How does one have access to HHD?


If someone wants to do HHD what are all the options available?

For example, they have to buy the NxStage machine or lease it for life from the NxStage company?
I see Davita offers HHD, how they do that? Do they just give you the NxStage machine for life as you would do if you buy it yourself? Or they rent it to you and you have it at home for years to do your dialysis?

Or are there other methods to get HHD?

Please give me some insight of the available ways.


In the U.S., options for HHD include HD like it’s done in an outpatient clinic 3 times a week, HD at home 4-6 times a week for less time per session, or HD done in-cener or at home for longer usually while sleeping 3 or more times a week.

Many dialysis providers offer home HD or PD. You can search a database on the full Home Dialysis Central website for clinics that do (search by zip code, distance and type of treatment–one type at a time) at You can also look up clinics in your state or within a set distance from you that offer home dialysis training and see the quality of care by the number of stars on the Medicare website at

In the U.S. people don’t buy or rent dialysis machines. Medicare and other insurance plans reimburse dialysis clinics on a per treatment basis no matter whether dialysis is done in the clinic or at home. Payment for home dialysis (HD or PD) includes equipment, supplies, and support services from staff. Medicare has a “bundled” payment system that includes most ESRD-related meds and ESRD-related labs. This booklet describes Medicare coverage for dialysis and transplant, including home dialysis.

To offer home dialysis training and support, the clinic must be Medicare certified and approved to provide training and support. Patients who do home HD or PD must be trained. An experienced RN trains patients to do HD or PD. If a patient needs a helper, that person is usually trained with the patient. sometimes for the full training time (3-6 weeks for HD) or less time if the patient is capable of doing all or most of his/her treatment without help. At minimum, helpers need to know what to do in an emergency and how to help the patient if he/she needs help and to recognize when help is needed. Patients have access to a team that includes an MD, nurse, dietitian and social worker for regular follow-up care.

Thanks but it is not clear from your answer how exactly I get the machine. Can you describe please?

For example, does the company send the machine home with a nurse visiting for 6 weeks? Then the machine is at home with me forever to use it whenever I want within the doctor’s prescription? I.e. if today it’s dialysis day, can I do it in the evening instead of the morning? Does the company deliver disposables?


Most patients are trained in a dialysis clinic although some clinics will do some training in a patient’s home. When the patient completes training, the physician writes a prescription for the home trained patient to get his/her dialysis equipment and supplies. The patient may take home the machine he/she has been using in training or it may be shipped or delivered to (depends on which manufacturer) the patient’s home by the company that makes the machine. Supplies are typically delivered to the patient’s home monthly for inside delivery. They’re supposed to be placed where the patient wants them and the delivery person is supposed to rotate the supplies so the supplies with the closest expiration date are used first. If storage space is limited, supplies may be delivered every 2 weeks.

Patients do dialysis at home at a frequency and length of time based on the doctor’s prescription, which should take the patient’s preference into consideration. One advantage of home dialysis over dialysis in a clinic is that the patient can schedule dialysis to fit their schedule. There is some flexibility in scheduling dialysis so it doesn’t need to be at exactly the same time on dialysis days and dialysis days can be adjusted somewhat. Research has shown that a 2-day gap increases the risks of hospitalization and death so it’s best not to skip 2 days in a row. Some HD patients dialyze every other day; others dialyze more often than that.

Dialysis equipment remains in the home as long as the patient needs it for dialysis. If the patient doesn’t need dialysis because he/she gets a transplant, chooses to stop dialysis, or dies, the equipment (dialysis machine, chair, scale, BP monitor, etc.) are the property of the dialysis clinic and are returned.