What's Good and Bad About In-center HD?
| What's good about in-center HD | What's bad about in-center HD |
|---|---|
| You don't have to have a machine in your home. | There is a very strict fluid limit and meal plan. Going to the unit, waiting for a chair, and having treatment takes up many hours a week. Survival is better with more dialysis. |
| Treatments are done by nurses and technicians. | The nurses and technicians are taking care of many patients at the same time. |
| You have a few hours three times a week to read, study, write letters, exercise, learn a foreign language, think deep thoughts, or do other quiet tasks. | You have to do these things at the clinic. The chairs may not be comfortable. The room may be too cold or too hot. Eating, drinking, or visitors may not be allowed. |
| You get to meet and spend time with other patients. Treatment times can sometimes be adjusted to allow you to keep your job. | The treatment schedule you get may not fit your life—or your job. (Ask about nighttime shifts.) |
| Local anesthetics can be used so the needle sticks don't hurt, and the rest of the treatment is most often painless. | Two needle sticks with large needles are needed for each treatment. |
| You can learn to monitor the machine and even put in your own needles, so you can be a partner in your care. | The fistula or graft looks like a big, rope-like vein. People may ask what it is. |
| If you plan trips far enough in advance, it is possible to travel on HD. | It is hard to travel on the spur of the moment. |
| You can take part in most of the things you like to do. | You may feel "washed out" after dialysis and have to rest for a few hours. |
| You can feel pretty good from day to day if water is removed gently. | Short treatments three times per week don't remove many toxins! Over a period of years, these can build up and damage nerves, joints, and bones. See Module 16—Long-term Complications, to learn more. |
In-center Self Care HD
People who decide to do HD in-center can take an active role in their care. Some centers offer in-center self-care, where patients are trained to do as much of the treatment as they want to learn. Training is done during treatments, and can take as long as it needs to. Patients who do self-care may learn to weigh themselves, take their pulse, blood pressure, and temperature, decide how much fluid to remove, gather their supplies, set up the machine, put in their own needles, track their care and take notes for the chart, etc.
Doing in-center self-care lets people feel more in control and have a much better understanding of the treatment and how it works. They can be sure that things are done right, with staff right there on hand to help and answer questions. Plus, since this is a self-care treatment, Medicare will start right away instead of after three months. For the center, there is extra payment for self-care training, self-care requires fewer staff, and patients who help take care of themselves are very rewarding to work with. So, it's a win-win all around.
