Who can perform solo HHD?
The choice to do solo HHD should be a shared decision between you and your doctor. You will need a prescription to perform solo home hemodialysis. You will be trained to receive your treatment in your home, during waking hours, and without a care partner present.
When can you perform solo HHD?
You can perform solo HHD anytime during waking hours.
What is needed to perform solo HHD?
- A prescription from your doctor.
- Training to perform solo home hemodialysis. Your center training nurse will teach you to perform your treatments as well as the proper use and techniques associated with the ancillary devices listed below.
- NxStage fluid detection system. This includes the cycler base, extended cycler base, filter holder, and fluid detection sensor. (Your training center will provide this equipment.)Or:
- Venous needle dislodgment device. This device alerts you with an audible alarm in the event of a vascular access blood leak . (Your training center will provide this equipment.)
Home is also the most practical setting to do more frequent HHD
Nieltje had been living with kidney disease for almost 20 years and was determined to avoid dialysis at all cost.
In-center treatments were difficult for Nieltje to balance in between taking care of her family and herself. As a solo patient, Nieltje has regained her independence and taken control over her life and treatments.
What are the clinical benefits of more frequent HHD including solo HHD?
Less Stress on Your Heart5,6
Time to Recovery7
Improved Sexual Function8
Improved 5-year Patient Survival
The reported benefits of home hemodialysis may not be experienced by all patients.
Despite the health benefits that home and more frequent hemodialysis may provide to those with chronic kidney disease, these forms of therapy are not for everyone. Please review this information carefully and discuss it with your doctor as you evaluate your therapy options.
Personal and Partner Responsibility
Home hemodialysis with the NxStage System during the day may not require a care partner, provided a physician and a qualified patient agree that solo home hemodialysis is appropriate. Patients performing nocturnal treatments are required to have a care partner. Care partners are trained on and follow guidelines for proper operation. If you choose to do more frequent home hemodialysis, you will be responsible for complying with your dialysis prescription, which may require treatments up to six days per week.
If you choose to do home hemodialysis alone during the day, you will need to take on the responsibility for tasks that would normally be taken care of by staff when in-center. You will need to perform all aspects of dialysis treatment from start to finish, including equipment setup, needle insertions, responding to and resolving system alarms, and system tear-down after treatment. In addition, you must monitor your blood pressure, ensure proper aseptic technique is followed, and follow all the training material and instructions given to you by your training nurses. You will also be trained on and need to know how to respond to health emergencies that might happen during treatment at home, including dizziness, nausea, low blood pressure, and fluid or blood leaks.
You must ensure that you have a clean and safe environment for your treatments. You also need to set aside space in your home for the needed supplies.
Risks Associated with All Forms of Hemodialysis
All forms of hemodialysis involve some risks. These may include high blood pressure, fluid overload, low blood pressure, heart-related issues, vascular access complications, cramps, backache, headache, dizziness, nausea, an “off” taste in the mouth, fatigue, fever, chills, joint pain, itching, seizures or sinusitis.
All hemodialysis therapies also involve the use of medical devices that introduce the potential for additional risks including air entering the bloodstream, damage of red blood cells, inflammatory reactions, blood chemistry imbalances, blood loss due to clotting of the blood tubing set or accidental blood line disconnection or other leak, allergic reactions, and excess warming or cooling of the dialysate. In addition, dialysis patients may have other underlying diseases that may, in some cases, make it more difficult for them to manage their hemodialysis treatments.
Risks associated with More Frequent Home Hemodialysis
Studies suggest that patients performing more frequent home hemodialysis may experience slightly fewer complications associated with their treatments and may experience improved clinical outcomes. However, there are certain risks unique to treatment in the home environment. Treatments at home are done without the presence of medical personnel and on-site technical support. Patients (and their care partners, if required), must both be trained on what to do and how to get medical or technical help if needed. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks.
Risks Associated with Solo Home Hemodialysis Therapy
A qualified patient may dialyze alone, without a care partner present (solo home hemodialysis), provided the patient and physician agree that solo home hemodialysis is appropriate. Certain risks associated with hemodialysis treatment are increased when performing solo home hemodialysis because no one is present to help the patient respond to health emergencies. If patients experience needles coming out, blood loss, or very low blood pressure during solo home hemodialysis, they may lose consciousness or become physically unable to correct the health emergency. Losing consciousness or otherwise becoming impaired during any health emergency while alone could result in significant injury or death. Additional ancillary devices and training are required when performing solo home hemodialysis.
Increased Risks Associated with Home Nocturnal Hemodialysis Therapy
The NxStage System may be used at night while the patient and care partner are sleeping. 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. Treatment with nocturnal therapy may require adjustments to medications, including but not limited to iron, Erythropoiesis-Stimulating Agents (ESA), insulin/oral hypoglycemics, anticoagulants, and phosphate binders.
- Moran J, Kraus M. Starting a home hemodialysis program. Semin Dial. 2007; 20:35–39.
- Suri, R.S. Larive B, Hall Y, er al. Effects of frequent hemodialysis on perceived caregiver burden in the Frequent Hemodialysis Network trials. Clin J Am Soc Nephrol. 2014;9:936–942.
- Yau M, Carver M, Alvarez L, Block GA, Chertow GM. Understanding barriers to home-based and self-care in-center hemodialysis. Hemodial Int. 2016 Apr;20(2):235-41.
- FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24):2287-2300.
- Lindsay RM, Heidenheim PA, Nesrallah G, Garg AX, Suri R; Daily Hemodialysis Study Group London Health Sciences Centre. Minutes to recovery after a hemodialysis session: a simple health-related quality of life question that is reliable, valid, and sensitive to change. Clin J Am Soc Nephrol. 2006;1(5):952-959.
- Culleton BF, Walsh M, Klarenbach SW, Mortis G, Scott-Douglas N, Quinn RR, Tonelli M, Donnelly S, Friedrich MG, Kumar A, Mahallati H, Hemmelgarn BR, Manns BJ. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life. JAMA. September 2007; Vol 298, No. 11, 1291 – 1299
- Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and postdialysis 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.
- Pinciaroli AR, Results of daily hemodialysis in Catanzaro 12-year experience with 22 patients treated for more than one year. Hemodial Int. 1998:2(1) 1342-1349