Home Dialysis: How It Works
Make an Appointment
Home dialysis is one of many dialysis treatments available at UVA Health.
You may benefit from home dialysis if you:
- Need flexibility in your schedule due to work or school obligations
- Can either set up dialysis equipment on your own or have a friend or family member who can help
- Feel comfortable following care instructions independently
- Can commit to performing dialysis on a regular basis
Home Dialysis to Fit Your Life
If your kidney function is declining and medications and other treatments aren’t working, dialysis can offer life-saving care. Nephrologist Daphne Knicely, MD, explains the types of home dialysis and how they can work to fit your life.
Dialysis is just a way to replace the kidneys when they're not working anymore. So when the kidneys stop working, they stop getting rid of water, stop balancing the chemistry, stop getting rid of the toxins. Then dialysis does its job by balancing the chemistries, getting rid of the toxins and helping remove fluid. It doesn't fix the kidneys. It just replaces them. I usually think of dialysis as two components. There's hemodialysis and peritoneal dialysis. So peritoneal dialysis can only be done at home. Hemodialysis can be done in a center, or it can be done at home. Hemodialysis is where you have some sort of access to the blood. Either some sort of shunt in the arm that connects an artery and vein, or a catheter. And it allows for blood to leave you, go through a machine, get cleaned, chemistries balanced, and then comes back to you. For home hemodialysis, the patient actually learns how to do that treatment. It's a very simple machine, very user-friendly. Training is usually about, anywhere from four weeks up to eight weeks and you work one-on-one with a nurse. You still see the physician. You come in about once a month, maybe twice a month to get labs. You'll see a social worker at the same time. You'll also see a nutritionist at the same time. Peritoneal dialysis takes place by putting a tube into your abdomen. And we take dialysis fluid that's chemically balanced. When we put it into the abdomen, it uses those little blood vessels to pull toxins out, to balance chemistries, kind of like little filters. Now, after it sits in there for several hours, we drain it out. Anyone that needs dialysis is a candidate for home dialysis. There's not one type of dialysis that's going to make you live longer. They're all equal. The goal is to pick the type of dialysis that fits with your life.
Getting Started
We start working with you and your family several weeks before your first treatment. We help with:
- Dialysis access — A dialysis access is a site on your body where we surgically create a way for you to receive dialysis.
- For hemodialysis patients, we connect smaller veins in your wrist to create a large vein. This makes it easier for blood to flow to and from the dialysis machine. It also protects you from infection and harmful blood clotting.
- For peritoneal dialysis patients, we create a small opening in your abdomen and attach a catheter.
- Home training program — A team of nurses, social workers and dietitians works directly with you and your family to teach the correct way to give yourself dialysis and how to prevent complications.
- Equipment and supplies — We help you get all the equipment and supplies you need. We also tell you how to order more supplies and what to do if you have any problems.
Overnight (nocturnal) dialysis
A special machine filters your blood while you sleep, so you don't need any treatments during the day. You typically dialyze for 8 to 10 hours, five or six days a week.
Short daily dialysis
This treatment uses a special machine that allows for shorter, more frequent treatments. You typically dialyze for two to three hours, most days of the week.
Peritoneal Dialysis
The most common form of home dialysis, peritoneal dialysis uses the lining of your abdominal cavity (peritoneum) to help your kidneys filter toxins and extra fluid. Because this form of dialysis closely mirrors your kidneys’ natural functioning, patients on peritoneal dialysis enjoy more flexibility in their diet and medications.
Our research into kidney disease and dialysis gives you access to devices and peritoneal dialysis solutions that are not widely available. We also use mobile devices to improve access to nephrology care for patients living in remote areas.
Blood Filtering: How it Works
Peritoneal dialysis features several steps:
- You use the catheter to fill your abdomen with dialysis solution. You may experience a sensation similar to having a full stomach.
- The solution stays in your abdomen, which allows special sugars to draw out the toxins in your blood. Toxins pass through tiny blood vessels in the peritoneum into the solution.
- The length of time the solution stays in your abdomen (dwell time) can last anywhere from four to six hours.
- Once the dwell time is up, you drain the solution into a disposable bag.
The process of filling your abdomen, allowing the solution to dwell and draining it, is called an exchange. Your doctor will let you know how much dwell time and how many exchanges you need to perform each day.
CAPD and CCPD Dialysis Techniques
We offer two types of peritoneal dialysis:
- Continuous ambulatory peritoneal dialysis (CAPD) — In addition to performing regular exchanges during the day, you also do a longer, overnight exchange.
- Continuous cycling peritoneal dialysis (CCPD) — Also known as automated peritoneal dialysis, CCPD uses a machine to perform exchanges at night while you sleep. You begin each morning with an exchange that lasts all day.
Follow-Up Care and Ongoing Support
You receive follow-up care on a monthly basis at one of our dialysis locations. Care includes:
- Testing — We run lab tests to see how well the dialysis is cleaning your blood. We'll adjust your treatment plan if you're getting too much or too little dialysis.
- Support — Our dialysis nurses, dietitians and social workers offer ongoing support and information about your care.
Dedicated home dialysis staff members are available by phone any time you have questions or need help.