Home dialysis

What is home dialysis?

Whether you are recently diagnosed with end-stage renal disease (also known as end-stage kidney disease) or have been on in-center dialysis for years, you may be interested in more flexible treatment options. Home dialysis allows you to receive your treatments from the comfort of your own home. Home dialysis also provides you with less food restrictions and better health outcomes. Learn more about home hemodialysis and peritoneal dialysis, the two forms of home dialysis treatments.  

What are the types of home dialysis?

Continuous cycler-assisted peritoneal dialysis (CCPD)

CCPD uses a machine called a cycler to do your exchanges, and it is needle free. CCPD is usually done at night while you are sleeping, but it must be done every night. The cycler usually does three to five exchanges each night and takes about nine hours. In the morning, the machine will fill your belly with dialysate that will stay in your belly throughout the day and until you go to bed and start your treatment again.

Continuous ambulatory peritoneal dialysis (CAPD)

CAPD doesn't use a machine for treatment and can be done during the day, but it must be done daily. It works by using gravity to help you do exchanges by hand. Most people do four exchanges a day. Before you go to bed, fill your belly with the cleaning liquid, dialysate, and let it stay overnight. In the morning, you'll start your exchanges again. It takes about 30 to 40 minutes to drain and refill your belly with the dialysate for each of the four exchanges. You can do CAPD anywhere that is clean and dry.

Short daily home hemodialysis

Short daily home hemodialysis is done almost every day for about two hours. Your doctor should discuss the amount of treatment needed. You can schedule your treatment at any time that is convenient. A care partner may be required. Since you are doing dialysis more often, less fluid needs to be removed each time. This can help you feel better between treatments.

Nocturnal home hemodialysis

Nocturnal home hemodialysis uses a machine to clean your blood at night, while you're sleeping. Each treatment session is 6 to 8 hours and can be done every other night, depending on what your doctor recommends. A care partner may be required. This may be an option if you have work, school, or other commitments during the day.

What are the benefits and disadvantages of home dialysis? 

Dialyzing at home offers many benefits, but it may present a few drawbacks that may or may not impact your lifestyle.

Potential benefits:

• Freedom to dialyze at your own convenience  
• More flexibility with what you can eat and drink 
• Improved quality of life and energy to do the things you enjoy  
• Potential to experience less dialysis side effects  
• Peritoneal dialysis is a needle-free treatment  
• Lower transportation costs and travel time to your dialysis center 

Potential disadvantages:

• Some clinics may require that you have a care partner to be eligible for home hemodialysis  
• Training for home dialysis will take a few weeks to complete  
• Additional storage space for home dialysis supplies needed  
• Lack of immediate access to trained staff to assist with your treatment 
• To get the most out of your treatment, peritoneal dialysis must be done daily or nightly 
• Special electrical connections and plumbing may be needed depending on your dialysis machine

How do I get started with home dialysis?

If you are interested in home dialysis, the first step is to speak with your doctor to learn more about your treatment options. Ask your doctor about the benefits, risks, and how each treatment option may affect your lifestyle.

Once you have made an informed decision about your home dialysis modality, the next step is to enroll in a training program that will provide you with the tools and support needed to stay healthy and safe while enjoying the benefits of home dialysis.

Lastly, it is important to prepare your home for treatment. This may include creating storage space for equipment and supplies. Your treatment space may be equipped with a dialysis machine, a comfortable chair, electrical outlets, and plumbing to drain treatment fluids. It is also important that you have a comfortable and clean space dedicated for your treatments. Your care team will work with you to identify if your home needs additional changes before starting treatment.

Can I do home dialysis on my own?

With proper planning and training, peritoneal dialysis can be performed without any assistance. Some dialysis clinics may require you to have a care partner to qualify for home hemodialysis. A care partner can be a family member, friend, neighbor, or anyone you trust and can reply upon to assist you during treatments. Your care partner will need to attend your home hemodialysis training and be present during treatments for support. Almost anyone can qualify to be a care partner if they receive proper training.  

Will I still have to go to a dialysis center?

In most cases, your time spent in a dialysis center will be limited. You will meet with your dialysis care team at least once a month to review your progress, check your labs, discuss your treatment records, and make any changes to your treatment if needed. Since you will not go to a dialysis center as frequently, you will have more flexibility to do the activities you enjoy, including traveling. Consider planning a short trip to practice traveling with your dialysis machine so you can become an expert in traveling with your equipment.

How do I pay for home dialysis? 

Your health insurance may pay for some, if not all, of your treatment. However, Medicare Part B will pay for 80% of home dialysis costs. This includes training, equipment, and supplies.  

You are responsible to pay for the remaining 20% of the costs or find a supplemental plan. If you have additional questions about the costs of home dialysis, you can call your insurance company or speak with your social worker. 

There are programs available to help you pay for out-of-pocket costs. Learn more about the financial help offered by AKF.  

Health equity and home dialysis 

If you would like to transition to home dialysis and your doctor turns you down, consider asking for a second opinion. You can also speak with your social worker to discuss the reasons you were turned down, as well as work with your health care team to determine ways you can meet the requirements for home dialysis. 

Despite its benefits, Black and Hispanic/Latino people are 25% less likely to use home dialysis and often aren't told about this treatment option. Being presented with all home dialysis options means you'll be able to make an informed decision about your treatment. You will also be more likely to: 

• Understand the pros and cons of each dialysis option 

• Be prepared to talk to your doctor about the available options 

• Follow through on your decision  

Learn more about AKF's efforts to advance health equity in kidney disease.