Should I do hemodialysis in a center or at home?

Your lifestyle will largely determine how you go forward with dialysis.

Choose between…

In Center

DAY

In Center

NIGHT

At Home

You can do HD (hemodialysis) at a dialysis center where a nurse or technician does dialysis for you.

In a center during the day

Done by: Nurses and technicians

Ideal candidates: Retirees, people available during business hours

Pros: Four hours in a chair to do whatever you want, whoo hoo! Read, nap, use your laptop, listen to music, pretend to work…

Details: Bloodwork will be checked monthly to track your progress. Your doctor will visit you in the dialysis unit. Technicians and nurses will closely monitor you during your dialysis treatments. A nurse, social worker, and dietician will be dedicated to you.

Treatment Schedule:

Sessions are typically 3-4 hours long

3 times per week:

Mon/Wed/Fri – OR – Tu/Th/Sa

1st shift: 5:30 – 8:30 am

2nd shift 9- 12 pm

3rd shift 12- 3 pm

4th shift 4-7:00pm

(Timings may vary according to dialysis units)

In a center during the night

Done by: Nurses and technicians

Ideal candidates: People who are busy during the day

Pros: Go to sleep, wake up, and you’re done! Nighttime dialysis is more ideal because it gives the machine longer to clean out your blood.  This can help alleviate symptoms of CKD.

You can also do dialysis at home where you are the one doing your treatment. This makes it easy to fit dialysis into your schedule.

Home hemodialysis

Done by: You and a treatment partner

Pros: Greater treatment access, no need to travel, better survival outcomes

Details: This option may require modification to your home to accommodate the machine. You will need a ‘treatment partner’ to help you through the process; the actual schedule will be determined by your doctor, and nurses will keep in contact with you to monitor progress.

1. Short daily home HD:  done 5-7 times / week, 2 hours each treatment. Since you are doing dialysis more often less fluid needs to be removed each time.  This reduces symptoms like cramping, HA, nausea and feeling ‘washed out’ after dialysis treatment

2. Nocturnal Home Hemodialysis:  slow, long treatments at night while you sleep. This is done every other night or 6 times a week. More dialysis per week means more waste removal

3. Conventional home hemodialysis: Same as in center. 3-4 times per week for 3-4 hours each treatment.

Remember, you can combine any of these regimen to make it suitable to your schedule. The most important thing is that you are getting adequate dialysis. For more information, talk to you doctor.

  • More frequent dialysis means less fluid removal with each treatment. With less fluid removal you fell less ‘washed out’ after dialysis
  • More energy
  • Better sleep
  • Better quality of life
  • Few hospital visits
  • Blood pressure is under better control
  • Less medication is required to prevent anemia and high phosphorus levels
  • Do it on your own time!

Care partners are very important; that is, a person at home who is willing to help you during your treatment. This can be a friend or family member. Patients can also hire a nurse or technician to be their partner.

Not too much prodding, promise! Nurses will draw your blood monthly to measure progress, and you will weigh in before each treatment to track fluid retention. The goal is to achieve your dry weight, which is the weight at which you are comfortable breathing and don’t have excess water. Sometimes salt/fluids in your diet will need to be adjusted.

As far as stopping dialysis, this would depend on the reason you started. Each case is different, so talk to your nephrologist for the answer. In general, if you started dialysis because of an acute kidney injury, there is a chance of recovery after several weeks/months.

If you have advanced CKD and have progressed to End Stage Renal Disease, you will need dialysis until you get a transplant.

Your nephrologist uses this tool to measure progress once a month. It tells us if we are doing a good job cleaning your blood. If you’re not achieving the goal Kt/V, your nephrologist will address this. Keep in mind that often people switch dialysis options based on their needs. You are NEVER locked into one type.
There’s a difference between quantity and quality of urine. A dialysis patient can still make more than a liter of urine, but this doesn’t guarantee that they are excreting adequate amounts of toxin, potassium, and acid. Think of it like adding salt to water: saltwater and freshwater may look similar, but they are totally different (anyone who has swallowed seawater can attest to this).