis. Most homes need:

Suitable water, plumbing and electricity as determined by MRP technologists
A telephone
A clean work area
Storage space for supplies
Space for the dialysis machine
Adequate temperature, humidity and ventilation control
Adequate sewage or septic system
Suitable flooring and lighting

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

Training & Clinic Visits

Home hemodialysis training takes four to six weeks and happens daily (during weekdays). Training is provided by home hemodialysis nurses at the hospital.

Some rural patients may choose to relocate during training. Talk with the health-care team if you need help arranging transportation or a place to stay.

Home hemodialysis program staff members are available to answer questions and there is technical support to help with equipment concerns and issues.

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

Responsibilities

You will have to be willing and able to:

Complete the training
Manage your own care
Order supplies
Attend clinic appointments
Have home plumbing and electrical adjustments done in your home to accommodate the machine

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.

Visit the Nutrition Section

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 on 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 if they are required. A consent form will be provided and must be signed by the property owner before training. MRP will return the rental unit to its original state (excluding paint) if the patient moves or ends home hemodialysis. If the patient decides to move they may be required to pay for the new renovations if any are required.

In addition to the dialysis machine, there may be a water purification unit. Optional patient chair and cart can be installed upon request. This equipment is provided and installed by MRP. Patients must have their own thermometre.

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

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.

A home hemodialysis technologist will visit the home if the patient decides to do home hemodialysis. The technologist will assess water quality, the septic system and the electrical panel to determine if home dialysis is possible. The cost of connecting a machine is covered by the program but there are minimum plumbing and electrical requirements that may need to be met by the property owner.

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 all initially provided equipment will be removed from the home. The patient will be responsible for disposing of other dialysis supplies.