Standard Home Hemodialysis
Standard home HD is done three times a week—or every other day—at home. You can choose your treatment days as long as you don't go more than 2 days in a row without dialysis. You can also choose your treatment times. Some people also do longer treatments than they would in-center. You and a partner learn to do HD at home on the "standard" three days a week schedule used in clinics. But, at home, you can choose when your treatments are—morning, afternoon, or evening. You can change the time or the day to fit your life.
Standard home HD benefits in brief:
- Flexible – Choose treatment times that fit into your life
- Control – Eat, drink, and have visitors during treatments
- Access – Lasts longest when you put in your own needles
- Time – Fewer trips to the clinic
- Survival – May be twice as long as standard in-center HD
Getting ready for standard home HD: Vascular access
To do any type of HD, you will need a surgeon to make you a vascular access (a way to get blood to the dialyzer).
When your access is ready to 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
- Take care of your access and put in 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 may come to your home for your first treatment to watch you and be sure that you feel confident. Once you are home, a nurse will be on call 24 hours a day, 7 days a week to help you and answer your questions.
Where can you get standard home HD?
Dialysis first started in the U.S. in the late 1960s and early 1970s. Back then, standard home HD was the most common type of treatment. In 1973, Medicare started to pay for dialysis. Many clinics began to open, and home HD faded away.
Thanks to demand from people like you, there are more home HD options. Some people even move to be closer to a center that will let them do the kind of treatment they want. Of the more than 5,000 dialysis clinics in the U.S., about 1 in 8 train people to do standard home HD. Standard home HD is offered in every state except South Dakota and Wyoming. Find a center near you.
Standard home HD takes about 5–6 hours each time a treatment is done, with set-up and clean up. It's best for you to get at least 4 hours per treatment—more is better. You decide when to start and finish the treatments.
It takes about 30 minutes to set up the machine for each run and about 15 minutes to clean it when you're done. To learn about home HD machines, check out our section on home HD equipment.
Once you're trained, you'll need to go to the clinic once a month to have your labs checked, meet with your care team, and go over your treatment logs. You'll also need time to check your supply levels, order supplies each month, and receive the shipment. You may need to make dialysate, depending on the machine you use. Your machine may need repair at times, too.
You will need a place for a dialysis chair and the machine. Why do you need a special chair? Since you can't get up during the treatment, you will want to be comfy. HD involves blood, and you won't want to get any blood on your other furniture. Dialysis chairs can lay flat and tip you back in case you feel faint. Your clinic must provide you with a basic chair as part of your care—and you should not have to pay for it. You can pay for upgrades, like heat or massage, if you want those. Read more about coverage of home equipment
You'll also need space to store dialyzers, bottles of dialysate, bleach and disinfectant, syringes, needles, medicines, blood tubes, water test kits, etc.—depending on the machine.
Care partner tasks
Clinics require a care partner for standard home HD. Your blood pressure could drop, and you may have cramps and need someone there to help you. Each patient and partner team is unique, but in most cases it's best if you do as much of your own treatment as you can—especially putting in the needles. It's your treatment.
Most often, a family member or friend trains to be a care partner. Sometimes, people hire nurses or techs to be care partners. Medicare does not pay for home HD care partners. A few clinics pay for them—but this is very rare. In most cases, people who hire a care partner must pay for it themselves. Some pay an hourly fee, others trade free rent in a spare room for help, or even trade helping tasks with someone else on home HD.
If you work, you may be able to write off the cost of a care partner as a deduction on your taxes. If you work and get Social Security disability income, home care partner payments may count as an "impairment-related work expense." This lets you earn more and still keep a disability check.
Standard home HD may be a good choice for you if you want to:
- Keep your job. Do your treatments before or after work. Standard home HD is work-friendly.
- Go home, but your clinic doesn't have a short daily or nocturnal program yet. Once you start at home, it's easy to switch to longer or more frequent HD when your clinic offers it.
- Swim or take tub baths. If you have a fistula or graft for access, you can swim and bathe after the needle sites scab over after a treatment.
- Spend more time with your loved ones. You won't need to spend much time at the dialysis clinic except for monthly visits. And, you may be more likely to think of yourself as mostly healthy.
- Feel in control! Research shows that the more you know about your treatment and do for yourself, the longer you may live. Standard home HD puts you in the driver's seat.
- Live longer. One study found that people who did standard home HD lived about twice as long as matched people who did standard in-center HD.
Standard home HD may not be a good choice for you if you want to:
- Spend time with others on dialysis. You'll go to the clinic once a month for a visit with your care team, but may not see others who use standard home HD. You can find them online, though.
- Dialyze by yourself. Clinics will require you to have a partner.
- Avoid needles. All HD requires needles (unless you use a catheter, which is risky).
- Keep dialysis out of your home. Since this is a home treatment, you would need to have a machine and supplies there.
- Avoid missing work time for training. Most clinics do home HD training during work hours. Some will be willing to try to work with your schedule. For most people, standard home HD training takes 3–4 weeks or longer. Training can be shorter if you learn to put in your own needles before you start. Once you are trained, you are likely to miss less work time than if you did standard HD in a center.
- Travel. If you use a standard HD machine, it is not portable. This means that to travel, you need to set up dialysis with a clinic where you'll be going.
Who is best suited for Standard home HD?
The most vital factor in whether you are suited for standard home HD is how much you want to do it. As long as you and a partner can pass the training and learn to place your needles, you can succeed. Each program has its own way to be sure that you know what you are getting into and will commit to the training and the treatment.
Tip: Bringing HD into your home is sort of like bringing home a new baby. There is a machine and supplies to find space for, and new roles for you and your care partner to take on. The "baby" affects your home and your schedule. Planning out who you think will do what is wise—but plans sometimes need to change in real life. Talk with your partner. Be kind to each other.
Try to clear your calendar when you go through training so you can focus without a lot of outside distractions. Make meals ahead and freeze them, if you can. When you start to do your own treatments at home, expect to feel overwhelmed for the first 3 months or so—that's very normal. Hang in there. You'll get into a routine, and the treatments will get much easier. You'll be so proud of yourselves when you succeed! Thinking about standard home HD? Learn about how to choose a home dialysis clinic.
Thinking about standard home HD? Learn how to choose a home dialysis clinic.