Home Hemodialysis (HHD) & Peritoneal Dialysis (PD)
Home Hemodialysis (HHD)*
Treatment in the comfort of your home during the day or overnight.
Hemodialysis involves accessing your blood through an access site. Most access sites are located in the lower arm but can also be located in the upper chest or leg. The dialysis procedure involves cleaning your blood through a special filter on a dialysis machine.
HHD follows a similar treatment procedure as in-center hemodialysis but is usually done in the comfort of your home, and more frequently, 5 or 6 days a week. More frequent hemodialysis may lead to improved health and quality of life outcomes compared to traditional 3 times per week in-center therapy. HHD can be performed during the day with or without a care partner or overnight while you and your care partner sleep (nocturnal home hemodialysis). A care partner is not a medical professional and can be a friend, spouse, colleague, or family member.
When treating at home, patients are not constrained by the schedule of a dialysis center, and physicians have more flexibility to tailor dialysis prescriptions to patients' individual clinical and quality of life needs. Most patients who do hemodialysis at home perform their treatment more frequently than in-center patients.
References
- *Daugirdas, John T.; Blake, Peter G.; and Ing, Todd S., "Handbook of Dialysis (5th ed.)" (2015).
Peritoneal Dialysis (PD)*
Treatment you can do almost anywhere.
PD uses a membrane inside your abdomen as a filter to remove toxins and extra fluid from your blood. Typically, PD patients can perform therapy on their own-at home or almost anywhere. PD treatments are done daily, so waste and toxins in your blood don’t have a chance to build up as much between treatments. PD may lead to enhanced health and quality of life outcomes vs 3 times weekly ICHD.
There are two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD).
Continuous Ambulatory Peritoneal Dialysis (CAPD): This type uses a disposable double bag system. The patient performs manual exchanges which take around 20-30 minutes to complete, and are usually done 3-5 times per day. After a CAPD exchange is started, most people read, watch TV, or use their computer for 20-25 minutes during drain and fill. Between exchanges, normal activities can resume while the fluid dwells.
Automated Peritoneal Dialysis (APD): APD includes several modality types. Typically, the patient sets up the cycler at bedtime and the machine performs the exchanges while they are sleeping. In the morning, the cycler can leave the patient dry or do a Last Fill that allows the patient to also dwell during the day. Once disconnected, normal activities are resumed.
References
- *Daugirdas, John T.; Blake, Peter G.; and Ing, Todd S., "Handbook of Dialysis (5th ed.)" (2015).
Live Healthier and Better
20% Fewer low blood pressure episodes1
58% - 5-6 times per week (more frequent HHD)4
Kidney Transplant List
5% Reduction in mortality for each hour that recovery time is reduced12
15%-17% Reduction in sleep problems13
HD - 68.6%
Talk to a Patient Consultant
The reported benefits of peritoneal dialysis may not be experienced by all patients.
Peritoneal dialysis does involve some risks that may be related to the patient, center, or equipment. These include, but are not limited to, infectious complications. Examples of infectious complications include peritonitis and exit-site and tunnel infections. Non-infectious complications include catheter complication such as migration and obstruction, peritoneal leaks, constipation, hemoperitoneum, hydrothorax, increased intraperitoneal volume, and respiratory and gastric issues. It is important for healthcare providers to monitor patient prescriptions and achievement of adequate fluid management goals.
Patients should consult their doctor to understand the risks and responsibilities of performing peritoneal dialysis.
Despite the health benefits that more frequent home hemodialysis may provide to those with chronic kidney disease, this form of therapy is not for everyone. Home hemodialysis with the NxStage System One requires a patient and partner who are committed to being trained on and following the guidelines for proper system operation.
The reported benefits of home hemodialysis may not be experienced by all patients.
The NxStage System One is a prescription device and, like all medical devices, involves some risks. The risks associated with hemodialysis treatments in any environment include, but are not limited to, high blood pressure, fluid overload, low blood pressure, heart-related issues, and vascular access complications. The medical devices used in hemodialysis therapies may add additional risks including air entering the bloodstream, and blood loss due to clotting or accidental disconnection of the blood tubing set. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks. Patients should consult with their doctor to understand the risks and responsibilities of home and/or more frequent hemodialysis using the NxStage System One.
Certain risks are unique to the home. Treatments at home are done without the presence of medical personnel and on-site technical support. Patients and their partners must be trained on what to do and how to get medical or technical help if needed.
Certain risks associated with hemodialysis treatment are increased when performing nocturnal therapy due to the length of treatment time and because therapy is performed while the patient and care partner are sleeping. These risks include, but are not limited to, blood access disconnects and blood loss during sleep, blood clotting due to slower blood flow or increased treatment time or both, and delayed response to alarms when waking from sleep. Patients should consult with their physician to understand the risks and responsibilities associated with home nocturnal hemodialysis using the NxStage System One.
These patients have given NxStage permission to share the experiences they have enjoyed with more frequent home therapy using the NxStage System One. Please note that another patient will not necessarily experience the same results reported by these patients. Also, training and treatment requirements reported by these patients are determined by their clinics. Your experiences and clinic requirements may differ.
References
- The FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24):2287-2300.
- Rocco MV, Lockridge RS, Beck GJ, et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int.
- U.S. Renal Data System, USRDS 2015 Annual Data Report: Table 6.3.
- U.S. Renal Data System, USRDS 2015 Annual Data Report: Table 6.3. and matched NxStage patient data on file.
- Bakris, G.L., Burkart, J.M., Weinhandl, E.D., McCullough, P.A., and Kraus, M.A. Intensive hemodialysis, blood pressure, and antihypertensive medication use. Am J Kidney Dis. 2016; 68: S15–S23.
- Finkelstein FO, Schiller B, Daoui R, et al. At-home short daily hemodialysis improves the long-term health-related quality of life. Kidney Int. 2012;82(5): 561-569.
- Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. JASN. 2012;23(5):895-904.
- Lerma EV, Weir MR. Henrich's Principles and Practice of Dialysis. Chapter 8: Long and Daily Hemodialysis, 2017. Print.
- Purnell TS, Auguste P, Crews DC, et al. Comparison of Life Participation Activities Among Adults Treated by Hemodialysis, Peritoneal Dialysis, and Kidney Transplantation: A Systematic Review. Am J Kidney Dis. 2013;62(5):953-973.
- Walker RC, Howard K, Morton RL. Home hemodialysis: a comprehensive review of patient-centered and economic considerations. Clinicoecon Outcomes Res. 2017;9:149-161.
- Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and post-dialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010;56(3):531-539.
- Rayner HC, Zepel L, Fuller DS, et al. Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2014;64(1):86-94.
- Jaber, B.L., Schiller, B., Burkart, J.M. et al, Impact of short daily hemodialysis on restless legs symptoms and sleep disturbances. Clin J Am Soc Nephrol. 2011;(6):1049–1056.
