in-center vs home dialysis

[LILO714]

Hi everyone and hope you all had a great weekend. I'm just wondering what made you choose the type of dialysis your on? Was it doctors requests or just a personal choice. My doctor wants me to do home hemo because he said since I'm younger it will be a better quality of life. Any feedback is much appreciated.

[cattlekid]

I agree 100% with your doctor.  I am 41 and work full time and was doing in-center hemo when I started.  It sucked royally.  I had no free time and couldn't make plans to do anything but work and dialysis.  With home hemo, I have more control over my life and my schedule.  If you can make it work, I would take home hemo any day over in-center.

[bevvy5]

Hubby is the "patient".  He started on peritoneal dialysis a little over three years ago.  We thought it would be the least intrusive once he was on a cycler at night. 

With some complications about six months after he started that, he ended up doing in centre hemo for six months.  That was a nightmare, frankly.  Your life is run by what time you have to show up for dialysis.  And he felt like crap.

Then did another year, approximately, on cycler peritoneal but it was not as effective.  He ended up in hospital about a year ago and pretty much started training for home hemo from there.  So he's really run the gamut in the three years and a bit he's been on dialysis.

His "favourite" was peritoneal.  It travels well, easy set up and take down, not much in the way of training.  He felt okay although he was still constantly battling high phosphorus, still pretty restrictive diet.

Home hemo is definitely much better than in centre hemo, especially if you are still able to work.  He normally does eight hours nocturnal every other night.  But it has been so hot here overnight that he's been doing shorter four hour runs during the day.  He coudln't do that if he was in centre.  Also, if we want to go somewhere for a night or two, we still can, just takes some adjusting of the schedule. 

Biggest benefit is that on in centre, three times a week, they'd have to be very aggressive to take his fluid down.  That led to some problems with low blood pressure, dehydration and falling over a lot!!  With longer, more frequent dialysis, his bloodwork is great and it's much easier on him.

We live in Canada so do not have access to NxStage, which I understand can be taken with you.  That would be a huge benefit, especially if you like to travel.

If you can see your way clear, definitely dialyze at home, even if overnight isn't an option.  It just gives you more control and better overall wellbeing, IMHO.

Modified to add:
Hubby's doctor really left the choices up to him.  However, when it became apparent that the PD was not working as well the second time he started and we mentioned that home hemo was really the only other option because in centre had been so horrific, he was extremely positive and put hubby's name in for training immediately.  His neph definitely is very positive about home hemo. 

[LILO714]

Thanks Bevvy5 and Cattlekid for sharing your personal experience

[jbeany]

Home hemo with a nxstage was a huge improvement for me.  I felt better with more frequent treatment from the minute I did it in-center during training.  Having the freedom to do it at home and not have to be in-center was even better.  I lived in a rural area, and the center was an hour's drive in good weather.  It was a nightmare in the winter, with snowy conditions.  Plus, I had to drag myself out of bed and get there, no matter how lousy I felt that day.  I hated having to run on the center's schedule. 

Doing hemo at home meant I could change my start time and my days whenever I wanted to.  If I had plans for a Friday night, I could simply take that day off, or run early in the morning, which ever worked best.  If I was running late getting home, I just started when I felt like that day.  There's no waiting for the staff to get things ready.  I ran 5 days a week, on a rotating schedule so I never had two days off in a row.  This ended my miserable weekends of trying not to drink anything so I wouldn't crash on Monday when they were trying to pull two days and 3 nights worth of fluid off me. 

Of course, there are reasons home hemo doesn't work for everyone.  Most centers want you to have a partner, and that's not possible for some people.  You have to fight long and hard to do it on your own usually.  You also have to have space for the equipment and supplies, and it's not a small amount.  People with pets and small children have to work out ways to keep the treatment area clean and safe for everyone in the house, not just the patient.  It's also a lot of work - there's inventory, setting up the machine, keeping in touch with the staff so they have your results and daily logs.  It takes effort to keep it up and learn how to run it.  Not everyone wants to do it, and not everyone wants to take charge of their own care. 

If you prefer to be in control though, home is the way to go.  There's no dealing with cranky nurses having a bad day, catching colds from other patients in flu season, or freezing in the center's uncomfortable chairs.  You can eat, make phone calls, have company over, pull up an entire table to spread out your books, laptop, craft supplies, etc. instead of trying to lug everything you might want with you and trying to balance it on the useless little tray table attached to the plastic chair.  No headphones for bad tv, and no listening to the senile patient several chairs over yelling and throwing up. ( No smelling them filling their adult diapers or using the commode either.  I hated that the most!)

PD wasn't an option for me, so it had to be hemo.  Home was far, far better.