How Does Home Dialysis Work?

If you’ve recently been diagnosed with chronic kidney disease (CKD), you may wonder what dialysis treatment options, such as home dialysis, will be available to you if you progress to kidney failure. Or, if you’re already on dialysis in a center, you might be curious about how home dialysis works. Home dialysis is a great option for many people with end stage renal disease (ESRD) as it allows you to take control of your treatment and may provide a more flexible schedule and fewer medications or food restrictions.

There are two forms of home dialysis treatment available: home peritoneal dialysis and home hemodialysis (home HD). There are various considerations for each treatment option and it’s important to understand the difference between them to decide what’s right for you.

Home Peritoneal Dialysis (PD) uses the inner lining of your abdomen—your peritoneum—to filter your blood. This is considered a gentle form of dialysis that most closely mimics natural kidney function. PD usually takes place daily.

PD uses a similar fluid as home HD, dialysate, which enters your abdomen via a peritoneal dialysis catheter. It then dwells for a specific amount of time necessary to filter and remove extra fluid from your blood before it drains out the same catheter. This process is called an exchange. The specific number of exchanges you’ll need will depend on your specific health needs.

There are two types of PD, continuous ambulatory peritoneal dialysis (CAPD), and automated peritoneal dialysis (APD). The main difference between these options is that APD uses a cycler machine to perform exchanges while CAPD does not require a machine. Many patients may benefit from choosing CAPD therapy as their treatment choice as it better preserves a person's residual renal function.

Your PD supplies will depend on which mode of PD you choose. Either type of PD will require a supply of dialysate, tubing, masks, hand sanitizer and anything else specific to your care. CAPD requires an IV stand to hang dialysate from as flows into your abdomen, while APD also requires a cycler machine and power source.

Your PD schedule is largely determined by the type of PD you choose. CAPD is designed to be done continuously throughout the day, with 3-4 exchanges per day. APD is often done at night while you are hooked up to a machine. You’ll work with your doctor and care team to discuss the PD option that best fits your lifestyle.

Home HD allows the same general process as dialysis in-center. Your blood is filtered outside your body using a dialyzer or “artificial kidney” to remove unwanted waste, toxins and excess fluid. Clean, chemically balanced blood is then returned to your body.

To do home HD, you’ll need your own artificial kidney machine, a cycler, and a water and power supply. Other supplies may include hand sanitizer, gloves, masks, dialysate (a solution that filters your blood), tubing, alcohol prep pads, and anything else specific to your needs. These supplies do require space for storage, so be sure you have a closet or other area where you can keep them.

Because you’ll be dialyzing at home instead of in a center, you and your doctor are able to customize your schedule to fit with your lifestyle and health needs. Some people dialyze daily for shorter periods of times, while others may dialyze every other day for longer sessions.

Many people who do dialysis at home choose to have a care partner who can help them prepare their access site and dialysis machine, although it is possible to do home dialysis on your own. You’ll also need space to store your machine and supporting supplies, as well as a clean area with access to a drain to perform treatments.

If you choose home dialysis, your care team will be with you every step of the way. With our award-winning training, you will learn at your own pace all of the aspects of performing home dialysis.  Once you begin home dialysis, a team of skilled healthcare professionals are available to answer your questions 24/7 so you’re never alone.