During hemodialysis, blood is pumped through a filter called a dialyzer, which acts as an artificial kidney. The dialyzer is made up of thousands of lengthy fibers, with blood flowing through the inside of the fibers and dialysate on the outside. Small pores in the sides of these fibers allow for the removal of water and toxins by the dialysate. The important parts of your blood, such as proteins and blood cells, are too big to fit through the membrane, so they stay in your body and keep you healthy – only the unhealthy waste products pass through the membrane so they can be removed by the dialysate. The clean blood is then returned to the body, with the blood circulated through the dialysis machine several times throughout a dialysis treatment, becoming a little bit cleaner each time it passes through the machine.

Where to have Hemodialysis

In-Centre Hemodialysis

During in-centre hemodialysis, patients usually go to a dialysis unit in a hospital or a dialysis centre 3 times a week, receiving 4 hours of dialysis each treatment. Sometimes other schedules are available, such as 2 hours 6 days a week or even overnight 3 nights a week. A nurse or a dialysis technician will perform all of your dialysis for you.

The dialysis centre will provide you with your schedule of the days and time (morning, afternoon, or evening) of your treatment. This will usually remain consistent for the entire duration of your dialysis treatments. While patients are on dialysis at the dialysis unit, they are seen by nephrologists, pharmacists, dieticians and social workers to ensure that they are receiving the best possible care.

Advantages of In-Centre Hemodialysis

• Nurses or dialysis technicians perform all aspects of the dialysis treatments, which may be better suited for you
• Many other people dialyze in the same centre, so you can develop friendships with other dialysis patients

Disadvantages of In-Centre Hemodialysis

• You will have to travel to and from your dialysis centre 3 times a week, either by driving yourself (or having a family member or friend drive you), paying out-of-pocket for a taxi or public transportation, or you may be eligible for accessible transportation
• Your dialysis schedule is fixed, such that your treatment days and time are consistent, which offers limited flexibility
• Since the nurses or dialysis technicians complete all of your dialysis, this leaves little opportunity for you to be involved and take an active role in the care you receive
• You have limited privacy since other people receive dialysis at the same time as you

Home Hemodialysis

As an alternative to going to a dialysis unit several times a week, if you are eligible…

You can be trained to perform your own hemodialysis in the comfort of your own home. Dialysis nurses will train you to complete your own dialysis treatments, from start to finish, and you will learn how to solve any problems that may arise during dialysis, just as nurses do during in-centre dialysis. Your house will need to be assessed by a plumber and an electrician to make sure that the dialysis machine will properly work, and once you are fully trained on how to perform your own dialysis, a dialysis machine will be set up in your house.

Schedules of Home Hemodialysis

There are 3 different hemodialysis regimens that can be done at home:

1. Conventional home hemodialysis – this is done 3 times a week, for 4 hours each treatment
2. Short daily home hemodialysis – this is usually done 5 to 7 times a week, for 2 hours each treatment
3. Nocturnal home hemodialysis – this is usually done 6 times a week while you sleep, for approximately 8 hours each treatment. Your machine will be set up so that you will be notified and woken up if something needs to be changed on your dialysis machine. This enables people to feel the healthiest and provides the best quality of life, since it is the most frequent, and longest amount, of dialysis in a week. Patients have been able to get pregnant and deliver healthy babies while on this form of dialysis. Similarly, if you do become pregnant on other treatments, you should switch to this form of therapy to assure the healthiest outcome for yourself and your baby.

Advantages of Home Hemodialysis

• You can perform your dialysis treatments in the comfort of your own home
• You can have greater flexibility in terms of the days and times you perform your dialysis
• You do not need to travel to a dialysis centre 3 times a week
• You can feel more independent and take an active role in your own health care
• With nocturnal home hemodialysis in particular, you can return to normal life with no interruptions to your day, especially with respect to work, since you receive dialysis at night while you sleep

Disadvantages of Home Hemodialysis

• You and/or your partner may need to take time off work in order to receive hemodialysis training by a dialysis nurse
• You need to ensure that there is enough space in your house that can be used for the dialysis machine and all the dialysis supplies
• It may be difficult to separate your health/kidney issues from other aspects of your life by having a dialysis machine in your home