UNDERSTANDINGUnderstanding YOUR HOMEYour Hemodialysis OPTIONSAccess Options

UNDERSTANDING YOUR HOME HEMODIALYSIS OPTIONS

HOW DO THE KIDNEYS FUNCTION? Most people are born with two kidneys. The kidneys are bean- shaped and about the size of a fist. They are located just below the level of the rib cage deep in the middle of your back. Properly functioning kidneys work 24-hours per day seven days per week. The kidneys are cleaning machines filtering your blood, removing wastes and extra water to make urine. They also help control and make hormones your body needs to stay healthy. When the kidneys are damaged, wastes can build up in the body. for , and the terms are used interchangeably. Individuals (CKD) is who suffer from complete renal described as the gradual loss of failure need or a kidney kidney function over time. When transplant to survive. the kidneys are damaged, they cannot filter blood as they should. This can cause waste to build up in your body which can lead to WHAT IS HEMODIALYSIS? other health problems. Diabetes Hemodialysis is a medical and high blood pressure are the procedure designed to remove most common causes of CKD. wastes, toxins and fluids from blood when the kidneys have failed. It is the most common WHAT HAPPENS DURING treatment for . KIDNEY FAILURE? Doctors may recommend hemodialysis if your kidneys have End-stage renal disease (ESRD) failed and can no longer perform or kidney failure is a condition the function of removing waste where the kidneys stop working and extra water from the blood to completely. Renal is another term form urine.

American Association of Kidney Patients: Understanding Your Home Hemodialysis Options 3 what time of day he will dialyze while in-center dialysis center WHAT IS HOME patients have a set schedule. HEMODIALYSIS? Home hemodialysis, as opposed HOME DIALYSIS to in-center hemodialysis, is a growing trend. Home TRAINING hemodialysis allows patients A patient will go through several to dialysize at home instead weeks of training with a nurse of going to a dialysis center. or dialysis technician before Home hemodialysis can be beginning a home hemodialysis done as either frequent home therapy. A patient selecting home hemodialysis, nocturnal hemodialysis is taking on a lot of hemodialysis or conventional responsibility. Home hemodialysis home hemodialysis. Most patients patients must make sure they who elect home hemodialysis have the equipment and supplies cite many benefits, including needed for each treatment. The the flexibility to have more patient will be in charge of setting control over when they get their up and preparing the dialysis treatments, being able to spend machine for treatment, cleaning more time with their family the machine and disposing and the ability to continue to the supplies used during the work. Home hemodialysis allows treatment. A patient who chooses patients to learn more about their home hemodialysis will still disease and how it is treated. have access to a professionally These patients tend to have trained staff at a dialysis center. more control and say in their The patient will visit the dialysis health care and this freedom center periodically and will empowers them to maintain their continue to see a doctor once a independence and may improve month. Most companies provide a their quality of life. 24-hour help line the patient can A patient may elect to dialyze call if there is a problem with the more frequently for longer dialysis machine. periods of time at home. The more frequent or longer the dialysis, the better the patient may feel. Home There are three home hemodialysis also affords the hemodialysis options: patient the opportunity to choose

American Association of Kidney Patients: Understanding Your Home Hemodialysis Options 4 FREQUENT HOME in the same manner as if he were always on a conventional HEMODIALYSIS hemodialysis schedule. When the Frequent home hemodialysis patient returns home from his (FHHD) is very similar to trip, he can return to his short conventional home dialysis. daily dialysis schedule. (The Instead of dialyzing three days a NxStage home dialysis machine is week, the patient dialyzes five to small and compacted enough to be six days a week for at least two checked on an airplane as luggage and half to three hours a session. which will eliminate the need for Frequent treatments more a patient to switch to in-center closely resemble normal kidney hemodialysis while traveling.) function than three times- a-week Because the patient is doing treatments. It also means fewer dialysis more often, less fluid dietary and fluid restrictions generally needs to be removed as well as fewer medications. A each time. This reduces symptoms patient and partner will train for like headaches, nausea, cramping several weeks with a nurse or a and feeling “washed out” after trained dialysis technician before treatment. The patient will also beginning home treatments. A continue to see their doctor on a FHHD patient and their care regular basis for check-ups. partner will learn to: • Setup the dialysis machine • Place needles in access NOCTURNAL • Determine how much fluid to HEMODIALYSIS get rid of Nocturnal hemodialysis is done • Order supplies overnight at home while the • Take blood pressure patient is sleeping. If nocturnal • Recognize potential problems hemodialysis is done more than three times a week or on alternative nights (four to seven TRAVELING nights a week) it is called nightly hemodialysis. Most patients When traveling, the patient may dialyze anywhere between six to have to temporarily switch to ten hours a night, receiving much conventional hemodialysis three more dialysis time. The more times a week in a dialysis center. dialysis, the better. This allows the patient to travel

American Association of Kidney Patients: Understanding Your Home Hemodialysis Options 5 Nocturnal hemodialysis is twice disconnecting the dialysis tubing as long and twice as frequent as from the access. This can be a conventional hemodialysis. It does problem if it is not dealt with right a better job of cleaning the blood away (This happens at dialysis of wastes, salt and water. It is the units too). Machine alarms as well closest method to normal kidney as proper taping of the needle, function. and the use of the ‘enuresis Many patients prefer nocturnal alarm’ make the method safe. dialysis because it keeps them The enuresis alarm is a moisture out of the dialysis center and it sensor that is taped on top of the leaves room to do other activities dialysis needle and alarms if there during the day, including work. is even a small blood leak. It is advised, patients who elect nocturnal hemodialysis have a family member or paid trained CONVENTIONAL HOME worker to help put needles in or if HEMODIALYSIS an emergency occurs. Patients are going to sleep through the dialysis. Conventional home hemodialysis Training can be completed in is similar to hemodialysis done as little as three weeks and will at a dialysis center. Instead of primarily be aimed at the patient. traveling to a center, the patient is able to stay home. Home Many of the symptoms caused hemodialysis is usually done by the lack of kidney function three times a week for three to such as nausea, vomiting, four hours each time, although shortness of breath, itchiness, the prescription can vary from dry skin, tiredness, lack of patient to patient. This is the energy disappear. Appetite and least common form of HHD, since ability to taste improve. Sexual it does not take advantage of the drive and function may also ability to provide more frequent improve. Symptoms related to or longer treatments. hemodialysis itself also improve dramatically. Muscle cramps, low blood pressure during dialysis WHAT ARE THE RISKS TO and exhaustion after dialysis often disappear. Patients often do not HOME HEMODIALYSIS? have to rest or go to sleep after Home hemodialysis is not for dialysis to recover. everyone. There are some risks There are risks associated with to the therapy. The most serious nocturnal dialysis including risk is the possibility of an air

6 American Association of Kidney Patients: Understanding Your Home Hemodialysis Options HOME HEMODIALYSIS PROS CHALLENGES

• More energy after • Patients may need a treatment partner to be there for • Better control blood each treatment pressure • Treatment may cause • Less stress on the stress on your family • Fewer diet and fluid • Training can take a few restrictions weeks which may mean taking time off of work • Better mental and physical health • You will need to learn to put in the dialysis needles • You don’t have to drive to and from the clinic • You need space to store the machine and supplies • Better quality of life embolism. An air embolism is a who are successful doing home condition in which air gets into hemodialysis usually are highly the blood stream accidentally, motivated who wants to maintain preventing the heart from the lifestyle they had before pumping enough blood. There renal failure. The patient and is also the risk of blood loss if a their doctor will decide together catheter separates. The patient if home hemodialysis is the and the care partner will be correct therapy option. Doctors trained to address these problem usually look to see if a patient if it happens. encompasses the following qualifications: • Willingness to train and learn WHO CAN DO HOME how to do the therapy at home • Manual dexterity and vision to HEMODIALYSIS? operate the equipment • Basic reading and writing skills Home hemodialysis will not work for everyone. People

American Association of Kidney Patients: Understanding Your Home Hemodialysis Options 7 • Desire to take greater private insurance plan or responsibility for their care . Medicaid, Veterans Health Benefits and state kidney programs also pay for dialysis. WHAT IS INVOLVED IN Medicare will pay for outpatient TRAINING? dialysis treatments, home dialysis equipment and supplies which The patient and care partner may include alcohol wipes, will train together with a home sterile drapes and rubber gloves. dialysis training nurse or social Medicare also pays for some home worker. The training is done until support services include visits by the patient and dialysis nurse feels trained dialysis staff support and he or she is ready to go home for certain drugs. self-treatment. Training takes At the present time, Medicare does between four to six weeks. During not pay for an aid to help with training, you will learn to: home dialysis, loss of pay during • Care for your access your home dialysis training • Take your blood pressure or transportation to a dialysis • Setup your dialysis machine facility. If you get your coverage and test the alarms through a Medicare Advantage • Insert your needles plan, call the plan and ask them • Monitor your treatments and what they cover. Most plans cover take notes what Medicare does not. • Order supplies • Recognize problems or potential problems and report them to your nurse or doctor • Safely dispose of medical wastes

HOW MUCH IS HOME HEMODIALYSIS AND WHO PAYS FOR IT? Dialysis services (in-center and home dialysis services) are paid for by an individual’s

8 American Association of Kidney Patients: Understanding Your Home Hemodialysis Options NOTES

American Association of Kidney Patients: Understanding Your Home Hemodialysis Options 9 GLOSSARY

Chronic Kidney Disease: A progressive condition, not requiring dialysis, in which the kidneys are not functioning effectively and may be unable to produce red blood cells, to control blood pressure or to rid the body of waste through urination. Dialysis: Process of cleaning wastes from the blood artificially. Dialyzer: A specially designed filter that acts as an . End-stage renal disease (ESRD): Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidney. Hemodialysis: A procedure that requires a machine to filter waste and fluid from your blood when your kidneys are no longer healthy enough to do the work on their own. Hemodialysis is the most common way to treat permanent kidney failure. Kidneys: Two organs in the lower back that clean waste and poisons from the blood. The kidneys are shaped like two large beans and they act as the body’s filter. They also control the level of some chemicals in the blood such as sodium, potassium and phosphate. Kidneys also control blood pressure and regulate red blood cell production. Nephrons: A tiny part of the kidney. Each kidney is made up of about one million nephrons, which are the working units of the kidneys, removing wastes and extra fluid from the blood. Urine: The liquid waste product filtered from the blood by the kidneys.

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