Most dialysis in the United States happens in a center, three times a week, on someone else's schedule. It does not have to.
Home dialysis — peritoneal or hemodialysis — is done by you, in your house, on your terms. Fewer than fifteen percent of American patients do it. In some countries the figure is several times that, which tells you the limit is not medical.
Why patients choose it
No one drives you anywhere. Your week is yours.
Fluid and solutes come off gradually rather than in a four-hour surge, which is gentler on the heart and easier on blood pressure. Patients often describe feeling steadier between treatments than they did on in-center hemodialysis.
Residual kidney function — whatever urine you still make — tends to be preserved longer, particularly on peritoneal dialysis. That matters more than most patients are told.
Diet is generally less restrictive. Travel is easier; supplies ship ahead.
What the training involves
Peritoneal dialysis. The catheter is placed and left to heal for about two weeks. Training runs one to two weeks and covers sterile technique above all — because peritonitis, infection of the abdominal lining, is the principal risk and it comes almost entirely from breaks in technique during an exchange. You learn to perform exchanges by hand, or to run a cycler overnight while you sleep.
Home hemodialysis. Longer. Three to eight weeks, typically. You learn to cannulate your own fistula, operate the machine, monitor yourself during treatment, and recognize and respond to alarms and complications. Most programs require a trained partner at home.
Neither is presented as easy. Patients who are told it will be simple and then find it is not tend to quit.
| Home option | What it involves |
|---|---|
| Home hemodialysis | You run a dialysis machine at home, often more frequently and gently |
| Peritoneal dialysis | Uses your abdomen's lining to filter, done daily — often overnight |
Who is a candidate
More people than are offered it.
Peritoneal dialysis is precluded by extensive abdominal adhesions, a large irreparable hernia, or documented loss of peritoneal membrane function. Severe obesity complicates it. Home hemodialysis requires adequate vascular access and, in most programs, a partner.
What both genuinely require is that you or someone at home can perform the treatment reliably and cleanly, every day, without exception. Vision, dexterity, cognition, and home environment all factor in. Advanced age alone does not disqualify anyone.
Where the training happens
We evaluate whether home dialysis is right for you, determine which modality fits, manage your prescription and your care throughout, and treat the complications when they arise.
The hands-on training itself is delivered at a partner home dialysis unit by a home training nurse, over the weeks described above. We coordinate it and remain your nephrologist throughout.
Timing
This is the argument for having the conversation early.
Peritoneal dialysis needs about a month from catheter placement to independence. A hemodialysis fistula needs three to six months to mature before it can be cannulated at all.
A patient who begins planning at an eGFR of 20 has every option. A patient who arrives in an emergency room at an eGFR of 6 has one, and it involves a catheter in the neck.