I’ve just been told that I need dialysis. What is the first thing I should do?
Educate yourself. Find out what all of your options are. Make an informed decision about which dialysis treatment is best for you and your lifestyle. Call us for a no-obligation, unbiased, 1-on-1 options training class.
Why should I contact HDT?
As the only independent home dialysis facility in San Diego, we strive to provide exceptional service which includes complimentary treatment options education. It is important that you have a choice in deciding what treatment option is best for you and your lifestyle. Therefore, it is important that you have enough information to make an informed decision. We understand that there may be other dialysis facilities closer to your home but you will find that the education you receive will be worth a slightly longer drive. If you choose Home Dialysis Therapies as your dialysis provider, you can rest assured that you will have the best dialysis team by your side, every step of the way.
How long does PD training take?
Peritoneal dialysis training generally takes 5-7 days with a 3-hour session per day. During this period, we provide one-on-one training to teach you the skills and concepts needed to successfully perform your dialysis treatments. We are here to support you every step of the way to ensure that you feel comfortable and confident while performing dialysis on your own in your home. We understand every patient situation is unique and we do our best to tailor our teaching methods to meet your needs.
How long does HHD training take?
Home hemodialysis training generally takes 4-5 weeks, 5 days a week, with 4.5 to 5-hour sessions. We provide one-on-one training to teach you and your care partner all the tools needed to successfully perform hemodialysis at home. We take additional care when transitioning treatments from the office setting to the home setting to ensure that your transition goes smoothly. Nursing support is available 24/7 should any troubleshooting be needed during the course of treatment.
What if my care partner and I need to take time off of work or school for the training?
We actually encourage you to take some time off while you are training for PD or HHD. With all the demands you are experiencing on a regular basis, it is a good idea, if you are able, to give yourself permission to learn about and adapt to this new routine. We can help you assess if you are eligible for State Disability, and if your care partner is eligible for FMLA, via the EDD. If you have AFLAC or other coverage, we will also assist you with those applications. We also encourage you to talk to your HR department to inquire regarding any intermittent leave paperwork that you may need to complete annually as an extra measure for job protection for individuals with chronic illness. If you are in school, we can try to help you with leniency for attendance. If you do not have flexibility, we will do our best to accommodate your needs.
What should I expect after the training period is over and I begin dialysis at home?
Once you begin home dialysis there will certainly be an adjustment period as you incorporate new responsibilities into your routine. We are here to support you with any questions or concerns that arise. You will visit our facility once or twice per month depending upon the type of dialysis you do at home. During those visits you will meet with your team – your physician, nurse, social worker, and dietitian who will review your labs, make changes to your regimen when needed and address any concerns that you may have. If there are concerns or questions after normal business hours, we have a PD nurse and an HHD nurse on-call to help you.
Can I travel on PD?
Yes. It simply requires planning ahead. With air travel, we provide you with a letter for the airlines. You carry the PD cycler machine as a carry-on bag with no additional baggage charges. If traveling in the US, you can make arrangements with Baxter to have your solution shipped to your destination with no additional fees. If you are driving to your destination by car or RV, you can take supplies with you or have them shipped to a predetermined location. Traveling internationally requires more planning, and additional fees may apply, but it is achievable.
Can I travel on HHD?
Yes. Again, it requires that you plan ahead. You can take the NxStage machine on the plane with you. However, it will be a checked bag that you specify is medical equipment so additional baggage fees will not apply. Another option is to leave your home hemodialysis equipment at home and get hemodialysis treatments at a center near your destination. Insurance coverage for hemodialysis treatments outside of the United States varies by company and our staff will provide you with the information you need to find out your benefits if you are traveling internationally.
What if I have to use the restroom in the middle of the night and I’m on PD?
We assess this need when you start services with HDT. If the PD tubing will not reach from the bed to the bathroom, you will be taught how to disconnect during treatment or you can utilize a urinal or a bedside commode.
Will I feel tired after PD treatments?
No. This is in contrast to in-center hemodialysis.
Is there a health benefit to PD vs HD?
Yes. Patients on PD retain their residual kidney function longer than those patients on HD which is thought to be beneficial to your health.
What if I have needle or catheter problems during HHD treatment?
During your training, you will be educated about how your NxStage machine works, how to handle alarms, and how to troubleshoot problems that may arise with your access. Situations sometimes occur that you will find difficult to resolve on your own. If that happens, you will have access to 24-hour technical support through NxStage and 24-hour support from our nursing staff.
Will needles for HHD hurt? Will I really be able to insert my own needles?
Our home hemodialysis training nurses explain it this way: “As a nurse, I can tell you that once, a long time ago, I put a needle into a patient for the first time. The more times I did it, the easier it became. Any person taking on a nursing or home hemodialysis role will always have a first time to insert a needle.” You will learn to insert needles using a fake arm and we will provide you with the guidance you need to insert needles proficiently. If needed, there is a cream that can be applied prior to your treatment that will numb the skin to reduce pain when the needles are inserted.
Can I exercise on home dialysis?
Yes! If you have been physically active and exercising, you are encouraged to continue. Just take into account your PD catheter or HD fistula/graft/catheter, as you may need to take precautions to ensure you don’t do anything to exert pressure on them. If you weren’t physically active prior to starting dialysis, you may want to put off any new exercise routine or activities until your body adjusts to the dialysis. With the PD catheter, it is also recommended that you maintain a 25-pound weight lifting restriction.
Can I swim if I do peritoneal dialysis?
Yes. After the PD Catheter heals in 1-2 months, you may swim in a private pool that gets regular maintenance. You can also swim in the ocean. Exit site care after any water activity is required. The catheter may not be submerged in a bathtub or jacuzzi due to high levels of bacteria.
How will dialysis affect intimacy with my partner?
Intimacy with your partner will not be affected by your PD catheter or fistula. Some patients experience body image concerns, but this diminishes over time. Advanced chronic kidney disease can lower your libido. If this is a concern for you, please discuss it with your doctor. Assistance may be available.
Will my diet need to drastically change once I start dialysis?
Generally speaking, home dialysis patients can enjoy a more liberalized diet than ICHD patients. Your dietitian will individualize your diet and meal planning based on your lab results and food preferences.
Do you need to see where I live in order for me to do home dialysis?
A home visit prior to starting home dialysis is not required at our facility unless the referring physician has questions about the suitability of your home. If you are concerned about the suitability of your home, we will gladly do a home visit prior to starting home dialysis so your questions can be answered. Home visits are required for all patients towards the end of your training period so the nurse can observe you performing your home dialysis treatment in your own environment. Repeat home visits are individualized based on the needs of the patient but are required if you move or if there is a change in care partner. Home visits are beneficial because your nurse can help you identify areas of concern and help you implement solutions.
Can I do home hemodialysis if I have a hemodialysis catheter instead of a fistula or a graft?
Yes. We do not feel that having a hemodialysis catheter should limit your ability to do home hemodialysis. However, having more permanent access like a fistula or graft is highly recommended and encouraged. Hemodialysis patients are at increased infection risk with a catheter. Thus, if you have a hemodialysis catheter you can expect that your physician will be discussing more optimal access options with you during your visits.
If I have a PD catheter in my belly, will people be able to see it?
Generally speaking, other people will not be able to tell that you have a catheter in your abdomen. Your PD catheter tubing, when not being used for treatment, will be securely taped to your abdomen or will be restrained utilizing a PD catheter belt. The belts are an elastic material that is worn under your clothes and are designed to secure the tubing in a built-in pocket. Your nurse will provide you with information about the different belts that are available. It is normal to be a little self-conscious about the PD catheter at the on-set, but many come to regard it as a symbol of perseverance and courage that is eventually shared freely; it is, after all, your lifeline. This holds true for fistulas, grafts, and hemodialysis catheters as well.
What if I start dialysis and I want to stop?
When you are educated about options for the treatment of advanced chronic kidney disease, you will discover that choosing not to initiate treatment is one of your options. If you choose to start dialysis, you have the right to stop treatment at any time if the burden of treatment outweighs the perceived benefits. This is a discussion that you can have at any time with your physician.
Can I be on hospice and dialysis at the same time?
Yes. Medicare guidelines indicate that if you have a qualifying diagnosis for hospice, other than end-stage renal disease, you can have hospice in addition to continuing with dialysis. There are many options we can discuss with you to support you with your care at home. We can compare and contrast home health and hospice, as well as other home care providers and resources, to see which type of care is most consistent with your goals for your care. Hospice can be a scary term for many, but for those who are eligible, and their families, the additional care and support that hospice is able to provide is truly appreciated. Read more on our Dialysis and Hospice page.
Will you help me get a kidney transplant?
Yes. If you start dialysis and you have not yet been evaluated by a transplant team, in conjunction with your physician we will help to facilitate a referral for evaluation to your preferred facility to assess your candidacy. If you are already listed when you start dialysis, or if you transfer from another facility, we communicate with that facility, coordinate your transplant blood work, and we receive quarterly updates regarding your status. If you are a good transplant candidate and this is consistent with your wishes, we provide you with transplant support. While you can wait for a deceased donor, we do help you explore all potential options to encourage you to try to find a living donor.
What if my nephrologist hasn’t talked to me about home dialysis or told me that I am not a good candidate for home dialysis?
Educate yourself about your options. Attend a one-on-one treatment options class at HDT with one of our nurses to discuss your unique situation. Have an informed discussion with your nephrologist at your next visit. If your physician is not receptive, and you would like to further explore your candidacy, contact us and we will help you find a nephrologist that is a proponent of home dialysis who can provide you with a second opinion.
What if my nephrologist does not recommend your facility?
Though physicians ideally should be impartial when it comes to referrals for services in the community, particularly Medicare participating providers, emphasizing patient choice and autonomy, this is not always the case. Physicians may have affiliations with a given provider that impacts their ability to be unbiased and neutral. This, again, is about you and your care. You and your family have choices when it comes to the providers you want to utilize. If you have a nephrologist that does not support you utilizing our services, and you want to pursue home dialysis with HDT, we will help you find a nephrologist to support your choices.
What are the credentials of your nursing staff?
The nursing staff at HDT consists of registered nurses with specialized training and experience in the care of patients with advanced chronic kidney disease. At HDT, we believe that primary care nursing creates the best environment for the care of our patients. So, you will be assigned a primary nurse upon admission to our facility. That nurse will be responsible for training and will ensure continuity of your care.
What if I switch from in-center hemodialysis to home dialysis, and I don’t like home dialysis?
In our experience, patients who switch from in-center hemodialysis vow never to go back. However, if you try home dialysis, and desire to return to in-center hemodialysis, we will support your wishes for your care, and coordinate your return to in-center hemodialysis.
Do you have additional questions? Contact us to coordinate a 1-on-1 options education class with one of our nurses. At your options education class, you can also arrange to have access to a registered dietician or licensed clinical social worker to address concerns specific to you and your family.