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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Home hemodialysis

In short

With home hemodialysis you, usually with a trained care partner, run the dialysis machine at home after weeks of training (NKF; NIDDK). You can dialyze on a standard schedule, for a short time on most days, or overnight while you sleep. More frequent sessions remove fluid more often, so the daily fluid allowance is usually larger (DaVita). You need space, supplies, and a plan for power cuts and supply delays (CMS). With type 1 diabetes, check glucose before and after every session, just as in a unit (JBDS–Renal Association).

Your numbers

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

Schedules

Type How often How long Source
Standard 3 times a week, or every other day 3–5 hours NIDDK
Short daily 5–7 days a week 2–4 hours NIDDK; NKF
Nocturnal (overnight) 3–6 nights a week while you sleep, often 6–8 hours NIDDK; NKF

Other numbers

What Number Source
Training 4½–6 hours a day, 5 days a week, for 3–8 weeks NIDDK
Fluid larger than in-center, because fluid is removed more often; your unit sets it DaVita
Protein 1.0–1.2 g/kg a day (70–84 g at 70 kg), as on in-center dialysis KDOQI 2020; KDIGO 2022
Emergency supplies keep spare supplies as your unit directs; 5–7 days of medicines, insulin, strips and glucose CMS
Medicare start can begin in the first month of dialysis if you start a home training program in the first 3 months (otherwise the fourth month) Medicare

Tests to expect

The same blood tests as in-center dialysis: calcium and phosphate every 1–3 months, PTH every 3–6 months (KDIGO 2017), hemoglobin and iron about every 3 months (KDIGO 2026 anemia), and dialysis dose checks by your home unit. For schedules other than 3 times a week, KDOQI measures the dose over a whole week (standard Kt/V, target 2.3, minimum 2.1) (KDOQI 2015, guideline 3.3).

What changes now

What people notice. NKF reports that people on short daily and overnight schedules often need fewer blood pressure medicines, feel less "washed out" after dialysis, have more energy for daily tasks, and have fewer and shorter hospital stays (NKF).

What KDOQI asks your team to tell you. Long overnight sessions on many nights a week can mean more access problems, more strain on your care partner, and a faster loss of the urine you still make (KDOQI 2015, guideline 2.4). Short sessions on most days can mean more access procedures and low blood pressure during dialysis (guideline 2.2).

A care partner. Most programs ask you to have a care partner, who trains with you (NKF). Ask your unit whether your partner must be there for every treatment.

Diet and fluid. Ask your dietitian whether your potassium, phosphorus and fluid limits change on your new schedule. Protein stays at 1.0–1.2 g/kg.

Diabetes (JBDS–Renal Association):

  • Check glucose before and after each session. Glucose is often lowest after dialysis.
  • Your insulin plan is set around your schedule by your team. Ask for it in writing for dialysis days and non-dialysis days.
  • If you dialyze overnight, agree with your team how your CGM low alert is set and who responds to it.
  • Keep glucose tablets within reach of the machine and the bed.

Access care. The same as in a unit: feel the thrill daily, no blood pressure cuffs or blood tests on the access arm, and watch for signs of infection (NKF).

What to do

  • Ask your unit whether your home has the space, water supply and electrics the machine needs.
  • Choose and train a care partner, if your program asks for one.
  • Register with your power and water companies for priority restoration (CMS).
  • Keep a flashlight and batteries next to the machine (CMS).
  • Ask your unit for a back-up unit, near home and further away, for times you cannot dialyze at home.
  • Keep a 5–7 day supply of medicines, insulin, strips and glucose, and in-date glucagon.
  • Set your dialysis days in the app so it totals fluid, potassium and sodium between sessions (Targets and warnings).
  • Write your session times next to your glucose readings, so your team can see the pattern.

Examples

A power cut on a dialysis night. Follow your unit's emergency steps. Call the unit and, if needed, arrange a session at your back-up unit. Until then, follow your unit's 3-day emergency diet and fluid limit, and try to get dialysis within 3 days of your last treatment (CMS). Keep treating lows straight away.

A short-daily week. On 6 days a week of short sessions, your fluid is removed every day instead of three times a week, so your daily allowance is usually larger (DaVita). Ask your unit for your number, and put it in the app.

An overnight low. Your CGM alerts at 3 a.m. during a session. Your care partner gives 4 glucose tablets (or you take them), you recheck in 15 minutes (ADA 2026 §6), and you report it to your team in the morning.

Ask your care team

  1. Which home schedule would suit me and my care partner?
  2. What does my home need: space, plumbing, electrics, storage?
  3. How long is training, and can my care partner train with me?
  4. Will my fluid, potassium and phosphorus limits change?
  5. How should my insulin plan change on my schedule?
  6. What is the plan for power cuts, storms or late supply deliveries?

Get help now if…

Call 911 (or your local emergency number)

Chest pain; severe breathlessness; fainting; bleeding from your access that is heavy or spurting, or has not stopped after 10–15 minutes of firm pressure, or starts again (keep pressing while you call, AKF); a low the person cannot treat themselves (give glucagon, then call); possible DKA: blood ketones of 3.0 mmol/L or more, or any ketones with vomiting, deep fast breathing or fruity breath; on dialysis these signs count even under 3.0 (2024 consensus). If you must leave in an emergency, follow your unit's disconnection training. Full list: Get help now.

Call your home unit today

No buzz (thrill) in your access; redness or pus at an access or catheter site; a missed session; weight gain above your limit; machine or supply problems you cannot fix.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06. Prices and benefit amounts as of 2026-10-06.