ALL YOU NEED TO KNOW ABOUT HOME DIALYSIS

10 Jan ALL YOU NEED TO KNOW ABOUT HOME DIALYSIS

Education

Edited by: Dr. Matthias Rudolf Hermann Zeiler, since 2004 Medical Director of the Nephrology and Dialysis Unit of the Carlo Urbani Hospital in Jesi in the Marche region, with a managerial role in coordinating clinical research activities since 2008. Member of the Italian Society of Nephrology and the Gesellschaft für Nephrologie (German Society of Nephrology) and reviewer for the Peritoneal Dialysis International, Clinics and Practice and Nephrology Dialysis Transplantation journals.

WHEN WE SPEAK ABOUT HOME DIALYSIS, WE REFER TO TWO TYPES OF DIALYSIS: HOME HAEMODIALYSIS AND PERITONEAL DIALYSIS.

 

In this guide, Dr. Zeiler summarizes the characteristics that are common to both types and the differences in order to help the dialysis patient decide which type of home therapy to choose. The information and training given to the patient and his caregivers are of fundamental importance for performing home dialysis correctly.

The patient always has to be assisted by a partner or a caregiver when doing home dialysis. The patient must have well-functioning vascular access. An arteriovenous fistula is the first line access or a permanent central venous catheter is the second line access. The correct positioning of the needles in arteriovenous fistula, the sterile techniques for handling the central venous catheter and the subsequent connection to the lines of the haemodialysis machine are fairly complex and require extensive training in order not to put the patient and vascular access at risk; for example from bleeding, extravasation, suction of the area and infections. This is why home dialysis is often regulated by specific regional resolutions.

 

Peritoneal dialysis training is not as complex as home haemodialysis. Peritoneal dialysis can be managed by the patient without the assistance of a partner or caregiver. After two or three weeks of “training”, almost all patients or caregivers can manage peritoneal dialysis autonomously.

 

HOME PERITONEAL DIALYSIS

HOME HAEMODIALYSIS

ADVANTAGES
  • Confidentiality, flexibility and convenience
  • Can be carried out overnight
  • Greater freedom: the treatment is tailored to individual lifestyles
  • Portable equipment
  • Dialysis is feasible without having to find a Dialysis Centre
  • Needle-free dialysis
  • Confidentiality, flexibility and convenience
  • Greater freedom: the patient can choose when to carry out home haemodialysis rather than at predefined times
  • Dialysis is feasible without having to find a Dialysis Centre
  • Patients can be assisted by a trusted person: partner, caregiver
  • Portable equipment (not all systems)

 

DISADVANTAGES
  • Training required: approximately 1-2 weeks
  • Presence of a peritoneal catheter in the abdomen
  • Space required for storing solutions and accessories
  • Dialysis fluid exchange several times a day (in CAPD)
  • Equipment in the bedroom (with APD)
  • Long training period required: over 2 weeks for both patient and caregiver
  • Presence of a vascular access: arteriovenous fistula, central venous catheter
  • Space required for the machine and for storing solutions and accessories
  • Piercing the arteriovenous fistula with a needle-cannula
  • Machines need to be connected to the water supply (not all systems)

 

HOW DO YOU DECIDE ABOUT HOME DIALYSIS?

The informative meetings and the training of the patient and caregivers are the cornerstone to making an informed choice about home dialysis. These meetings are scheduled on an outpatient basis during the patient’s pre-dialysis period.

 

The decision about whether to do home dialysis takes into consideration the patient’s lifestyle, his autonomy in doing daily activities, his view about the impact of dialysis, his housing situation (available space, location, electrical and water systems, hygiene, storage space), the willingness of the patient and caregivers towards managing the disease autonomously and the willingness to take or delegate greater responsibility for dialysis management.

 

This initial multidimensional and multifactorial assessment by nurses and dialysis physicians ultimately becomes a multidimensional and multifactorial informed choice by the patient and their caregivers. In some cases, it may be useful to involve a psychologist to overcome difficulties associated with changing one’s outlook on life.

 

 

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