Home Program

The home program is the solution for a patient that wants to continue with this normal routine. With this program patient don’t have to go out to specific clinic; everything can be done at convenient patient home.

Here are some options for home dialysis:

Peritoneal dialysis (PD)

Peritoneal dialysis (PD) is a treatment with few ups and downs, so you won’t feel wiped out or tired after exchanges. With fewer diet and fluid limits and a flexible schedule, you can fit dialysis into your day.

Some benefits of PD are:

• Portable - take it with you
• Flexible - choose treatment times that suit your schedule
• Saves time - make fewer trips to the clinic
• Easy - learn it in a week or two
• No needles - avoid needle sticks
• Fewer limits - eat a more-normal diet

How PD works

PD uses the inner lining of your abdomen (the peritoneum) as a dialysis filter. The peritoneum is lined with tiny blood vessels. Wastes and extra water in your blood can flow out of these blood vessels, through the peritoneum, and into special fluid that you put into your abdomen. Then you drain the fluid, and the wastes, out of your body.

PD catheter

To do PD, you’ll have a soft plastic tube, called a catheter, placed in your abdomen or chest by a surgeon. You’ll learn how to use the catheter to fill your abdomen with a sterile fluid called dialysate. Most people use about 2 liters of dialysate for each treatment.

PD exchanges

After you put the dialysate into your abdomen, it stays there for a few hours. The period between putting fresh fluid in and taking used fluid out is called dwell time. While you go about your day, the fluid will collect all the wastes and water it can hold. Then you drain out the used fluid and put in clean fluid. This process is called an exchange. There are two types of exchanges:

1. Exchanges by hand - Some people do exchanges by hand, usually four each day: one when you wake up, one at lunch time, one at dinner time, and one at bedtime. Each takes about 20–30 minutes. This is called continuous ambulatory (walking around) PD, or CAPD.

2. Exchanges with a machine - most people who do PD use a cycler machine. The cycler does a few exchanges for you at night while you sleep. Your days may be free, or you might need to do one exchange during the day by hand. Your cycler prescription can be adjusted to you. This is called automated PD (APD), or continuous cycling PD (CCPD).

Getting ready for PD

Catheter Placement can be done as outpatient surgery so you won’t need to stay in the hospital. Some people have little or no pain afterwards; others have pain for a few days.

Ask the surgeon who puts in your catheter to put a “transfer set” onto your catheter at the same time. A transfer set is a tubing extension with a valve that will open and close the catheter. Having a transfer set will make it easier for you to get started with PD. You should also ask the surgeon to make sure the catheter won’t exit your body at your belt-line or under a skin fold. This will make your catheter much more comfortable and easy to live with, as well as to keep clean.

After surgery, your PD training nurse will check your catheter, flush it with fluid, and teach you how to change the dressings until it heals (usually about a week or so).

Training

Once your catheter is placed, you’ll have one to two weeks of training. Your PD training nurse will teach you how to:

• Store and order your supplies
• Keep treatment logs
• Take your blood pressure
• Follow your diet and fluid limits
• Recognize and report any problems
• Set up a good place to do exchanges
• Wash your hands
• Take care of your catheter and exit site
• Do an exchange
• Learn what kind of dialysate to use and when to do an exchange
• Use your cycler (if you do APD or CCPD

A PD nurse will be on call 24 hours a day if you need help.

When you first begin to put fluid in, you are likely to feel very full and even stretched. After a week or two, you’ll get used to the fluid and it won’t bother you.

Availability

PD is the most common type of home dialysis. It is offered in every state. There are about 5,600 dialysis clinics in the U.S., and about 40% train people to do PD.

Cost

In the U.S., a large part of the cost of PD is paid for by the Medicare ESRD Program. Most Americans (93%) qualify for these Medicare benefits, no matter how old they are. Cost for you: Do you have a job with a health plan? If you do, your health plan will pay first for your first 30 months of dialysis treatments. Medicare, if you choose it, will be secondary. That means it will pay all or some of the balance left over after your health plan pays (if the charge is something Medicare pays for). Depending on your insurance plan, you will most likely have some co-pays.

If you don’t have a health plan through an employer, PD can really help you cut the costs you have to pay for dialysis. Why? Most people under age 65 can’t get Medicare until the 1st day of their 3rd month of dialysis. Those 3 months of treatments can cost tens of thousands of dollars! But if you choose PD, Medicare Can start pay on day 1 of treatment. If the timing is right, Medicare may even pay for your catheter surgery.

Even though it is not easy, read your health insurance policy. Some health plans charge co-pays per day for PD. You may be able to avoid plans like these if you read the fine print.

Cost for your clinic: Medicare pays your clinic a fee for each dialysis treatment it provides. The fee covers the cost of treatment plus the cost of the medications and supplies you use during the treatment. Because the fee covers all of those things at once, it’s called a bundled payment. The bundled-payment system may help more people choose PD for treatment, because clinics are able to make more money when people feel better and use fewer meds. Both of these tend to be true on PD.

Time

You can do PD at home, at work, or when you travel. Manual PD exchanges do take time each day, but you can choose the time to fit your schedule. PD with a cycler at night lets you do your treatments while you sleep so that you can leave your days free. Once you’re trained, you’ll only have to go to the clinic once a month to check your lab tests and treatment logs. You’ll also need to allow time to check your supply levels, order supplies each month, and receive the shipment.

Helper tasks

You can do PD without a helper. If you have someone who can help you, he or she may train with you. They can also help you gather supplies, move boxes, set up the cycler (if you use one), or in some cases, do your exchanges.

PD pluses:

• PD is done all day, or each night—not just 3 days a week. This means no ups and downs in how you feel. You won’t feel wiped out or tired after exchanges.
• You choose your schedule. Fit your exchanges in around your day or do them at night. You can have a more-normal diet than standard in-center HD.
• PD uses no needles and the exchanges are painless.
• Your own body—not a dialyzer—cleans your blood. Your blood does not leave your body.
• You can do PD at home, at work, in a car, or while you travel. Supplies can be shipped to you for free in the continental US. A cycler can go with you, even on an airplane.
• You won’t be around other patients, except at clinic visits. And, you may be more likely to think of yourself as mostly healthy.
• Research shows that the more you know about your treatment and the more you do for yourself, the longer you are likely to live. PD puts you in the driver’s seat.

PD minuses:

• Dialysate has sugar in it, which can cause weight gain.
• The catheter is a doorway into your body. Infection (peritonitis) can occur at any exchange, so you need to follow the PD steps just as you are taught.
• Due to the risk of infection, your care team may want you to avoid tub baths, or swimming in lakes or ponds. (If your PD catheter is in your chest, you can take baths, but swimming is still not advised.)
• There are no days off from CAPD. It must be done a few times each and every day.
• Supply delivery times may not be convenient (you may have to miss work), and the boxes are heavy.