Most states and countries subsidise the cost of dialysis. So you can choose to dialyse in a public unit, a private unit or at home.
- Public units are busy and (by their nature) no frills.
- Private units are for profit, and offer a more personalized service which is funded partly by government and partly by your health insurance provider.
- Home dialysis involves setting up your own BigD machine in a space at your home, usually with special plumbing and wiring, a storage area for supplies and consumables and a disposal service – all paid for by the government.
From a government perspective, the one off setup cost and relatively small consumables cost for home dialysis is the cheapest alternative and is often promoted to new starters.
As for which is the best option for you, there are arguments for both sides.
Dialysing at home
Dialysing at home means you can be independent. You can set your own schedule (and vary it as the occasion warrants). These are big pluses that for many people outweigh the downsides of home BigD
You and a nominated carer (often your spouse or partner) need some training first (which can take a few months) and you can’t dialyse alone. That’s a big commitment for another family member, to be there and to help out at every run, day-after-day, usually for many years. It can be difficult to the point of heroic and I know several people who have come to my unit to give their partner a rest, and have never returned to home dialysis.
In that regard, home dialysis could be a good short term option (say a few years).
There is also the family dynamics, especially when you have children. All of a sudden you are either locked away behind a closed door, or constantly there, the sick person of the family. This is the primary reason why I didn’t go for home BigD: when I’m home, I’m a health member of the family. When I dialyse, I’m out of site (and mind).
Finally, there is the self discipline required. If you dialyse every three days, or daily, you’ve got to dialyse every three days, or daily. No excuses or tradeoffs. No “I’ll do half an hour less today and add 30 minutes to the next run”. It doesn’t work. I know other people who have lost the plot on regular home dialysis and have arrived at a unit on doctor’s orders, de-conditioned and quite unwell.
Dialysing at a Unit
For me, the unit is the best option. I am not dependant on my spouse to dialyse. I get safe dialysis in a flexible environment. The family dynamics are only minimally affected. And while it’s not difficult to swap times, I can be certain I’ll have my full treatment. Also, the three hours I’m on the BigD are mine to do what I like. I don’t have to worry about how the machine is going, about blood flows, fluid levels and pressures (unless I want to), and to have constant responsibility for an effective run.
For me, at my time of life and situation, it’s a clear win: Unit Dialysis – 5; Home Dialysis – 2.