By Christopher Blagg, MD

From the earliest days of the Medicare ESRD Program, the regulations have required that patients be made aware of all the treatment options available to them, including home hemodialysis and transplantation.  Unfortunately, today the best dialysis treatment – home hemodialysis – is only available through a few units in the United States.

Why is home hemodialysis the best treatment for patients who can do it?  Because it provides the best survival, the best quality of life and the greatest opportunity for rehabilitation of any form of dialysis.  This is not just because healthier patients are pre selected for home hemodialysis – even when this is factored into the equation, it is still the best. 

Who can use home hemodialysis?  Anyone with a suitable home, who is medically stable on dialysis, has the will to be independent and take responsibility for his own treatment and well being and has a willing family member or other person to assist them.  Note that the assistant should be a helper – not a dialysis technician.  Remember, independence is what is needed, not dependence.

Why is home hemodialysis better than peritoneal dialysis? Because most patients on CAPD or CCPD will have to change to hemodialysis after several years.  In comparison, there are patients who have been on home hemodialysis for more than 20 years.

What are some other advantages of home hemodialysis?  Rehabilitation, whether back to work or back to many of the things you enjoyed before you became sick, is important.  In our Northwest Kidney Centers’ home hemodialysis program, three quarters of the patients aged between 18 and 55 are working or going to school full or part time.  Many of the older home hemodialysis patients are active in the community and with their family and friends.  You will have more time with your family.  You won’t have to come to a unit three times weekly and mix with other sick people.  You won’t have to worry about transportation for treatment.  You will become independent and confident in your own abilities to care for yourself.

Is it safe?  With appropriate training and effective support services it is as safe, if not safer, than dialysis in a center.  Remember, the patient is in control, not some technician.

Is home hemodialysis for everybody?  No, but at a recent meeting several experienced nephrologists felt that some 20 percent of patients could be trained to do home hemodialysis if training programs and support services were made available.

What about the future?  Every study of patients dialyzing five or more times a week (“daily dialysis”) has indicated an improvement in well being.  After all, the normal kidney works seven days a week, and if you dialyze every day or almost every day, this is much more like the normal kidney – fewer ups and downs.

What are the advantages of more frequent or daily dialysis?  More energy and strength, better mental clarity, better rehabilitation, better sexual function, better sleep, better toleration of dialysis, better blood pressure control with fewer drugs, less anemia, fewer fluid problems and better appetite and nutrition.  At the same time there is less thirst, itching, tiredness and depression, and fewer dietary restrictions, fewer hospitalizations, and fewer drugs are needed.

What does all this mean?  If we are really going to improve dialysis and all aspects of the life of ESRD patients, the only way will be more frequent dialysis.  This can be short – one to two and a half hours – or long – six to eight hours at night while sleeping.  Several hundred patients in the U.S. are already doing this.  Almost all of them say they hope never to go back to the three-times-a-week schedule because they now feel so much better.  And, if you are going to dialyze more often, the obvious place to do this is at home.  New equipment is being developed to make home hemodialysis easier to use and understand.

How can I learn more about home hemodialysis?  There is nothing like first-hand experience. Talk to someone on home hemodialysis about the advantages and disadvantages of dialyzing at home. The AAKP Annual Convention provides kidney patients a unique opportunity to share their experiences with fellow kidney patients from all over the country.

Why don’t you ask your doctor about home hemodialysis?  This should be available to you now.  More frequent dialysis will require changes in Medicare reimbursement to pay for more than three treatments weekly but if you are lucky enough to be able to do this, you can then add your voice to those of us pressing the government to change the rules to allow the best possible treatment for more patients.

Dr. Blagg is the Executive Director Emeritus of the Northwest Kidney Centers and Emeritus Professor of Medicine at the University of Washington. He also serves as a member of AAKP's Medical Advisory Board.

This article originally appeared in aakpRENALIFE, Vol. 15, No. 5, May 2000.

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