Home Dialysis. Peritoneal Dialysis. Home Hemodialysis

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1 Home Dialysis The information provided is not intended to be a substitute for professional medical advice. A licensed healthcare professional should be consulted for diagnosis and treatment of any and all medical conditions. Take control with dialysis at home. There are two types of dialysis you can do at home: Peritoneal Dialysis (PD) and Home Hemodialysis (HHD). With either type of home dialysis, you ll be trained by health care professionals to do the procedure yourself, at home, or with help from a family member or a friend if you need it. Many patients choose home dialysis because it can be more comfortable, flexible and convenient -- providing more freedom to maintain their current lifestyles Peritoneal Dialysis With Peritoneal Dialysis (PD), waste, toxins and fluids are removed from your kidneys inside your body using your body's natural filter called the peritoneal membrane. PD can be performed during the day or night. Home Hemodialysis With home hemodialysis, the blood is filtered outside the body in a system called a dialyzer. There are different types of Home Hemodialysis (HHD), some of which are performed daily and some a few days per week 1

2 Peritoneal Dialysis The information provided is not intended to be a substitute for professional medical advice. A licensed healthcare professional should be consulted for diagnosis and treatment of any and all medical conditions. What is Peritoneal Dialysis (PD) Peritoneal Dialysis Catheter The Exchange How will Peritoneal Dialysis (PD) Affect your Lifestyle? Dialysis Treatment Options What is Peritoneal Dialysis (PD) Peritoneal Dialysis (PD) cleans your blood and removes extra fluids using one of your body's own natural filters, the peritoneal membrane. The peritoneal membrane is the lining that surrounds the peritoneum, or abdominal cavity, which contains your stomach, spleen, liver, and intestines. Peritoneal Dialysis (PD) solution is placed in the peritoneum. The peritoneal membrane filters waste and fluids from your blood into the solution. The solution containing the waste is drained from your peritoneum after several hours and replaced with fresh solution. This is called an exchange. A nurse experienced in Peritoneal Dialysis (PD) will train you to perform peritoneal dialysis in the dialysis unit as an outpatient. Most people can learn to do Peritoneal Dialysis (PD) within five to seven training sessions, depending on learning style. If you have concerns or problems, the nurse and doctor are never more than a phone call away. You will probably need to visit your clinic each month 2

3 Peritoneal Dialysis Catheter CLICK TO ENLARGE IMAGE A small, soft tube called a catheter is put through the wall of your abdomen into the peritoneal cavity. The catheter is called an access because it provides a way to get Peritoneal Dialysis (PD) solution into your peritoneum. Solution flows in and out of the peritoneal cavity through the catheter. Placing the catheter requires minor outpatient surgery. The opening for the catheter should heal for a few weeks before starting dialysis. The catheter is usually not painful and stays in place throughout your time on Peritoneal Dialysis (PD). The Exchange How will Peritoneal Dialysis (PD) Affect your Lifestyle? Most people enjoy the flexibility and independence that they have with Peritoneal Dialysis (PD). Your dietitian can help you manage your diet. It is very important to follow the meal plan recommended by your dietitian in order to avoid malnutrition. Also, poor diet can cause depression, tiredness, and a lower quality of life. People on Peritoneal Dialysis (PD) can lead normal lives. It is easy to adjust the treatment schedule according to your work, school, or travel plans because you are in charge of your own treatment. 3

4 Home Hemodialysis The information provided is not intended to be a substitute for professional medical advice. A licensed healthcare professional should be consulted for diagnosis and treatment of any and all medical conditions. What is Home Hemodialysis (Home HD) How will Home HD affect your lifestyle? Home Hemodialysis Therapies o o o Conventional Home HD Short Daily Home HD Nocturnal Home HD Dialysis Treatment Options 4

5 What is Home Hemodialysis (Home HD) Hemodialysis removes wastes, toxins and excess fluid from your body with the use of a dialysis machine and other supplies. When hemodialysis is performed at home it is referred to as Home HD. During a hemodialysis treatment, blood is removed from your body and pumped by a machine through a dialyzer. All your blood is filtered through the dialyzer several times. After being filtered, the blood goes back into your body through tubing attaching to the other needle. As with in-center hemodialysis, access to blood is required. During your treatment, you sit or lie near your hemodialysis machine. You may require a partner to perform your Home HD treatment. Since your treatments occur in the convenience of your home, you can stay active by doing things like watching TV, spending time with family or friends, reading, talking or just enjoying the quiet time. Some patients choose to perform Home HD while they sleep at night. Home HD provides more flexibility on dialysis time, duration, and frequency compared to hemodialysis performed in an in-center environment. How will Home Hemodialysis (Home HD) affect your lifestyle? Home HD can give you the flexibility, comfort and control you want while preserving a dialysis routine. Exercise and most sports can be continued with approval from your doctor. You may have fewer dietary restrictions as compared to conventional HD, because you are dialyzing longer (e.g. nocturnal), and/or more frequently (e.g. short daily). (But be sure to follow the meal plan recommended by your dietitian!) Many patients also report an improvement in their quality of life 1 while feeling more independent and knowledgeable about their dialysis with Home HD. Home Hemodialysis Therapies There is more than one type of Home HD therapy. You should discuss with your doctor which option is best for you. For the types listed below, you and a care partner will be trained on how to do the procedure safely and effectively. The training usually takes several weeks. 5

6 Conventional Home HD Conventional Home HD is performed three times per week, for 3-4 hours each time, similar to the schedule you may have for in-center HD. Short Daily Home HD Short daily Home HD lasts approximately 1.5 to 3 hours and is performed about five to seven times per week. Because this treatment is performed more frequently, this type of therapy can help reduce symptoms like headaches, nausea, and cramping after treatment because less fluid is generally removed with each treatment. Nocturnal Home HD This type of dialysis consists of long, slower treatments while you sleep. Depending on what you and your doctor discuss, you may perform this dialysis three to seven nights per week, and treatments last about 6 to 8 hours. This type of therapy also reduces symptoms like headaches, nausea, and cramping after treatment because less fluid is generally removed with each treatment, and the fluid is removed more gradually over time than shorter dialysis treatments. 6

7 HomeChoice APD system: A cycler that gives you more daytime flexibility Caution Caution: Federal (US) law restricts this (these) device(s) to sale by or on the order of a physician or other licensed practitioner. For safe and proper use of this (these) device(s) refer to the device(s) instructions. HomeChoice is an Automated Peritoneal Dialysis (APD) system that has been designed to meet the needs of many patients, including children and adults of different weights and sizes. It is used at night for APD therapy and has been the only pump-based cycler for over a decade with history of proven performance. And because it's small in size, easy to use and won't get in your way, it's ideal for use at home and can easily be placed on your bedside nightstand. It is also highly portable, so it can be used when you travel. HomeChoice PRO is an Automated Peritoneal Dialysis (APD) system that allows your doctor to remotely monitor your therapy with the use of customized clinical software, and a special data card. HomeChoice PRO is easy to use; you just insert a PRO card into your machine at the start of treatment to capture all the information from that dialysis session. This information can help your doctor determine if your treatment or prescriptions require any changes, which can help make the most of your therapy. 7

8 Dialysis Treatment Options Types of Treatment Attributes of Treatment PD Home Hemodialysis* In APD CAPD Nocturnal Short Daily Conventional Center Hemodialysis Clinical Has survival outcomes closer to that of kidney transplant 1 Has less fatigue with fewer energy peaks and valleys 2, May improve heart structure and function 3,4,5 Requires fewer phosphate lowering medications 3,4, Requires fewer blood pressure lowering medications 3,4 Has less limitations on fluid intake6 Has less limitations on diet 6 Can provide continuous therapy Has nurses and technicians present in case of 8

9 emergency May lead to weight gain or larger waistline Requires permanent vascular access typically in the arm Requires permanent catheter typically in the abdomen Runs some risk of infection Lifestyle Requires less frequent visit to the clinic Can travel with dialysis equipment (portable equipment) More able to keep regular work schedule while on therapy Allows patients to be involved in own care Can regularly have each daytime free Can do nocturnal therapy at home Can regularly have at least a day off per week Has nurses and technicians performing treatment 9

10 Allows regular contact with other dialysis patients Requires clinic visits three times a week on fixed schedule Allows dialysis in the privacy of own home May require partner to help set up treatment May require home modification (electrical, plumbing) Requires training on how to perform dialysis treatment Requires device at home, and storage space for supplies PD - Peritoneal Dialysis APD - Automated Peritoneal Dialysis CAPD - Continuous Ambulatory Peritoneal Dialysis *Nocturnal and Short Daily treatments can also be done in-center; however this is not commonly practiced at dialysis clinics References : 1 Gill JS, Rose CL, Asad RA, et al. Surviving among nocturnal home hemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant Sep; 24(9): Epub 2009 Jul 7. 2 Heidenheim AP, Muirhead N, Moist L, et al. Patient quality of life on quotidian hemodialysis. Am J Kidney Dis Jul; 42(1 Suppl): Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis versus conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA. 2007; 298: Ayus JC, Mizani MR, Achinger SG, et al. Effects of short-daily versus conventional hemodialysis on left ventricular hypertrophy and inflammatory markers: a prospective controlled study. JASN. 2005; 16: Hiroaki Lo, Yuuki Ro, Yoshimi Sekiguchi et al. Cardiac structure and function in longitudinal analysis of echocardiography in peritoneal dialysis patients. Perit Dial Int. 2010; 30 (3): Schorr M, Manns BJ, Culleton B, et al. The effect of nocturnal and conventional hemodialysis on markers of nutritional status: Results from a randomized trial. J Ren Nutr Jul 20. [E-pub ahead of print]. Observational/intuitive for Peritoneal Dialysis based on its attribute as a continuous therapy 10