In-Center vs. Home Dialysis: Your Options
Compare in-center hemodialysis, home hemodialysis, peritoneal dialysis (CAPD and CCPD), and nocturnal options, plus how home training works.
The main types of dialysis
When kidneys fail, dialysis takes over part of their job by removing waste and extra fluid from the blood. There are two basic kinds. Hemodialysis filters your blood through a machine and a special filter called a dialyzer. Peritoneal dialysis uses the lining of your belly as a natural filter, with a cleansing fluid (dialysate) that flows in and out through a soft tube. Both can be done at home, and hemodialysis can also be done at a dialysis center. The right choice depends on your health, your daily life, and the support you have, so it is a decision to make with your kidney care team. Kidney transplant is another treatment option to discuss.
In-center hemodialysis
This is the most familiar option. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), you usually have a fixed time slot about three times a week, and each treatment lasts about four hours. Trained staff handle the treatment and are with you the whole time.
- Pros: no equipment or supplies at home, and staff are always present.
- Trade-offs: a set schedule, travel to and from the center several times a week, and less flexibility.
- Evening and overnight options: some centers offer shifts that start after 5 p.m., which can help if you work during the day. NIDDK notes that some centers also offer in-center nocturnal dialysis, done three nights a week while you sleep, with longer treatment times.
Home hemodialysis
With home hemodialysis, you (often with a care partner) run the treatments yourself after training. NIDDK describes three common schedules:
- Standard home hemodialysis: three times a week or every other day, for 3 to 5 hours.
- Short daily hemodialysis: 5 to 7 days a week, for 2 to 4 hours.
- Nightly (nocturnal) home hemodialysis: three to six times a week while you sleep.
NIDDK notes that training may take 4½ to 6 hours a day, 5 days a week, for 3 to 8 weeks. Home hemodialysis can give you more control over your schedule, but it requires space for equipment and supplies and a commitment to learning the process.
Peritoneal dialysis: CAPD and CCPD
Peritoneal dialysis is done at home or anywhere clean and private, without needles. A catheter is placed in your belly, and NIDDK suggests planning that placement at least three weeks before your first treatment. There are two main types, described on NIDDK's peritoneal dialysis page:
- Continuous ambulatory peritoneal dialysis (CAPD): you change the fluid by hand at least four times a day. Each exchange stays in your belly for 4 to 6 hours or more, and you sleep with fluid in your belly at night.
- Automated peritoneal dialysis, including continuous cycling peritoneal dialysis (CCPD): a machine called a cycler fills and empties your belly three to five times during the night while you sleep.
Training usually takes one to two weeks with a dialysis nurse. The most serious risk is infection, including peritonitis (an infection of the belly lining), so careful hand-washing and technique are essential.
How home training and coverage work
Home dialysis training must be provided by a facility certified for home dialysis training. According to Medicare's dialysis coverage page, Part B covers training for you and the person helping you, along with home dialysis equipment, supplies, and certain home support services. Your dialysis facility is responsible for providing those home dialysis items and services, directly or through an arrangement.
Starting home training early can also affect when Medicare begins. Medicare coverage based on kidney failure usually starts in the fourth month of dialysis, but it can start in the first month if you take part in a home dialysis training program at a Medicare-certified facility during your first three months and your doctor expects you to finish training. See the Medicare ESRD page for details.
Finding centers that offer home training
Not every center trains patients for home dialysis. Medicare's Care Compare data records whether each facility offers home hemodialysis training and peritoneal dialysis, whether it has a shift starting at 5 p.m. or later, and whether it offers in-center hemodialysis. You can filter for these services in our directory or on Dialysis Facility Care Compare.
If your current center does not offer the option you want, federal rules help you. Under the patients' rights regulation (42 CFR 494.70), your facility must inform you about all treatment options, including home hemodialysis, peritoneal dialysis, and transplant. It must also give you resource information for options it does not offer, including other scheduling options for working patients.
Questions to ask your care team
- Which types of dialysis are medically suitable for me, and why?
- Can I keep working, and are evening or overnight treatments possible?
- Where would I store supplies if I dialyze at home?
- Who would be my care partner, and is one required?
- Where is the nearest center that offers home training?
NIDDK's guide to choosing a treatment for kidney failure lists more questions. This guide is general information, not medical advice.