NUTRITION

4.0 Basics of Home Haemodialysis

Introduction

This is an overview of Home Haemodialysis (HHD). It will give you an idea of some of the basics. There is more detail in the other chapters.

4.1 Am I suitable?

If you (or partner) can do everything on this list you should consider Home Haemodialysis

• Able to learn a new skill.
• Can handle simple equipment so that you can set up the machine.
• Have reasonable sight.
• Willing to have the equipment at home.
• Can move around reasonably¹.

Age is not a barrier to Home Haemodialysis². Also, many people have a partner (carer) to help but it is not always essential.

4.1.1 What are the benefits?

There are many benefits³ including:

• You have independence and control over your dialysis and health^4,5,6,7.
• It reduces the time and cost of traveling to a dialysis center.
• You can choose when you dialyse.
• There are less diet restrictions if you do more hours.
• On average you live longer and healthier and sleep better, especially if you do more hours.
• Your blood pressure should be better controlled reducing the need for medications^8,9.
• It is easier to work, study or manage your usual family life^4,5,6.
• The needles are always put in by you which is often better for the fistula.
• You spend less time away from your family.

Even if you are on a different type of dialysis you can transfer to Home Haemodialysis.

4.1.2 What are the disadvantages?

There are always disadvantages to every treatment choice;

• You have to spend time preparing the dialysis machine.
• You will have medical equipment at home.
• You will not have nurses and doctors around every time you dialyse.

4.1.3 How much dialysis will I need?

There are a range of different options for Home Haemodialysis such as undertaking short sessions of dialysis (about 3 hours) most days or long sessions overnight for up to 5 nights a week. Most people do at least 20 hours split into separate sessions and many do more. Discuss your options with your doctor or dialysis nurse.

4.2 The NxStage Dosing Calculator

(https://dosingcalculator.nxstage.com) is an online software tool, designed to assist in prescribing haemodialysis therapy with the NxStage System One. This calculator can be used to work out a range of appropriate treatment frequencies, treatment durations, and therapy fluid volumes, according to your special needs. This prescription can be planned in partnership with your doctor or nurse^10,11.

4.3 What type of Vascular access do I need?

All types of vascular access can be used for Home Haemodialysis^12,13.

• Arteriovenous Fistula (AVF).
• Arteriovenous Graft (AVG).
• Central Venous Catheter (CVC).

More detail is available in the vascular access section.

4.3.1 What room and equipment do I need?

Many patients will dialyse in an existing room such as the bedroom or the lounge, depending on what time of day you intend to dialyse.

• Minor changes to power, water or drainage are often sufficient. It is strongly recommended that a technician or nurse visits your home to check your planned room is suitable for dialysis.
• If you wish to develop a new space for dialysis or adapt an existing space it can be helpful to make a drawing and share it with the nurses or technicians.
• If there are any structural changes (for plumbing, power or storage space) it is important that the owner of the building is notified and agrees to the changes.
• Costs will often be your responsibility.

The basic requirements include:

• Electricity: The dialysis machine should have 240V / 10A fuse and an RCD. Installation should be carried out by an electrician. Regulations vary by country.
• Tap water: The water should be drinking water quality. Water pressure should be adequate.
• Light: The room needs good background light. Two 75W bulbs at the ceiling and a lamp with an adjustable arm are ideal. It’s possible to purchase an LED LAMP with a magnifying screen.
• Dialysis chair: A comfortable armchair, which can lean back, with a footrest is preferred. However every type of bed may also be used.
• Table for Connection/Disconnection: A small table on wheels is useful during the connection and the disconnection process.
• Storage of disposables: Two wardrobes with wire baskets are ideal for storage of concentrates, needles, tubings, dialysis filters, and other disposables that are used during the dialysis treatment. Some people just stack the boxes in a dry area.
• Phone: You need a phone close by for emergency calls.
• Floor coverings: Avoid regular carpet as there may be some leaking water or saline around the machine.
• Waste: A waste bin will be needed after dialysis.

4.4 Will I be supported at home?

Home visits

The nurses will visit you regularly at first and decrease these visits once you are happy and in control. They will always be at the end of the phone and usually have emergency on-call 24 hours a day. You will also see the doctors for regular check-ups and blood tests¹⁴.

4.4.1 How do I manage the supplies and waste?

Dialysis supplies will be delivered to your home by either the company that provides the equipment or a common carrier may be used. Supplies will be brought to the door or into the home. The frequency of supply depends of the home storage size, frequency of the treatments and the distance from the warehouse.

Waste disposal

Home Haemodialysis produces a large amount of waste products:

• Clean cardboard and plastics can be recycled/normal rubbish.
• The dialysis equipment is biohazardous waste, and requires appropriate storage and pick-up.
• All sharps waste should be collected in special containers.

Each country or council will have its own regulations regarding waste management. Your dialysis unit will know the local regulations and share these with you.

4.4.2 What steps will happen if I choose Home Haemodialysis?

• Education about Home Haemodialysis.
• You and your nurses or doctor decide it is the right treatment.
• Home inspection to see if your home suitable.
• Creation of vascular access (if not already done).
• Training (you may already be on Haemodialysis at a centre).
• Home installation and set up.
• Self-care once you (and your carer) are happy.
• Regular follow-up and contact with your health care team.

References

1. Blagg CR. It’s time to look at home hemodialysis in a new light. Hemodialysis Horizons 2006; 22-28.
2. Pipkin M. Eggers PM. Larive B et al. Recruitment and Training for Home Hemodialysis: Experience and Lessons from the Nocturnal Dialysis Trial Clin J Am SocNephrol 2010;5(9): 1614–1620.
3. Wang P, Mony S, Harwood L et al. Patient experiences and preferences on short daily and nocturnal home hemodialysis. Hemodialysis Intern 2013; 17:201–207.
4. Helantera I. Haapio M. Koskinen P et al. Employment of patients receiving maintenance dialysis and after kidney transplant: a cross-sectional study from Finland..AmJKidneyDis.2012;59:700–706.
5. Nadeau-Fredette AC. Hawley C. Pascoe E et al. Predictors of Transfer to Home Hemodialysis after Peritoneal Dialysis Completion. Perit Dial Int. 2016 ;36(5):9-10.
6. McLaughlin K. Jones H. VanderStraetenC,et al. Why do patients choose self-care dialysis? Nephrol Dial Transplant 2008; 23, 3972–3976.
7. Marshall MR, Hawley CM, Kerr PG et al.Home hemodialysis and mortality risk in Australian and New Zealand populations. Am J Kidney Dis 2011; 58,782–793.
8. Hawley CM,Jeffries J, Nearhos J, Van Eps C. Complications of Home Hemodialysis. Hemodialysis international. International Symposium on Home Hemodialysis. 2008; 12 Suppl 1:S21-5
9. Karkar A, Hegbrant J, Strippoli GF. Benefits and implementation of home hemodialysis: A narrative review. Saudi J Kidney Dis Transpl. 2015;26(6):1095-107.
10. https://dosingcalculator.nxstage.com (accessed January 10, 2017).
11. NxStage Therapy Handbook. NxStage Hemodialysis Treatment. 2015 NxStage Medical, Inc.
12. Piccoli GB. Bermond F. Mezza E, et al. Vascular access survival and morbidity on daily dialysis: a comparative analysis of home and limited care haemodialysis. Nephrol Dial Transplant2004;19:2084-2094.
13. Borman N, Nair S, Goffin E. More Frequent Haemodialysis Improved Outcomes. The Wish Comes true at Home. European Medical Journal 2017; 5(1):36-42
14. Young BA. Chan C. Blagg C. et all. How to Overcome Barriers and Establish a Successful Home HD Program. Clin J Am SocNephrol , 2012;(7): 2023–2032.