Concerned friend

A friend of mine has been on dialysis for years, driving a long way to a clinic 3 times a week to get it. Her doctors have recently suggested she do home dialysis (nocturnal) and that it would be better for her, from the little research I have done I tend to agree. Here is the problem. Her mother was put on home dialysis ( I am unsure how many years ago, but I believe her mother died many years ago) and was only on the home dialysis for a few months before she died. My friend feels the same thing will happen to her if she begins this procedure. Can anyone tell me how much if any, home dialysis has changed in recent years? I am assuming that like most of the medical field, there have been major changes…?

Oh, gosh, what a tough choice for your friend. It’s hard to overcome personal history. Do you know anything about exactly what caused your friend’s mom’s death? Do you know if she was doing nocturnal home hemo, or standard home hemo? What caused her kidneys to fail?

The machines that are used for home hemo today have been much simplified for home use. Most clinics use the NxStage System One ( It has not yet been approved by the FDA for nocturnal treatment–but no machine has, and this one is in review and expected to be approved shortly. When hemodialysis is done at night, it’s important to use alarms that will wake you up if there is a blood leak. Bedwetting alarms or a special alarm called Redsense are used for this purpose. It’s safest if there is an alarm pad under the arm where the needles go in and a second pad under the dialyzer.

Here’s the really important thing. Healthy kidneys work 24/7 to clean the blood. Standard in-center hemo only does this for 3-4 hours three times a week, with a 2-day gap where there is no treatment over the weekend. This schedule is associated with some of the poorest dialysis outcomes in the civilized world. (Most other countries do longer treatments). The 2-day gap has been called the “killer gap” by one prominent kidney doctor, who estimates that 10,000 Americans on dialysis die unnecessarily each year just because treatments are not done minimally every other day. But even doing this 3x/week schedule at home improves survival by 50%. While it may seem to be a good thing to have a staff of people doing dialysis, folks who get their treatments in-center are exposed to many more germs and the varying practices of all of the different people who work there.

More dialysis is more like having healthy kidneys. A prospective randomized controlled study of short daily hemo (done 6 days a week for 2-3 hours in-center) found improvement in heart health and better physical function compared to standard treatments. Both predict longer survival. So, more days a week of treatment are good (at least getting rid of the 2-day gap).

Longer treatments (preferably done more frequently) are best of all. They are more gentle and more effective. People who do their hemo at night feel better, have more energy, sleep better, can eat a normal or near-normal diet and drink normal amounts of fluid, need fewer meds, and on and on. Life just looks more normal when treatment can be done at night instead of taking time out of the day. Bringing back nocturnal hemo, which was done in the 1960s and 1970s and then dropped, is the most significant change in hemo for decades.