10 / 06 / 2021

Home dialysis an option usually ignored

There are two main types of home dialysis, either of which “can allow patients to achieve the same degree of longevity, peritoneal dialysis and haemodialysis.

Two approaches to home dialysis

There are two main types of home dialysis, either of which “can allow patients to achieve the same degree of longevity,”. Peritoneal dialysis involves a catheter surgically inserted in the abdomen. A solution of salt and other substances flows from a bag attached to the catheter into the abdomen. The solution dwells in the abdomen for a period of time, during which it and the lining of the abdomen, or peritoneum, cleanse the blood.  The patient then drains the used solution and repeats the process is repeated.

Patients who choose peritoneal dialysis can either do the filling and draining of the abdomen themselves several times a day or do it overnight, with the work done by an automated machine. Setting up the machine before bed, then allows it to do its job for about nine hours before she gets up and readies herself for work. Before leaving, she fills her abdomen with a fresh supply of solution, which takes her through her day.

In-home hemodialysis, patients use a machine called a dialyzer to do the work of the kidneys and filter the blood. The approach requires surgery to create access through which blood can flow from the body to the dialyzer and back. The preferred method is an arteriovenous fistula, which a vascular surgeon forms by connecting an artery to a vein, the vessel that carries blood to the dialyzer. Over time – about eight to 12 weeks – the vein strengthens and widens, making it easier to accommodate a needle for dialysis. Patients can perform home hemodialysis in a variety of ways, ranging from three to seven days a week and for different lengths of time and periods of the day.


Extensive training required for home dialysis

Regardless of which method they choose, however, home dialysis patients must get extensive training before they receive approval to take on the responsibilities themselves.


Home hemodialysis training takes much longer than peritoneal dialysis – no less than 15 days, versus five to eight. But she emphasized that the time allotted for education and evaluation depends on the patient’s understanding and confidence in operating the equipment. There is no hard-and-fast timeline.

Dialysis team offers patients round-the-clock support for questions about their health and their dialysis equipment, which they may have to pass on to the manufacturers. They also help patients manage their supplies, such as solutions for peritoneal dialysis.

The team also focuses on managing expectations. “Patients didn’t get sick overnight and they’re not going to feel better overnight. They have to give [dialysis] a chance,” Harman said. With regular treatments, the benefits include less fatigue, better sleep, improved appetite – and the chance to eventually get a new kidney.


Barriers to home dialysis

So patient preferences and medical requirements aside, what are the primary obstacles to increasing the use of home dialysis? it may be safer than in-center dialysis; it is a “gentler therapy” because it spreads out toxin removal over longer periods of time. It is also less expensive, which was just one of many reasons the last presidential administration heavily touted it.

one obstacle is “a lack of understanding on the part of other clinicians and even nephrologists” about the benefits of home dialysis.

“There is a misconception that the quality of care for home dialysis patients isn’t as good,” he said. He also noted a shortage of adequately trained nurses