Hi Steven. When I first read your reply, I was perplexed about why your clinic would require a partner for 3x/week home HD. It took me half a moment to realize that this makes sense–and coincides with why I would strongly recommend that you consider every other day treatments instead of just 3x/week.
You said, “I don’t have fluid problems, I have a lot of residual function, and my labs are great and I met adequacy just fine in center.” Awesome. You want to keep that residual function. Every mL of residual function you keep extends your life. The thing that is most likely to reduce your residual function is doing dialysis only 3 days a week, IF that means you STUN your heart, brain, gut, and any kidney function you have left by having to pull fluid too quickly or pull too much to get to your goal. The more urine you still make, the less likely this is–but that will drop over time.
I wonder if doing every other day treatments would let you keep doing solo, since the risk of a “crash” (drop in blood pressure – organ stunning) is so much less without a 2-gap? That might be worth asking if you don’t have someone who can be a partner. (Keep in mind that in those same Conditions for Coverage, Medicare NEVER defines the role of a “care partner” or “caregiver.” So, just having someone in the home who could call 911 if you crash could be enough.) But, most clinics will want to train a care partner to at least stop the machine. And, some go overboard and try to turn care partners into technicians, even for people who are perfectly capable of doing their own treatments.
My very strong personal bias, which is based on population research with hundreds of thousands of people on dialysis, is to never have a 2-day gap, and never do aggressive ultrafiltration. Not to get too morbid on you, but people on peritoneal dialysis have an equal chance of dying on any of the 7 days of the week. This is not true with standard HD. Folks who did that were 50% more likely to die on a Monday or Tuesday after the 2-day no-treatment weekend. And, in the 12 hours before that Monday or Tuesday treatment, the risk of death was triple.
If every other day will fit your life, maybe think about it and see if you could do that solo? Another option, if you don’t travel, may be to ask your clinic to train you on a full-sized Fresenius machine.