Hi Jane
I happened to check for recent posts and I noticed nobody replied to your questions.
As you may recall, I started daily home hemo over a month ago, following 6 weeks of doing short daily hemo while training. I’ve been doing short daily, which for me, means 2 hours 6 days per week. However, this is only while I wait for my 3 night hospital sleepover when I will convert to daily nocturnal hemo. Where I live, they like patients to do short daily for a few weeks to get comfortable with it before going nocturnal.
Does short daily meet my needs?
Well, yes and no.
Yes because I can already see it’s much better dialysis than 3 times per week. I can eat much more phosphorus and more potassium, but not only can I eat more, I actually have more appetite for it, plus, I find that food actually tastes normal again. Before, it was like everything was cardboard. I have more energy, and everyone tells me I have more normal colour now rather than the greyish complexion many dialysis patients have. Also, yes! because I no longer seem to need any BP med - for the first time in over a dozen years.
No because it’s very time-consuming and a lot work and responsibility in comparison to the actual treatment time (which is 12 hours a week, so, the same treatment time overall as in-centre, more or less). In addition to the dialysis, there’s also managing the supplies and being there for deliveries and for when technical support has to come in (they only work during daytime office hours). I also find that short daily doesn’t really facilitate drinking much more than before, simply because the short 2 hour treatment time doesn’t provide enough time to remove it. My home dialysis unit doesn’t want patients to remove more than 1100ml of fluid per hour (that’s the UF rate).
My feeling is that nocturnal justifies the time spent doing it a lot more than short daily does, because, since it’s done during the night, it frees up your days and evenings for other things, plus, it not only improves the diet and fluid restriction, but it virtually eliminates them. Because I’m converting to nocturnal at the end of this month, my monthly supply delivery yesterday actually included a whole boxful of phosphorus additive for my dialysate!
Yes or No, if I couldn’t do nocturnal for whatever reason, I would still want to do short daily at home. It’s very time consuming, but the health and dietary advantages are just too good to ignore. Of course, I know I could be called for a kidney any day (I have over 2 and a half years done on the waiting list), so, that helps to “put up” with any disadvantages.
Service:
I live in Canada. I can’t imagine having to deal with some of the issues people in other countries have to deal with. Dialysis in my province, Ontario, is basically just a matter of showing up, and it’s first rate all the way, with fully integrated pre-esrd, dialysis and transplant services. I have nothing but praise for the whole system. Since starting home hemo, I couldn’t ask for better medical and technical support. So far, with a couple of technical problems, a technician has been at my place such that I haven’t had to miss a single treatment nor even change my treatment time. All the technical support is local, on staff at the dialysis centre.
Machine
I use a standard Fresenius 2008K, which is identical to the machines at the 4 dialysis centres in the city, except it’s on a shorter base. Personally, I like using the same machine as in-centre. It’s flexible, reliable, easily serviced, and when I have to dialyze at the centre or hospital, I know exactly what’s going on because everything is the same (I’ve dialyzed in-centre or hospital a few times since starting home hemo, ie. when I had my fistula angiogram, when they wanted to do a follow-up transonic). I don’t think the machine is an issue in deciding whether to do home hemo or not. Once you know what to do, it’s easy, and it quickly becomes second nature. I truly would have used whatever machine they had in order to get into the home hemo program. One thing I like in particular with my setup is that, when dialysis is over and the machine is already into its heat disinfect cycle (which takes about an hour or so and then it switches itself off), I simply turn off the R/O and the water supply, and that’s all the extra water and electricity use for that day (total time from when I turn it on to when I turn it off about 4 hours). The supplies do take up a lot of room in my small apartment though, because the dialysis machine uses one 8 litre bicarb jug and one 4.5 litre acid jug each treatment. The upside to this is that I don’t have do to any mixing.
All in all, the only way I would go back to in-centre treatment is if it were done daily.
Pierre
27 years with chronic IgA nephropathy
2-1/2 years on hemodialysis
