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Last Updated 09/13/15

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The benefits of daily hemodialysis treatments seem obvious. Daily treatments more closely resemble normal kidney function than three-times-a-week treatments. It also means fewer dietary and fluid restrictions as well as fewer medications. Patient testimonials about the benefits of daily treatments are abundant.

Medicare payment policy, also known as the composite rate, is based on three-times-a-week dialysis. This is, at first glance, less expensive for the government than daily treatments. Evidence is building, however, that daily treatments may result in overall lower healthcare costs for end-stage renal disease patients by reducing hospitalizations and lowering overall drug costs.

The most expensive cost component of a hemodialysis treatment is the patient-care (nursing) labor. This can be greatly reduced by performing hemodialysis treatments in the home. A new generation of home hemodialysis machines is currently under development that greatly simplifies their operation and reduces the burden on a home partner. The Internet also makes remote monitoring of the dialysis machines by trained professional staff affordable and convenient.

Warning:  Changes should never be made in a patient's treatment or care based solely on the information found here.  Every patient has unique healthcare concerns and considerations and all these factors must all be taken into account before any changes can be safely made.  All medical and therapeutic decisions must come from a qualified health care provider.  Read RenalWEB's Legal Disclaimer before proceeding.

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Advanced Dialysis Technology (Hemodiafiltration) Moves into Western Australia Homes - Article from Science Network. - September 10, 2015

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Nocturnal Dialysis Program a Success at Royal Jubilee Hospital in British Columbia - Article from Victoria News. - September 8, 2015
Editor's note: Forty years ago, my first job in dialysis was to deliver this kind of dialysis treatment. In my opinion, we haven't improved on the fundamentals of dialysis patient care since then.

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Patient and Caregiver Values, Beliefs and Experiences When Considering Home Dialysis As a Treatment Option: a Semistructured Interview Study - Advance Access abstract from NDT. - September 7, 2015

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It's Time to Start Adequately Funding Home Hemodialysis Training - Article from Nephrology News and Issues. - September 2, 2015

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First Light After the Long Night: A Follow-up Report of the Randomized FHN Nocturnal Trial - Free, Full-Text Article from American Journal Of Kidney Diseases - September 2015

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Mortality, Hospitalization, and Technique Failure in Daily Home Hemodialysis and Matched Peritoneal Dialysis Patients: A Matched Cohort Study - Free, full-text,Open Access Article in Press from American Journal of Kidney Diseases. - August 26, 2015

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Infection-Related Hospitalizations in Home Hemodialysis Patients - Free, full-text, Online First article from Blood Purification. - August 25, 2015

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Home Dialyzors United Submits Comments to CMS on ESRD Prospective Payment System and QIP Program - Comments on the proposed rules for the calendar year (CY) 2016 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and the payment years (PY) 2018 and 2019 ESRD Quality Incentive Program (QIP), which was published in the July 1, 2015 Federal Register, vol. 80, no. 126, pages 37806 – 37860. - August 24, 2015
Editor's note: Today is the last day to comment on these proposed rules. At 6 a.m. this morning there were 179 comments received. The majority appear to be from patients concerning home hemodialysis.

Many dialysis providers and nephrologists are holding patients hostage in their clinics until CMS increases the reimbursement for home training.

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Manitoba to Reimburse Dialysis Patients for At-Home Utilities - Article from Winnipeg Free Press. - August 20, 2015

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blue ball Latest Scientific Journal Articles on Home and Daily Dialysis Continually Updated!
Home Dialysis Central web site
Nocturnal Home Haemodialysis web site
Home Dialyzors United web site
Current Issues of Home Dialysis Central Newsletter
Current Issue of At Home with AAKP an electronic newsletter produced and distributed by the American Association of Kidney Patients (AAKP)
Alliance for Home Dialysis web site
Home Hemodialysis Fact Sheet (pdf format requires Adobe Acrobat reader.) from the American Nephrology Nurses’ Association
PD and Home Hemo Coverage Maps from the Home Dialysis Central web site
Home Hemodialysis (pdf format requires Adobe Acrobat reader) from the National Kidney Foundation (NKF) web site
Home Hemodialysis: Helping Patients Lead a Healthier Life online seminar from the American Association of Kidney Patients (AAKP)
Home Hemodialysis from the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
Home Dialysis DVD from Home Dialysis Central web site
Home Dialysis Assessment Tool (pdf) from the Home Dialysis Central web site

Live healthier, better, longer with more frequent home hemodialysis an educational booklet that outlines the documented benefits and risks of home and more frequent home hemodialysis therapy from the NxStage web site

Book: Daily and Nocturnal Hemodialysis by Lindsay, Buoncristiani, Lockridge, Pierratos, and Ting © 2004

Book: Help, I Need Dialysis! How to have a good future with kidney disease by Dori Schatell, MS and Dr. John Agar © 2012

Nocturnal Home Hemodialysis - A First Person Account, Part I and Part II by Michael Williams
American Nephrology Nurses Association (ANNA web site) position on daily home hemodialysis

Self-Cannulation - Video via Renal Fellow Network web site

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A Home Dialysis Slide Show—And Sign Up For A Meeting! from the NxStage web site

blue ball Search result for Nocturnal dialysis by Google Continually Updated!
Home Dialysis web sites by Yahoo! Continually Updated!
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Find a home dialysis center in your area from the Home Dialysis Central web site
The following Frequently Asked Questions (FAQs) were prepared by the staff of the Nocturnal Home Hemodialysis (NHHD) program at the Humber River Regional Hospital in Toronto.
Lynchburg Nephrology (Virginia) has their Nightly Home Hemodialysis (NHHD) Program.
Rogosin Kidney Center of The Rogosin Institute is the first center in the New York City metropolitan area to offer patients nocturnal hemodialysis. This type of self care home dialysis offers patients independence and freedom for day time activities.

Four, well known, not-for-profit dialysis providers:

Northwest Kidney Centers
Rubin Diaylsis Center
Satellite Healthcare

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  PUBMED SEARCHES (National Library of Medicine's MEDLINE Database)
daily dialysis AND hemodialysis Continually Updated!
home hemodialysis Continually Updated!
nocturnal AND dialysis Continually Updated!
MEDLINE / Pubmed Information from the National Library of Medicine
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  K/DOQI™ -  Kidney Disease Outcomes Quality Initiative
NKF-K/DOQI Clinical Practice Guidelines

Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates
K/DOQI Home Page from the National Kidney Foundation web site
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Care-Partners for Home Dialysis discussion page
Daily, Home, Nocturnal Hemodialysis Discussion Forum - RenalWEB Discussion Forum
Home Dialysis Central Face Book discussion page
Home Dialyzors United Face Book discussion page
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Adequate Hemodialysis Therapy - topic page from RenalWEB
Hemodialysis Dose and Adequacy from NIDDK
Clinical Practice Guideline on Adequacy of Hemodialysis - a book available from the Renal Physicians Association web site
Consensus Statement: Mortality and Morbidity of Dialysis from the NIH Consensus Development Program (written in 1993 with 1998 update)
United States Renal Data System (USRDS) 
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E-mail to RenalWEB on the Hemodialysis Adequacy Topic
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