DAPHNE KNICELY, MD: I'm Daphne Knicely and I'm a nephrologist. Home dialysis is two parts. So you can either do home hemodialysis or peritoneal dialysis. So home hemodialysis is just like what you go to in a center for hemodialysis, but it's more simplified. You have the access to the blood, your blood comes out, goes through machine, gets cleaned, and comes back to you. Peritoneal dialysis-- it's a little different. Your blood is still getting clean but kind of in a different way. So you have a catheter placed into your abdomen, and then you put dialysis fluid into your abdomen, and it sits in there. That whole space within your abdomen is covered in little blood vessels and so there's little blood vessels act like a filter. And so because of the chemistry within that dialysis fluid it causes the blood to be cleaned, chemistries to be balanced, fluid to be removed. And then once it sits for a while you drain it back out and then refill it. 

For both home hemodialysis and peritoneal dialysis, you need a stable home situation and you need space in the home. And for home hemodialysis, you'll also need a partner. You have to think about it, if your blood's getting clean through a machine what if something happened. You want somebody to be there, and so dialysis units require you to have a partner. 

The equipment that you use at home is very simplified and it has a lot of safety mechanisms to it. And we don't just send you out into the world with home hemodialysis equipment without any training. You get anywhere from four to eight weeks of training, and it's kind of like graded responsibility. You learn how to do just your vitals and by the end you're doing the entire treatment with the nurse just being there. 

I mean, there are-- of course there are risks. Your blood is circulating through the machine. The machine can malfunction, your blood pressure could drop, a lot of things could happen. But that's why we require a partner. If something happens, somebody has to be there when you're doing it. Also there's a lot of safety mechanisms. These home hemo machines, they will shut off if there's anything wrong. They turn right off and they stop working just so you won't cause problems or you won't hurt yourself, 

Anyone can do home hemodialysis. We simplify the machine, so if you look at a machine that's in our in-center units, there's tons of buttons, tons of screens. And if you look at our home hemo machine, it's just one screen with little up and down arrows that you punch, so it's super simplified. And we train you so that how to use the machine and what to do. 

So that's a really good question. There are ways that you can learn how to stick yourself so that it's less painful. And once you get over the actual psychological fear of sticking yourself, plenty of people can do it. I actually encourage my patients that go into a center for hemodialysis to learn the stick themselves so that they have some control over their dialysis. There's a little bite whenever you stick yourself, but you can use things like lidocaine gel or creams that numb your skin so they take away that bite. And actually, the more you do it and the more comfortable you get with it, the easier it gets. And actually develop some numbness in that area after you've done it for long. 

So probably the biggest complaint I get from probably every one of my dialysis patients is being really tired after dialysis. And I always describe it as think of dialysis as running a marathon. I would be pretty tired after one of those. And they do it three times a week if they're going in a center to a dialysis unit, and if they're doing it at home, they're usually doing it more than three times a week. So that's the benefit of doing home hemodialysis. 

One of the benefits from doing home hemodialysis, their treatments are a little bit shorter. They're more frequent, they do it more days. But in hemodialysis, they can do it for a little less time. And so they're not as fatigued or as tired as somebody who's only going three days a week. And some of that might be from clearing the toxins out of their body more frequently. They're able to kind of bounce back more. And also because it's a little shorter maybe they're able to bounce back quicker as well.