Peritoneal Dialysis/Home Dialysis
01. What is dialysis?
Dialysis is a way of cleaning your blood when your kidneys can no longer do the job. It gets rid of your body’s wastes, extra salt and water, and helps to control your blood pressure.
02. Are there different types of dialysis?
There are two kinds of dialysis. In hemodialysis, blood is pumped out of your body to an artificial kidney machine and returned to your body by tubes that connect you to the machine. In peritoneal dialysis, the inside lining of your own belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of your belly in cycles.
03. How does peritoneal dialysis work?
A soft plastic tube (catheter) is placed in your belly by surgery. A sterile cleansing fluid is put into your belly through this catheter. After the filtering process is finished, the fluid leaves your body through the catheter.
There are two kinds of peritoneal dialysis:
1-Continuous Ambulatory Peritoneal Dialysis (CAPD)
2-Automated Peritoneal Dialysis (APD)
The basic treatment is the same for each. However, the number of treatments and the way the treatments are done make each method different.
CAPD is “continuous,” machine-free and done while you go about your normal activities such as work or school. You do the treatment by placing about two quarts of cleansing fluid into your belly and later draining it. This is done by hooking up a plastic bag of cleansing fluid to the tube in your belly. Raising the plastic bag to shoulder level causes gravity to pull the fluid into your belly. When empty, the plastic bag is removed and thrown away.
When an exchange (putting in and taking out the fluid) is finished, the fluid (which now has wastes removed from your blood) is drained from your belly and thrown away. This process usually is done three, four or five times in a 24-hour period while you are awake during normal activities. Each exchange takes about 30 to 40 minutes. Some patients like to do their exchanges at mealtimes and at bedtime.
APD differs from CAPD in that a machine (cycler) delivers and then drains the cleansing fluid for you. The treatment usually is done at night while you sleep.
04. What kind of peritoneal dialysis is best?
The type of peritoneal dialysis that is best for you depends on your personal choice and your medical condition. Your doctor will help you to choose the one that is best for you.
05. What are the pros and cons about being on peritoneal dialysis?
Some doctors feel that CAPD and APD have several benefits when compared to hemodialysis. With continuous dialysis, you can control extra fluid more easily, and this may reduce stress on the heart and blood vessels. You are able to eat more and use fewer medications. You can do more of your daily activities and it is easier to work or travel.
However, there are some people for whom peritoneal dialysis may not be appropriate. The abdomen or belly of some people, particularly those who are morbidly obese or those with multiple prior abdominal surgeries, may make peritoneal dialysis treatments difficult or impossible. Peritonitis (infection of abdomen) is an occasional complication although should be infrequent with appropriate precautions.
When making a decision about the type of treatment, you should take into consideration that peritoneal dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body. Peritoneal dialysis is an effective form of dialysis, has been proven to be as good as hemodialysis.
06. How are treatments paid for?
All types of dialysis are expensive, but, for most patients, the federal government now pays 80 percent of all dialysis charges, while private insurance or state medical assistance pays the rest.
Home Dialysis
When you are told you have kidney failure and need treatment to stay alive, it can be a difficult time in your life. If your kidney diagnosis is new, you may feel overwhelmed, confused and angry. But there are some important things you can do to help yourself. Learn all you can about your different treatment options and take an active role in decisions about your care.
01. How hemodialysis works?
Hemodialysis is a treatment that replaces the work of your own kidneys to clear wastes and extra fluid from your blood. This is done using a special filter called a dialyzer or artificial kidney. Your blood travels through plastic tubing to the dialyzer, where it is cleaned and then returned to you. At the beginning of each treatment, two needles are placed into your access. These needles are connected to the plastic tubing that carries your blood to the dialyzer. Only a small amount of blood is out of your body at any one time. The dialysis machine pumps your blood through the dialysis system and controls the treatment time, temperature, fluid removal and pressure.
This basic process is the same for home hemodialysis, except that you and a care partner are trained to do your treatment at home.
02. Hemodialysis: At home or in-center
Hemodialysis is a treatment that replaces the work of your own kidneys to clear wastes and extra fluid from your blood. This is done using a special filter called a dialyzer or artificial kidney. Your blood travels through plastic tubing to the dialyzer, where it is cleaned and then returned to you. At the beginning of each treatment, two needles are placed into your access. These needles are connected to the plastic tubing that carries your blood to the dialyzer. Only a small amount of blood is out of your body at any one time. The dialysis machine pumps your blood through the dialysis system and controls the treatment time, temperature, fluid removal and pressure.
This basic process is the same for home hemodialysis, except that you and a care partner are trained to do your treatment at home.
03. Different types of home hemodialysis
Three types of hemodialysis can be performed at home. They are:
- Conventional home hemodialysis: You do this three times a week for three to four hours or longer each time. You and your care partner are trained to do dialysis safely and to handle any problems that may come up. Training may take from several weeks to a few months.
- Short daily home hemodialysis: This is usually done five to seven times a week using new machines designed for short daily home treatment. Treatments usually last about two hours each. You and your care partner are trained over several weeks. Because you are doing dialysis more often, less fluid generally needs to be removed each time. This reduces symptoms like headaches, nausea, cramping and feeling “washed out” after treatment.
- Nocturnal home hemodialysis: Long, slow treatments done at night while you sleep. You may do this kind of dialysis six nights a week or every other night. This depends on what your doctor prescribes for you. Treatments usually last about six to eight hours. You and your care partner are trained over several weeks. Some centers monitor your treatments by sending information from your dialysis machine to a staffed location by telephone modem or the Internet. More hours of dialysis each week can result in more waste removal.
It is also possible to combine daily and nocturnal home hemodialysis. Whether you can combine treatments depends on your needs, your medical condition and your machine.
Whatever treatment option you choose, it is important to know if you are getting the right amount of dialysis. Tests should be done regularly to check the amount of dialysis you receive. For more information, speak with your doctor and your dialysis care team.
04. Added benefits of short daily and nocturnal home hemodialysis
Many reports indicate that people using short daily and nocturnal home hemodialysis:
- Take less medication to control blood pressure and anemia
- Take less medication to keep phosphorus under control to help prevent bone disease
- Have improvements in neuropathy (nerve damage) and less restless leg syndrome
- Feel better during dialysis and less “washed out” after
- Have more energy for daily tasks
- Sleep better
- Have fewer and shorter hospital stays
- Have better quality of life
- Live longer.
05. New technology
New, easy-to-use machines are being developed for home hemodialysis. These are easier to set up, clean and disinfect. With some newer machines you have fewer supplies to store. If you think home hemodialysis is a good choice for you, ask your doctor about the best equipment for you.
06. Deciding if home hemodialysis is right for you
Home hemodialysis is not a good fit for everyone. You need to learn a lot about it. You need to be willing to be responsible for your own treatment. As long as you and/or your care partner can pass the training and learn to place your needles, you should be able to do home hemodialysis.
07. Finding a center that offers home hemodialysis
Finding a center that offers home hemodialysis can be a challenge. If your center does not offer home hemodialysis, see below for Web sites that can help you find centers that offer home hemodialysis. Visit the center. Talk with the home training nurse and other staff. If possible, talk with home patients.
Two things are needed for success:
1- A center and doctor willing to train you and follow your care
2- Your commitment to learn and do home hemodialysis for at least a year.
08. Your care partner
Most home hemodialysis programs ask you to have a care partner who is willing to be with you to help during each treatment. Your care partner can be a family member or friend. This person goes through the training with you so he or she can learn what to do. Sometimes, patients hire a nurse or technician to be their care partner. Medicare does not pay for these helpers, however.
Insurance coverage for home hemodialysis
The social worker at your dialysis center should give you information about coverage for home hemodialysis. Medicare pays for part of the cost and training. If you are 65 or older or disabled, you should already have Medicare. You can also get Medicare at any age if you have kidney failure and you or your spouse or parent worked long enough to qualify for Social Security. There are other sources that help pay for dialysis. Check with your social worker. He or she can also discuss any plumbing or wiring changes or additional costs that may occur with home hemodialysis.
If you have an employer group health plan, it will be the primary coverage for the first 30 months of your treatment with Medicare as your secondary insurer. After those first 30 months, Medicare will become your primary insurance.
Online information
Dialysis Facility Compare—Find information about dialysis centers that offer home hemodialysis training programs. www.medicare.gov
Home Dialysis Central—Learn about home dialysis options, talk to other patients, find out if a dialysis center near you offers a home hemodialysis program. www.homedialysis.org
