I am considering assisting a relative begin home dialysis rather than at dialysis center where the she currently visits three times a week.
Would appreciate if one of the experts here could make some general comments on home dialysis and some specific comments:

1. Comparing it to Clinic based dialysis in terms of efficacy?

2. Is it safe? Has anyone heard of or experience problems with home dialysis?

3. My relative is fairly able, but does the patient ever initiate their own vascular access?

4. Does a technician/nurse have to be present during the dialysis.

5. What are the best machines for home dialysis?

Thank you in advance for your kind assistance.

My husband has been on 3x/wk home hemo for 21+ years. Most studeies show that home patients overall do better than center. Some attribute this to motivation and being responsible for one's own care, taking charge and not being dependent on anyone else. another theory is that home patients are less ill.

As to safety--Yes, it is safe.(Some people , however, do have a different opintion). The helper needs to follow procedures just as at a center. Home patients can get careless, just as center personnel could be careless. It's just a matter of staying "on top of" things. And NO, a tech or nurse is not present. However, there should be (as we have) access to your home training unit's "on call" nurse and tech. The worst that has happened to us is that we had to discontinue the treatment, get the machine
checked and do the treatment the next day.
He has never been hospitalized due to treatment caused infection, etc. At home, there is only one patient and less chance of cross contamination.

The machines vary depending on your home training program. We have an old Baxter 550, not the newest machine, but a really reliable "workhorse."

Before leaving a training program, patients are normally made to learn to insert their own needles. Some patients like this. In my husband's case, he rushes in from work (usually late) and just plops down and sticks out his arm. I have always put his needles in, but this is our choice.

Hope this gives you some info from people who have "Been there, done that!"

I was going to reply but read Dez post and I think the answers were right on. So I'll just say "ditto".

Hi:

I�m a bit confused. You say, Dez, your husband has been on 3xweekly home hemo for 21 years. Could you possibly mean home peritoneal? (Hal refers only to home dialysis). Home hemo is usually meant to be used six or even seven times a week, while sleeping. That is the reason for the huge improvement in quality in life.
You also say you use a Baxter machine. Is that a full-sized machine like the Fresenuius 2000H?
The home hemo program also does not "require" an assistant, although one doesn�t hurt. My wife often assisted me. The hospital, though, usually monitors the progress of the dialysis treatment via modem.
I have written a couple of articles at this site under the "Your Words" section. They might be worth the read for Hal and Dez.
One last question: May I ask, Dez, which hospital has been offering home hemo for more than 20 years?
These questions are meant for clarification only and not to dispute something I might not have heard of.
Best to both of you.
Mike

Mike,

I think Dez's post is accurate.

1. Home hemo is typically done 3x/week with the exception of the few SNHD programs which are 5-7x/week.

2. The Baxter 550 is a full-size hemo machine that is a little shorter than the Fresenius 2008H but also a little wider.

3. Our home hemo program requires a partner. I think to do hemo solo is only asking for trouble.

4. My company (Independent Dialysis Foundation) has been offering home hemo since 1979. I am sure there are more than just a few others because home hemo used to be very popular.

I hope this is helpful!
Chuck

Hi,
I'd be glad to clarify, although Chuck did a pretty good job of it already.
Yes, we are talking about home HEMOdialysis, NOT peritoneal. It is done exactly the same as in center with a full size machine. We run high blood flow rates for 4 1/2 hours just like a center. For this reason, a partner is almost always essential. There can be rapid fluid shifts, hypotension, etc. I only know of 1 or 2 people who do not use a partner.

The trend now, of course, is for 6 or 7 night hemodialysis done with slow blood flows over a longer period. The obvious advantages include more stable labs, etc., more closely simulating natural kidney function.

Our home training program is out of University of Iowa Hospitals and clinics. They have had a top notch home hemo training program for over 25 years and, unlike many centers I read about, actually encourage it for the right patients. I happen to be an R.N. also, but this did not exempt me from all the training. We live in the Quad Cities so also are fortunate to have a VERY high quality hospital based center with which my husband's local nephrologist is associated. If I want a break or need to be out of town, he can dialyze there.

I love to get on my soap box about the advantages to home dialysis, so feel free to ask any more questions.

Dez,

Just a couple of questions...

1. How many people are there in your home hemo program? Our numbers have dwindled to next nothing over the years. Which brings me to my next question....

2. Any suggestions on motivating people to do home hemo? Our decline is largely due to lack of interest.

Chuck

Those are a couple of difficult questions.

We only go up to Iowa City approximately every 3 months for checkups. I do talk to them occasionally. I do know that the numbers are less. However, the hospital maintains 2 or 3 staff 5 days per week and there seems to always be 2 or 3 people in training. I can get you some numbers if you'd like. The other thing that factors into the equation is that University of Iowa is a very large teaching hospital that services a wide area, so almost all home training is conducted there. (Luckily, we are only 45 minutes away.)

As to your second question, I do have a few thoughts. First and foremost, the docs at UI are pro home dialysis. Patients are given all options and the advantages of home hemo are strongly stressed. The main motivator I think they used when we made our decision is stressing that you control dialysis when doing home, it does not control you. Being able to still work full time and spend the additional time with family in the evenings was also discussed.

Over the years, we have also volunteered to talked with quite a few couples trying to decide what option to choose. We invite them to our home, let them see us functioning in the home setting. (maybe fixing dinner, kids running around, taking phone calls, watching TV, etc) It usually amazes them how normal everything is, except for the machine. I'm not sure how to motivate people except by stressing home as a real, viable option and having home training staff and docs with a positive attitude. In talking to prospective patients and partners, one stumbling block also seems to be "Can I handle this complex equipment? What if I do something wrong?" We've found that many people are simply intimidated by the machine and the procedure.

It sounds as if you are an employee of a place that offers home training. Is it in the midwest or elsewhere?

rapid fluid shifts.

Dez,

Thanks for your responce.

We are a not-for-profit company in Maryland and are affiliated with the University of Maryland Medical System. We operate 9 chronic facilities and 4 acute programs.

Chuck

Chuck,

As my fathers dialysis partner, I can tell you from my experience it wasn't that I needed to be motivated. I was just afraid and I mean afraid at a level 10.

I felt like I was on the end of a diving board and everyone was saying jump you can do it but I was "just to scared". Then I got a push and the rest is history.

If daily dialysis and slow nocturnal, become more available I think you'll see a turn back to home hemo. More patients will be willing to jump if they can get better results.

The program (FMC) that I've been looking into doesn't require a partner. Your "partner" is the computer monitoring system. However you can opt to have a partner. My husband cannot take off from work for the entire training course, btw may learn how to insert the needles (I have a fistula)in case I'm for any reason unable to do so. Hi Marty !!!ROFL

Hi Sandy:

Is yours a six-week training course? And what connection will you be using? Toronto uses a screw-on system and if you�d like more information, I�d suggest contacting Dr. Andreas Pierratos at apierratos@utoronto.ca

Best,
Mike

Hi, I am not on dialysis yet but am exploring what is out there for options. I don't know if NOCTURNAL dialysis is available where I live, I have never heard of it. But I am very interested. How available is it and what is needed. I live in a small town about 45mins. from a major centre.I would be scared of problems I couldn't handle. I was on dialysis in 1989 for 3 mths. I had so many scary moments on it. I crashed a few times... is that a possiblitity also with home dialysis... what would you do?

Hi Susan:
I was hom nocturnal home hemo for some time and wrote a couple of articles under the "Your Words" section at this site. You might want to take a look.
mw