Home Dialysis
The patient takes the control on his own dialysis
Home Dialysis
More flexibility and freedom for patients. Treatment is performed at home according to the patient’s schedule; it can be done during the evening, the night or whenever it is the most convenient.
The most common types of Home Dialysis are
PD
Peritoneal Dialysis
HD
HemoDialysis
Peritoneal Dialysis
Peritoneal dialysis allows replacing the kidney function when it is not able to do the job adequately. The target is to remove waste products (toxins) from the patient’s body thanks to his own membrane, the peritoneum, which allows transfer of solutes and water to the peritoneal cavity from where it is extracted to a drain bag.
PD
Peritoneal Dialysis
in case of
- Chronic renal failure
In case of chronic renal failure, the peritoneal dialysis (PD) uses the patient's peritoneum as a membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged beetween the blood and a fluid named dialysate which is injected in the abdomen.
This therapy is usually performed daily with 4 to 5 exchanges either manually during the day (CAPD) or nightly with a machine (APD) for automatically refreshing the fluid.
Technically speaking
A fluid named dialysate is introduced through a permanent tube, the catheter, in the abdomen and flushed out after a dwell time of 1-3 hours which is the time necessary to transfer the waste products from the blood to the dialysate. It is done either every night while the patient sleeps (automatic peritoneal dialysis: APD) or via regular exchanges throughout the day (continuous ambulatory peritoneal dialysis: CAPD).
Home Hemodialysis
As peritoneal dialysis, hemodialysis can be performed at home. It is used in case of chronic kidney failure (CKD). Compared to in-center dialysis, home hemodialysis gives more freedom to the patient who can continue to work and keep an active lifestyle. Home hemodialysis is performed thanks to a machine that the patient manages with a schedule according to his availabilities.
HD
HemoDialysis
in case of
- Chronic renal failure
There are three main types of hemodialysis :
- Conventional hemodialysis : is usually done three times per week, for 3–4 hours per each treatment.
- Daily hemodialysis : is usually done for 2-2.5 hours six days per week
- Nocturnal hemodialysis : The procedure of nocturnal hemodialysis is similar to conventional hemodialysis excepted that it is performed three to six nights per week and between six and ten hours per treatment while the patient sleeps.
This therapy is usually performed at least 3 times per week and up to 7 times during 2-8 hours according to the protocol which can be agreed upon between the doctor and the patient.
Technically speaking
The principle of hemodialysis involves diffusion of solutes across a semipermeable membrane, as in peritoneal dialysis, but in this case an artificial dialyzer (filter) is used instead of the patient's peritoneum and the connection is made through a patient’s blood access.
HF
HemoFiltration
in case of
- Fluid overload
- Congestive heart failure
- Acute renal failure
- Crush syndrome
- Lactic acidosis
In ICUs, HemoFiltration (HF) is usually indicated in case of Fluid overload, Congestive heart failure, Acute renal failure, Crush syndrome, Lactic acidosis … . But HF may also be successfully used for patients with chronic renal failure.
This technique allows removing all the substances that would normally be cleared by the kidneys through the generation of urine such as water, urea, creatinine or salts, as well as medium size substances which result from an injury to body cells and are often nephrotoxic.
This therapy is usually performed according to the same protocol as hemodialysis, at least 3 times per week and up to 7 times during 2-8 hours.
Technically speaking
In hemofiltration, blood is passed through a hemofilter which allows water to be filtrated together with some other substances which are important in this case, such as salts, urea, creatinine or other medium size substances such as inflammatory mediators, the resulting fluid being named ultrafiltrate.
Ultrafiltrate is removed at a rate which allows the necessary clearance of the desired substances. As this rate is too important for other substances a substitution fluid is injected in the blood to compensate for undesired losses, such as that of water and salts.
HDF
HemoDiaFiltration
in case of
- Renal failure
HDF is a combination of hemofiltration and hemodialysis which can be preferred to these 2 methods. Reasons for this are, for example, the higher clearance of medium size substances when compared to hemodialysis or less dependence on blood flow when compared to hemofiltration.
This therapy is usually performed such as hemodialysis, at least 3 times per week and up to 7 times during 2-8 hours.
Technically speaking
In HDF, blood is passed through a hemo(dia)filter while dialysate is injected on the other side of the semi-permeable membrane at a rate which is less than that of the drain flow, which also includes ultrafiltrate, thus combining the filtration process to the dialysis one. In HDF, substitution fluid must be injected in the blood to compensate for the filtration flow.
UF
UltraFiltration
in case of
- Fluid overload
UF is used to remove water from the body in case of fluid overload. Thus it allows to reduce the pressure within the body, especially on the heart, and to remove water that has cumulated within some organs, such as the lungs, and forms oedema there. At home, this therapy can be used alone or in addition to the others technics. In this latest case, the total volume of fluid injected is less than that removed from the patient, the difference providing the targeted removal of water.
UF is usually performed from 4 to 8 hours, until the targeted water volume to remove from the patient is reached.
Technically speaking
In UF, blood is passed through a hemofilter which allows water to be filtrated, together with some other substances which are not of relevant importance in this case. The water is removed at a rate that is well tolerated by the patient and there is no compensation for the few undesired losses of other substances.
HHD advantages
Home HD offers several advantages; one of them is to let the patient set his own schedule. The patient can choose treatment times and duration with the medical team to fit other activities, such as going to work or caring for a family member.
Another advantage is the treatment quality as patients can dialyze more often at home. People who dialyze at a clinic skip 3 days each week (the interdialytic period) during which wastes and fluid buildup in their bodies. Dialyzing at home five to seven times per week means wastes and fluid don't build up as much in the body.
Patient’s pain is less present when HD is realized at home, in fact, muscle cramps that are common in people using the standard HD become less common in those who choose home HD because wastes and fluids are cleared more often.
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