The Question: I want to do dialysis at home but am worried. Is it safe? Is it possible?
The Answer: This is the kind of question Alireza Zahirieh, head of home hemodialysis, encounters all the time from patients. The vast majority of them are waiting for kidney transplants – some up to a decade. In the interim, they face coming to hospital for at least four hours a day, three days a week, until they receive a new organ.

With hemodialysis, a machine and special filter are used to clean the blood. To draw the blood, a doctor either inserts a special intravenous catheter in a large vein, usually in the neck or surgically connects a vein to an artery to create what is known as a fistula, which can be needled or accessed during each dialysis session. The blood is withdrawn from the body and then passed through a dialyzer, an artificial kidney.
A small number of those patients are here – 270 of them – including the 12 who are doing hemodialysis at home.
In addition, they also need to monitor their treatment and then be able to do everything in reverse.
The bulk of patients with end stage renal failure are those with diabetes and renal vascular disease.
There are several hemodialysis options at home. In broad terms, dialysis can either be done during the day or done at night, while a patient is asleep. Most patients either choose to do intermittent hemodialysis, which is done every other day or nocturnal hemodialysis, which takes place overnight, four to six nights a week. By comparison, patients who receive their treatments in hospital typically spend four hours on the machine three days a week.
“The typical patient is younger and healthier than the average patient in our unit,” he said, noting that patients doing home dialysis range from their 30s to their 70s.
Either way, it is significant investments in time and patients have to be motivated to undergo the six to eight weeks of training. Patients have to be able to insert needles, properly clean equipment and use the machines, noted Dr. Zahirieh, Assistant Professor of Medicine at the University of Toronto.
“In comparison to the alternative form of home based dialysis [peritoneal dialysis] hemodialysis takes a lot of training, involves a lot of monitoring and is the most involved form of dialysis,” he said.
“This can really limit the number of people who choose to do it. However, I believe it offers a number of unique benefits. It can dramatically reduce and even eliminate some dietary constraints, improve fertility, lead to improvements in heart health and possibly overall health as compared to other forms of dialysis.”