Frequently Asked Questions
Home hemodialysis is a way to do hemodialysis in your own home using a compact dialysis machine and a special blood filter called a dialyzer. The treatment itself is the same basic process as in a dialysis center: your blood travels through sterile tubing to the dialyzer, waste products and extra fluid are removed, and your cleaned blood returns to your body. You still need a vascular access, such as a fistula, graft, or catheter, just as you would for in-center dialysis.
The main difference is where and how the treatment is delivered. In-center hemodialysis usually happens three times per week on a fixed schedule, with nurses and technicians running the machine. Home hemodialysis allows you and a trained care partner to perform treatments yourselves. This often makes it easier to adjust the timing and frequency of treatments to fit around work, family, or school. Some programs offer several schedule types, such as conventional three-times-per-week home treatments, short daily home hemodialysis, or nocturnal home hemodialysis done while you sleep.
For many people with kidney failure, home hemodialysis can reduce travel time, give more privacy, and create a stronger sense of control over treatment. It is not automatically the best option for everyone. The right choice depends on your overall health, your home situation, and your comfort with learning new skills. A detailed options education visit, ideally one-on-one with an experienced home dialysis nurse, is the best setting to compare home hemodialysis with peritoneal dialysis, in-center hemodialysis, and transplant, and to decide what matches your goals.
Most adults with end stage kidney disease can be considered for home hemodialysis if they are medically stable, willing to learn, and have a safe physical environment for treatments. Common factors that support success include the ability to follow instructions, take an active role in your care, and keep a clean, organized treatment area with enough space for the machine and supplies.
Many programs require that you have a care partner who can attend training with you and help during treatments, especially for tasks like cannulating your access, responding to alarms, and assisting in an emergency. Some patients may eventually handle parts of the process more independently, but this varies by program and by individual. If you have significant problems with blood pressure, frequent hospitalizations, severe cognitive impairment, or other unstable medical conditions, home hemodialysis may not be suitable, or it may require closer supervision. These decisions are made case by case with your nephrologist.
If you are interested in home hemodialysis but uncertain about your eligibility, the next step is usually a structured options education session followed by a consultation with your home dialysis team. That visit can also explore whether another home therapy, such as peritoneal dialysis, might fit your situation better.
There is no single schedule for home hemodialysis. Instead, your nephrologist writes a prescription that specifies how often you dialyze, how long each treatment lasts, and how much fluid and waste should be removed. In many programs, conventional home hemodialysis looks similar to in-center care: about three sessions per week, each lasting roughly three to four hours.
Because treatments at home can be more flexible, some patients use “short daily” home hemodialysis. This usually means more frequent sessions, often five to seven days per week, with shorter runs of around two hours. Others choose nocturnal home hemodialysis, where treatments are done at night while you sleep, often six nights per week or every other night, with slower and longer sessions. These schedules can allow gentler fluid removal and may improve blood pressure and certain lab values for some patients, but the benefits are not identical for everyone and depend on your overall health and how well treatments are performed.
Home hemodialysis requires a structured training program before you are allowed to dialyze on your own. Training typically lasts several weeks. During this period, you and your care partner come to the clinic regularly and learn each step of treatment: setting up the machine, preparing and handling supplies, cannulating the access, monitoring blood pressure and symptoms, responding to alarms, and performing cleaning and disinfection.
At a program like HDT that is centered around home therapies, training is usually one-on-one with an experienced home dialysis nurse, and education does not stop once you go home. Your team continues to review your machine downloads or flow sheets, labs, and blood pressure trends, and they adjust your prescription as needed. Many units now use remote patient monitoring, where data from your machine are transmitted electronically to the clinic so nurses can identify potential problems between visits. You also have access to 24/7 on-call nursing support for urgent questions, and a social worker and dietitian who can help with lifestyle, emotional, and nutritional issues that arise during treatment.
In most home hemodialysis programs, a care partner is required. This might be a family member or close friend who attends training and is present during treatments. Their role includes helping set up the machine, checking the access during treatment, and assisting if you feel unwell. If you do not have a care partner, it is still worth discussing options with your care team, since programs sometimes have creative solutions or may recommend another home modality such as peritoneal dialysis that can be done independently in many cases.
Home hemodialysis is considered a safe and medically accepted alternative to facility based hemodialysis when patients meet eligibility criteria, complete training, and have ongoing support from a dialysis program. National guidelines, insurance policies, and regulatory agencies recognize home hemodialysis as an appropriate treatment for people with end stage renal disease when they are stable and able to manage treatment or have a trained caregiver.
The main risks are similar to those in a center. They include drops in blood pressure, cramps, problems with the vascular access, and rare but serious events such as significant bleeding or air getting into the blood circuit. Infections at the access site are a concern whether dialysis is done at home or in a clinic, which is why strict hand hygiene, cleaning procedures, and regular access checks are part of your training and monthly care.
Your training includes specific steps on what to do in different scenarios, such as dizziness, unusual pain, machine alarms, or suspected infection. You will be given clear thresholds for when to stop treatment, when to call the on-call nurse, and when to seek emergency care or call 911. Home Dialysis Therapies of San Diego also provides written emergency plans that cover power outages, earthquakes or other disasters, and temporary backup in a local dialysis center if home treatments are interrupted.
Many people choose home hemodialysis precisely because they want more control over work, family, and daily life. By moving treatments into the home and adjusting the schedule, it is often easier to maintain employment, attend school, and/or spend time with your family compared with a fixed in-center schedule. Short daily or nocturnal home hemodialysis schedules can free more daytime hours, although you still need to allow for treatment setup, cleanup, and regular clinic visits. Your social worker and nurse can help you plan around your job, transportation needs, and energy levels so the treatment plan is realistic.
Travel is possible on home hemodialysis but requires planning. Supplies can often be shipped ahead to your destination, and your clinic can help you arrange backup treatments at another dialysis center if needed. For some trips, especially international travel or cruises, peritoneal dialysis or temporary in-center hemodialysis might be more practical. The key is early communication with your home program and your social worker so that logistics, backup plans, and emergency contact information are in place before you leave.
Regarding cost, home hemodialysis is usually covered by Medicare and most private insurance plans when prescribed by your nephrologist. Medicare rules are specific: for patients who are eligible for Medicare based on kidney failure, choosing home dialysis (peritoneal dialysis or home hemodialysis) can remove the usual 90-day waiting period that applies when you start with in-center hemodialysis. In that case, Medicare coverage can begin on the first day of the month in which you start home dialysis training. You may still have deductibles, coinsurance, and out-of-pocket costs such as higher utility bills. Our team can review your individual insurance plan, help you apply for programs such as Medi-Cal, and guide you to transplant-related financial resources when appropriate.
