Some patients may feel nervous about deciding to switch to nocturnal haemodialysis, but for me it was a clear choice. I had been going to a centre to dialyse for 16 years, which took up a lot of my time – six hours during the day, three times a week, so in total 18 of my waking hours every week. It was the most inconvenient part of my life, comprising a lot of time, effort and travel expense. This began to matter more once I had a family, as I wanted to be able to spend every spare moment with my wife and child.

I have been on dialysis since I was a 17 due to my kidney syndrome, focal segmental glumerelosclerosis (FSGS). I’d never haemodialysed at home before, but I knew there were huge benefits in doing so more frequently. I thought home haemodialysis was unavailable to me until I switched consultants and (my new consultant) immediately suggested nocturnal dialysis. I was the perfect candidate due to the fact I’m young, have a family, and work long shifts.

Switching was surprisingly simple. I’d been needling myself in-centre for a while beforehand, so I had no fear to get over. It only took me and my wife/care partner a couple of weeks training with nurses and I was ready to go home (alongside a couple of supervised sessions). I think my wife was more nervous than I was. She worried we would need expensive adjustments to our home and that she wouldn’t get any sleep. But the machine isn’t noisy, and we simply had to run a water pipe to our bedroom because it isn’t next to the bathroom.

Nocturnal dialysis allows you to dialyse every day, for as long as you sleep. It’s a gentler, longer process than dialysing only a few times a week in-centre and puts far less stress on my heart1. Since switching to home haemodialysis, I have always dialysed overnight and have noticed huge benefits to my health, life and wellbeing.

When I first started, it did unsettle my sleep for a short time but now I don’t notice it. For me personally, the benefits definitely outweigh that brief period of restlessness a million times over. I have so much more energy than before, which is very much needed with two children, and can take on my fair share of parenting duties.

As a chef, I work long hours and often have split shifts. When dialysing in-centre, I used to struggle driving back and forth, but I can now cycle the 10 miles to work. I can also eat a wider variety of foods and have cut the amount of medicine I need to take. I am so much happier.

I haven’t looked back since switching to nocturnal dialysis, and it’s been five years. I can now fill my days with the life I want to lead. No more sitting around waiting for the day to begin.

Risks associated with More Frequent Home Hemodialysis
Studies suggest that patients performing more frequent home hemodialysis may experience slightly fewer complications associated with their treatments and may experience improved clinical outcomes. However, there are certain risks unique to treatment in the home environment. Treatments at home are done without the presence of medical personnel and on-site technical support. Patients (and their care partners, if required), must both be trained on what to do and how to get medical or technical help if needed. When vascular access is exposed to more frequent use, infection of the site, and other access related complications may also be potential risks.

Increased Risks Associated with Home Nocturnal Hemodialysis Therapy
Certain risks associated with hemodialysis treatment are increased when performing nocturnal therapy due to the length of treatment time and because therapy is performed while the patient and care partner are sleeping. These risks include, but are not limited to, blood access disconnects and blood loss during sleep, blood clotting due to slower blood flow or increased treatment time or both, and delayed response to alarms when waking from sleep. Treatment with nocturnal therapy may require adjustments to medications, including but not limited to iron, Erythropoiesis-Stimulating Agents (ESA), insulin/oral hypoglycemics, anticoagulants, and phosphate binders.

References
  1. FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24):2287-2300.
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