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Haemodialysis (HD) is a form of treatment for chronic kidney disease (CKD). It can be performed at home where it is known as ‘home HD’, in a hospital or a specialist dialysis unit.
What is HD?
When your kidneys don’t work properly, toxins and excess fluid buildup in your blood stream. HD works by taking blood from your body and ‘cleaning it’ in a dialysis machine to remove the toxins. Blood is taken out of your body and run through a filter. Toxins are removed from your blood into the dialysis fluid, which is then disposed of.
What is home HD?
Home HD is when your dialysis treatment takes place in your own home. You can carry out the dialysis yourself or with the support of a family member or friend who has been trained to help you.
Who can have home HD?
Most people receiving HD are suitable for home HD if your kidney function is currently stable. There is no age limit or any specific health requirements apart from being able to learn how to set up and use the machine – either by yourself or with the help of a family member or carer.
If you are interested in trying home HD, talk to your dialysis team who can arrange a home visit to see if it is a suitable option for you and your accommodation.
Do I have to have home HD?
No. It is entirely your choice. You can choose to have dialysis at home, in hospital or in a local satellite unit.
What equipment do I need for home HD?
Your hospital will provide and install the dialysis machine and all the equipment you need for home HD free of charge. There are different types of home HD machine and your dialysis team will assess which is the best one for you to have. It may be similar to the machines used in the hospital or it could be a smaller machine which is about the size of bedside table.
You will need a dedicated clean area to have your dialysis in, an electrical outlet, an easily accessed water source and a plumbing system for draining away waste water. You will also need space to store the supplies which includes the dialysis fluid, needles and cleaning products. These need to be kept in a dry area away from damp or direct heat. A member of your kidney team will visit your home to review the arrangements before you start home HD.
The supplies will be delivered directly to your house, usually on a monthly basis although a two week delivery schedule can be arranged if you have limited storage space. The delivery driver will move the supplies to your chosen storage area and stack them for you.
Is training available?
If you decide that you would like to try home HD, you will receive full training. Some people on home HD are supported by a partner or carer who will also receive full training if you decide that this works best for you.
You will be shown exactly what to do and how all of the equipment works. The initial training will take place at your dialysis unit or at a dedicated training centre. This usually takes around four weeks. A date will then be agreed for you to start home HD. You will not have to perform home HD by yourself until you and your kidney team are completely confident that you are ready.
Is there any financial help available?
Your hospital may be able to help with financial support towards the cost of the water and electricity that are needed for home HD. You may also be able to apply for a reduction in council tax and your partner or carer may be eligible for attendance allowance. Our Advocacy Team can advise on this.
Will I still need to go to hospital?
You will normally only need to go to hospital if your HD machine breaks down or if you or your carer are unable to perform your dialysis. You may also still need to go to the hospital for occasional blood tests and to see your kidney team.
What are the benefits of home HD?
Home HD may be the right choice for you if it suits your medical and physical condition. If you have dialysis at home, it gives you flexibility, including being able to have your treatment at a time that suits you. You may be able to change your dialysis schedule to suit your lifestyle rather than relying on set time slots and transport for hospital appointments.
You will be able to have your treatment in an environment which is familiar to you, and you can avoid frequent hospital visits. In consultation with your kidney team, you may choose to have more dialysis than you would receive in hospital and this can improve your blood tests, allowing you more freedom with your diet and possibly fluid intake as well.
Through learning how to manage your own treatment, you are likely to be more confident about haemodialysis, understanding how it works and what works for you. This can help you to manage your CKD more effectively and to make choices about your treatment that are right for you.
Are there any drawbacks with home HD?
Most people on home HD manage very well with support from their kidney unit. However there may be times when you need to temporarily stop home HD. This may be for practical reasons such as if you are decorating a room or moving house. It may also be for medical reasons where you might need more support during an illness. When this happens, you will receive dialysis back in hospital or in a specialist unit. This is perfectly normal and your home dialysis team will be happy to help support you.
It is important that you keep enough equipment supplies in stock (at least a week’s worth) in case of any emergency such as bad weather. You should tell your electricity, gas (heating) and water companies that you are on home HD so that they can treat you as a priority in case of any supply issues.
If you are used to receiving dialysis in hospital or in a specialist until you may find that you miss the companionship of other patients if you move to home HD. Remember that it is your choice and you will not be put under any pressure to start home HD if you do not feel that it is the right thing for you. You are free to move back to hospital care at any time if home HD doesn’t work for you.
Find out more
Talk to your dialysis team if you would like more information on home HD. They can guide you through the training and exact requirements based on your specific situation. They may also be able to put you in touch with a current home HD patient so you can discuss how it works for them.