Daily Home Hemodialysis Therapies (DHDD)
Daily Home Hemodialysis means that a patient dialyses at home five (5) to six (6) times a week either on a slow Nocturnal (at night while sleeping) or a short hemodialysis regimen. The treatment is performed by the patient or support person who we can train. The committed support can be a family member, a close friend or paid caretaker. Once the training is complete the patient / support person can now begin to perform the treatments at home.
Home hemodialysis is NOT prescribed simply for patient convenience, though that is certainly part of the benefit; home treatments are prescribed to accommodate more frequent dialysis to achieve better outcomes than can be provided to conventional 3 times a week in- center patients. Patients have to be committed to this goal and agree to usually a minimum of 5 hemodialysis treatments per week to qualify for Quotidian Home Hemodialysis. The goal of the program is get patients to do enough treatments to improve their health outcomes and thus frequent hemodialysis treatments is fundamental and therefore a mandatory part of the home hemodialysis program.
Nocturnal Hemodialysis
Nocturnal Hemodialysis, By far the most efficient form of dialysis, nocturnal dialysis is performed by patients (usually five to six nights a week) while the patient is sleeping. The duration of the treatment is dependent on the patient's sleeping habits which could be anywhere from 6 to 10 hours. This is a slower form of dialysis with slower blood flow and slower dialysate flow with changes in the patient's body occurring more naturally. The amount of blood cleaning is at least 2.5 times higher than conventional dialysis.
Phosphate Removal
Phosphate removal is twice as effective as conventional therapy, with many patients actually requiring additional phosphate in their diet. This allows for most patients to stop using phosphate binders. Most patients undergoing nocturnal dialysis have NO dietary restrictions.
Sleep Disorders
Sleep disorders, which are prevalent in the chronic hemodialysis population are significantly improved. Sleep apnea, a common problem for End Stage Renal Failure patients may be corrected with nocturnal dialysis. No other modality of dialysis has been shown the benefits of nocturnal dialysis to improve sleep disorders.
Anemia
Another condition commonly caused by Kidney failure is anemia which is a reduction of red blood cells in the blood. The main symptoms of anemia are feeling very weak and tired and sometimes being more sensitive to cold.
People with kidney failure have anemia because they have stopped producing a hormone called erythropoietin (EPO) which stimulates their bone marrow to produce red blood cells. Daily Nocturnal Hemodialysis improves anemia and allows a reduction in erythropoietin (EPO) dose needed to treat this problem.
High blood pressure (hypertension)
High blood pressure (also called hypertension) is a common problem for people with kidney disease. High blood pressure is made worse by fluid overload. The excess water in the body increases the volume of blood in the arteries. The extra volume of blood causes the pressure in the arteries to increase. When high blood pressure occurs, patients are given medication to control this condition though in dialysis patients the primary cause of high blood pressure is fluid overload.
The majority of patients on Daily Nocturnal hemodialysis no longer require blood pressure medication because their body fluid level is normalized.
They have normalized albumins ( a protein found in blood and an indicator of nutritional level) and an increase in nutritional status.
Short Daily Hemodialysis (SDH)
Short Daily Hemodialysis (SDH), is performed at home by the patient five or six times a week. The treatment is performed while the patient is awake. The duration of dialysis is usually 2.0 - 2.5 hours. The clearance or cleaning of the blood achieved in six 2.0 - 2.5 hours sessions is equivalent to three 8.0 hour sessions on conventional schedule.( i.e 12 hours of daily is equal to 24 hours of conventional dialysis). Short daily dialysis offers patients flexibility and a better quality of life compared to the three times a week on ‘conventional’ in-center dialysis.
Better Blood Pressure control with a reduction in blood pressure medication is one benefit of SDH.
The use of phosphate binders is reduced, however, patients continue to take some binders.
Patients on short daily hemodialysis display a better fluid and phosphorus management compared with those on "conventional" hemodialysis.
Heart damage in the form of thickening of the heart muscle can be reversed and normalized.
Regardless of the modality choice for home hemodialysis, patients feel better and show a statistically significant improvement in quality of life compared to patients on 'conventional hemodialysis'.
