What is the best Home Dialysis Routine?

Dulcie emailed me recently with this home HD question:

I’ve been reading your blog for about six months now and it has been a great support. My husband’s kidney failed last year after eighteen years and he has started dialysis again. He’s in the process of training up for home hemo and I wondered if you had any advice as to how many times a week he should dialyse for when he starts at home? In centre he has been doing Monday, Wednesday, Friday 3.5 hrs each.

My reply:

Hi Dulcie.  I am a big believer in short, frequent dialysis: it minimises the toxin build-up and the shock to the body after each session.  It also helps reduce the roller coaster ride of feeling well, then feeling weak and washed out, then feeling well, etc.

I dialyse 5 days @ 3 hrs per session.  That routine suits me; I feel healthy and have the energy I need to work and relax through each day.  However there are other alternatives available on home HD, including nocturnal dialysis.  Some Home HD patients dialyse four nights a week for 7+ hrs per night (the dialysis pump is usually set much slower that daytime dialysis).  Many people on nocturnal dialysis swear by it: better blood results, reduced meds and generally good health.

But for the best advice, we should put your question onto the blog.  Many BigD readers  have strong opinions about the best routine that are really worth hearing.

So let’s ask them.

8 thoughts on “What is the best Home Dialysis Routine?

  1. I’m a Home Hemodialysis patient. I dialize 5 times a week for 3 hours. How can someone do hemo treatment when sleeping? That sounds very dangerous. I know Peritoneal Dialysis patients can dialize while sleeping but that doesn’t involve their blood. Also I wonder who is this lady’s husband’s helper. Is he going to come home and hook himself up? My wife had to train with me. I couldn’t do any of this without my wife. I stick myself, but I have an upper arm fistula and can not reach the lines to hook myself up.


    • Hi Jonathan, I do home haemodialysis every second day for 5 hours, like you, my fistula is on my upper arm, but I can do everything myself. You should be provided with some long tubing fistula needles, they are a few inches longer than what’s provided in the fistula packs, and I can hook myself up easily and withdraw the needles as well. My wife attended some training sessions with me, but more to learn how to cope if I passed out from low blood pressure.


  2. Pingback: What is the best Home Dialysis Routine? - Home Dialyzors United

  3. The best routine is the one that suits you.
    I aim for 2 sessions of 3 hours in every 3 days. I’ll do a little more or less depending on how busy I am, and whether I’ve been sensible with diet and fluids. Very rarely I’ll take two consecutive days off, but on the whole it’s not worth falling behind.
    I’m entirely independent in terms of getting myself on and off the machine, so I don’t have to worry about coordinating with a helper. It’s a bit of a challenge getting to this point, but well worth the effort. It means I have more flexibility, and I feel less like a patient, and more like a survivor. Home dialysis has been a tremendous boon, and I hope your husband gets the same benefits.
    I would definitely consider nocturnal hemodialysis, as I’ve heard from a number of people that they feel almost normally well on it, but the noise from the water treatment machine would keep my wife awake, I fear.


  4. Hello All,

    I’m an advocate for nocturnal home dialysis. I wouldn’t do it any other way.
    I do 9hrs every second night. I can do everything myself if needs be, but usually my wife helps by setting up the machine whilst I shower and set up the table.
    It took me a while to get used to sleeping with the needles in. You use tape and mefix to hold the needles in place and it make it feel very secure. Although my fistula is in my forearm so it might be different for others. It was about 3months before I felt like I got a restful night’s sleep. I still feel a little tired after dialysis, so I usually nap for an hour after coming off.
    But I work full-time and would say I feel normal most of the time. I barely have to restrict my diet – just can’t go overboard with potassium. Whereas prior to doing nocturnal I was doing 4hrs 4 times a week. On that regime I could not get my phosphate below 2.0mmol/L even when taking a maximum dose of binders and restricting my diet as best I could. It was often around 2.2 even after dialysis. Yet immediately after my first 8hr nocturnal session my phosphate was down to 1.3 and is now not a problem and I’m on no binders.

    A lot of people are worried about sleeping with needles in. However I’ve never had a problem or hurt myself. The first few weeks you don’t get a good sleep and I felt quite sore in the neck from tensing up subconsciously and not relaxing. But if you persist you can train yourself to not roll over and still get a good nights sleep. If you can sleep in the chair, you can learn to sleep over night in bed.

    My wife sleeps in the other room on Dx nights, to give me more room and partly because of the noise. If you’ve spent as much time in hospital as most of us have, the noise won’t bother you too much.

    If you can cannulate yourself and have a machine at home – why wouldn’t you do the extended hours over night? You’ll feel better, free up your days and your long term prognosis will improve. I’m currently considering upping it to 6 nights a week, however I really like the nights off. So haven’t quite done it. However, those I’ve spoken to reckon you’ll never go back if you do because you feel even better.


  5. I am on home haemo and dialyse 4.5 hours every second day. I work and finds that this works for me. I dialyse when I come home – watch my bad tv that I have recorded during the day, have tea and play a bit of Candy Crush and the time has gone. When you get home you will figure out a routine that suits everyone. I was told a long time ago to fit your dialysis into your life not your life into dialysis. This philosophy has worked well for me for 32 years! Good luck!


  6. I’m glad this works for so many. I’ve been on home hemo for over a year and still have not found a a schedule that works well. My unit advocates nocturnal, but I a rarely able to sleep through the night. When I try to get on early after work so as to sleep on the machine, my sleep is still difficult because I’ve spent so much time in bed. I’m not well rested and feel exhausted all the time. I can barely keep my eyes open during the day. I do treatment every other day.


  7. A note from Lucie:

    We’ve been dialysing at home for just over two weeks now and everything was going well until we got the alarm message Microbubbles in bubble trap. We got ourselves out of the situation as best we could but has anyone else had to deal with this error message or the other error message we dread getting “Air in the line below bubblecatcher”?



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