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Concept
Home hemodialysis
Summary
Home hemodialysis (HHD) is the provision of hemodialysis to purify the blood of a person whose kidneys are not working normally, in their own home. One advantage to doing dialysis at home is that it can be done more frequently and slowly, which reduces the "washed out" feeling and other symptoms caused by rapid ultrafiltration, and it can often be done at night, while the person is sleeping.
People on home hemodialysis are followed by a nephrologist who writes the dialysis prescription and they rely on the support of a dialysis unit for back-up treatments and case management. Studies show that HHD improves patients' sense of well-being; the more they know about and control their own treatment the better they are likely to do on dialysis.
HHD was introduced in the 1960s as a way to conserve scarce healthcare resources.
There are three basic schedules of HHD and these are differentiated by the length and frequency of dialysis and the time of day the dialysis is carried out. They are as follows:
Conventional HHD – done three times a week for three to five hours. It is like in-centre hemodialysis (IHD), but done at home. Some patients utilize a modified conventional "EOD" (Every Other Day) strategy in which treatments are performed an average of 3.5 times a week. It is generally accepted that the "3 day gap" that occurs once a week in conventional HHD on the normal 3x/week schedule increases risk to the patient.
Short daily home hemodialysis (SDHHD) – done five to seven times a week, for two to four hours per session.
Nocturnal home hemodialysis (NHHD) – done three to seven times per week at night during sleep, for six to ten hours.
Thus an NHHD schedule results in a larger dose of hemodialysis per week, as do some SDHHD. More total time dialyzing, shorter periods between treatments and the fact that fluid removal speeds can be lower (thus reducing the symptoms resulting from rapid ultrafiltration), accounts for the advantages of these schedules over conventional ones.
Official source
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