Home hemodialysis
Anyone who can drive a car can learn to do home HD, with a few weeks of training. People who do home HD most often need to have a partner (or pay someone) to help with treatments. Some programs will allow home HD without a partner because doing longer and/or more frequent HD treatments gets rid of most of the symptoms (like muscle cramps, headaches, nausea, etc.) that occur during standard in-center HD. As with PD, Medicare can start right away if home HD training starts before the fourth month of dialysis.
One of the new machines for home HD is small and portable. It is a 17-inch cube that weighs 70 pounds and has a handle. With someone to help, the NxStage machine can be taken on a car trip, cruise, or airplane, with supplies shipped to a destination. This machine does not need special plumbing or wiring. Some other machines used for home HD do need special plumbing or wiring. As with PD, you would need to have space to put the machine and store some supplies.
Medicare pays for dialysis done in the home. You do not have to buy the machine; the center supplies it and trains you and a partner to do the treatments. Your clinic must also give you a chair, scale, blood pressure cuff, and other supplies. With home HD, the center has someone on call 24 hours a day to answer questions.
It is possible to do home HD three times a week for a few hours, just the way it is done in-center. But this type of home HD is much less common now. Having a 2-day gap in HD treatments is hard on the heart. In fact, two large studies have shown that sudden death from heart failure is twice as likely on the day after the 2-day dialysis "weekend." So, most people who do HD at home do it at least every other day.
These days, home HD is most often done as short daily treatments (5 to 7 times per week for 2.5+ hours a day) or "extended" nocturnal treatments (at night for 8 hours or so during sleep, 3 to 6 nights per week, so days are free). These types of treatments are the fastest growing in the U.S., though the number of people using them is still small.
Paying for Home HD More than Three Times per Week
Medicare pays for three HD treatments per week. This means that if you want to do daily home HD (5 to 7 treatments per week), you either need to have health insurance other than Medicare or your doctor needs to write a letter to Medicare to ask them to pay for more treatments. You may need both. For this reason, if you have better insurance, you may be more likely to be offered this treatment option.
In-center Nocturnal HD
Did you know that you can get the benefits of long, slow dialysis while you sleep, without doing your treatments at home? A number of centers around the U.S. now offer in-center nocturnal HD. They use the machines at night, when they would otherwise be idle, to offer a treatment that can help you feel better and keep your job.
In most cases, people go to the center at about 9 p.m. to start treatment and leave at about 4 a.m. Treatments are done three times per week.
If you don't have a partner and still want to do dialysis while you sleep, so your days are free, ask your center about in-center nocturnal HD.
