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Conventional home hemodialysis

Conventional home hemodialysis benefits in brief

  • Flexible—plan your own schedule, keep your job
  • Quality—dialyze longer to feel better
  • Control—eat, drink, and have visitors
  • Access—lasts longest because you insert your own needles
  • Time—fewer trips to the clinic

How conventional HHD works

Hemodialysis (HD) replaces your kidney function by using a dialyzer—a plastic tube filled with hollow fibers—to filter your blood and remove wastes and excess fluid. One needle carries your blood through tubing to the dialyzer, and another needle returns your cleaned blood to your body. The dialysis machine pushes your blood through the system and monitors time, temperature, and pressure.

In conventional HHD, you and a partner train for a few weeks and learn to do your treatments at home, three times a week (or every other day).

See how daily HHD works. Reused with permission from Kidney School™.

Preparing for conventional HHD: vascular access

To do HD, you need access to your bloodstream through one of three types of vascular access:

  • Fistula - The "gold standard" of access, a fistula is a surgical connection between an artery and a vein, usually in your arm. Because it is entirely natural and completely under your skin, fistulas can last for years, especially if you or a partner are the only ones putting needles in it.
  • Graft - In some cases, your artery and vein are linked with a piece of artificial vein. Grafts are more prone to infection and blood clots than fistulas, and often need "tune-ups" to declot or replace them. Grafts may last a couple of years or more.
  • Catheter - Another way to access the blood is to insert a plastic catheter into a central vein in the neck or chest. Catheters can allow bacteria to enter the body, so it is vital to be careful. Studies have shown higher death rates in people who use catheters, rather than fistulas, for dialysis.

Training

After your access is ready for use, you'll have a few weeks of training. Your training nurse will teach you and your partner how to:

  • Set up a treatment room
  • Care for your access and place the needles
  • Figure out how much fluid to remove
  • Run and care for the dialysis machine
  • Store and order your supplies
  • Keep treatment logs
  • Take your blood pressure
  • Follow your diet and fluid limits
  • Recognize and report any problems

A nurse will be on call if you need help.

Availability

Conventional HHD first began in the United States in 1964, and by 1973, 40% of patients did hemodialysis at home. But once many dialysis clinics began to open, HHD became less available. Now, with new, easy-to-use machines on the market (or soon to be released), conventional HHD is coming back.

It can be challenging to find a provider to train and support you, but with demand from patients like you, HHD options are increasing every day. Some people even move to be closer to a center that will allow them to do the kind of treatment they want. Find a dialysis clinic near you.

Cost

For most Americans who qualify (93%), a large part of the cost of dialysis—including conventional HHD—is paid for by the Medicare ESRD Program, no matter how old you are.

Cost for you

Medicare is secondary to your work insurance for the first 30 months of treatment. After 30 months, it becomes primary. Having more than one form of insurance can reduce your out-of-pocket costs.

Your home may need plumbing or wiring changes to do HHD, and these changes may or may not be paid for by your insurance plan or by Medicare. You'll need to work with the social worker at your clinic to see what can be done in your case. It's also likely that your water and electricity bills will go up.

As hard as it can be, it is very important to read your policy. Some insurance carriers have begun to charge co-pays per treatment for hemodialysis. You may be able to avoid plans like these if you read the fine print.

  • Life Options offers a free 108-page booklet called Employment: A Kidney Patient's Guide to Working and Paying for Treatment. Download it here.

Cost for your clinic

Medicare pays for dialysis with a set fee per treatment, called the composite rate. This rate has lost value, in real dollars, since 1972. Clinics actually lose money on Medicare-only patients for every in-center HD treatment, so it's much better for them—and you—if you have other insurance, too.

Because with HHD the clinic must provide a machine, ensure water treatment, and train you, they will lose money on you for up to 2 years. You will need to show a real commitment to doing HHD for them to say yes. After 2 years or so, HHD costs about 30% less than in-center hemodialysis, and your clinic will begin to make money.

Dialysis is the only Medicare-covered treatment that does not have an automatic cost-of-living adjustment. Efforts are underway to fix this—if you'd like to help, go to our Legislative Action Center.

Time

When you dialyze at home, you can run longer or may be able to dialyze every other day, for 15 treatments per month instead of 12. Some people run as long as 6 hours, because they find they feel so much better. Since the machine is in your home, you can dialyze early in the morning, late at night, or whenever it works best for you and your partner.

It takes time to set up the machine for each run and to clean it afterward. How much time this will take depends on the machine. To learn about HHD machines, visit our section on dialysis equipment.

Once you're trained, you'll have monthly clinic visits to check your lab tests and treatment logs. You'll also need to allow time to check your supply levels, order supplies each month, and receive the shipment. Your machine may need maintenance sometimes, too.

Space needed

You will need a place where a chair, dialysis machine, and water treatment tanks (depending on the machine) can be placed with access to water and a drain. You'll also need space to store dialyzers, bottles of dialysate, bleach and disinfectant, syringes, needles, medications, blood tubes, water test kits, and all other equipment and supplies.

Helper tasks

Since your blood is going outside your body during a treatment, it's safest to have someone on hand in case you run into a problem, and most clinics will require it. A helper may place one or both of your needles, fetch things you can't reach when you're hooked up to the machine, give you medications or saline, or even call 911 if necessary.

Most often, a family member or friend trains to be a helper, although some people have hired dialysis nurses or technicians. Medicare does not pay for home hemodialysis helpers. A few clinics pay for them, but this is very rare. In most cases, people have paid out-of-pocket for a helper. Some have also offered free rent in a spare room in exchange for a helper, or even traded helping tasks with another HHD patient.

If you are working, you may also be able to write off the cost of a helper as a medical deduction on your taxes. If you are working and getting Social Security disability income, you may be able to submit proof of home helper payment to Social Security as an "impairment-related work expense." Doing this allows you to earn more and still keep a disability check.

Conventional HHD pluses

Some of the benefits of conventional HHD include:

  • You can choose your own treatment days and times. Conventional HHD is a work-friendly treatment.
  • Because you or a partner are the only ones putting needles in your access, it is likely to last longer with fewer problems or trips to the hospital.
  • You can do longer or more-frequent treatments to feel your best, and follow your own house rules for eating, drinking, or having visitors during treatments.
  • You'll save time not having to travel to and from the clinic three times a week.
  • Research shows that the more you know about your treatment and the more you do for yourself, the longer you are likely to live.

Conventional HHD minuses

Some of the negatives to conventional HHD include:

  • Needing a partner to be there for each treatment can put stress on your relationship, or cost you money to hire someone.
  • Training can take several weeks, and you may need to take time off work to do it.
  • You'll need room to store the machine and supplies, and time to set up the machine, clean it, and order what you need.
  • You and a partner will need to learn to keep your cool and deal with problems that may arise.
  • Two needle sticks are needed for each treatment, and you or your partner will need to learn how to place them. (You can use medication to numb the sites so it doesn't hurt.)

Who is best suited for conventional HHD?

The most important factor in whether you are suited for conventional HHD is how much you want to do it. As long as you or a partner can pass the training and learn to place your needles, you should be able to do conventional HHD.

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