In-Center Hemodialysis (ICHD)

ICHD is a therapy option that filters your blood outside your body using a hemodialysis (HD) machine. It is performed in a dialysis clinic under the supervision of your clinical care team.

What is in-center hemodialysis (ICHD)?

During hemodialysis (HD), the HD machine removes a small amount of your blood from your body through a needle or catheter. The dialyzer then filters your blood, removing waste, toxins, and excess fluid before returning your filtered blood back into your body.

ICHD treatments take place at a hospital or dialysis clinic under the supervision of a clinical care team.

How does ICHD work?

During ICHD, the hemodialysis machine removes a small amount of your blood from your body through a needle or catheter. A manufactured filter, called a dialyzer, then filters your blood, removing waste, toxins, and excess fluid before returning your filtered blood back into your body.

Typically, you will travel to your hospital or dialysis clinic 3 times a week to receive 3-5-hour treatments each time, depending on the dialysis schedule your clinician has prescribed. There, you will be taken care of by a nurse or clinician throughout your treatment.

Before each ICHD treatment, a member of your care team will give you a short physical examination and weigh you to determine how much water will need to be removed from your body. Your treatment access site will be cleaned, the needles needed for treatment will be inserted, and the tubing that connects your access site to the HD machine will be set up. Your HD treatment will then begin, and you will be looked after by a nurse. When your treatment is done and you’ve been disconnected from the machine, your blood pressure will be measured, and you can leave the center.

It is a good idea to arrive early for your ICHD appointments to allow ample time for your healthcare team’s preparation. It is best to wear comfortable clothing and bring a book or other form of entertainment to keep yourself occupied while you’re being treated. During and after your HD treatments, you may feel tired or experience uncomfortable leg cramps or nausea. Therefore, it is common to want to go home and rest. If you experience unusual symptoms during or after your treatment, you should talk to your clinical team about your symptoms.

You may feel some mild pain during the needle insertion phase, and as mentioned before, you may feel tired or experience uncomfortable leg cramps or nausea after therapy. The therapy itself should not be painful.

Choosing a type of ICHD

If you and your clinician decide that ICHD is the best treatment option for you, you may be able to choose between receiving in-center treatments during the day (daytime HD) or, in some cases, receiving them at night (nocturnal HD). Daytime HD is the most common choice of therapy and is the most likely to be available to you. Your sessions will be scheduled at a time that fits your hospital or clinic. Days and times for therapy will be allocated depending on available spaces.

It is crucial that you attend all of your in-center treatment sessions, so discussing your lifestyle needs with your healthcare team in order to find a suitable treatment timeslot is the best way to ensure that it’s easy for you to stay on your treatment plan. You should be aware that it is not always possible to have in-center treatments at the exact time you would prefer – so flexibility is key. You should also talk to your clinician regularly about your treatment options, in case the option you first choose doesn’t work for your lifestyle.

Daytime in-center HD

If you work nights, are retired, or have free time on most weekdays, it might be convenient for you to get treated during the day. You will have to commit to 3-5 hour in-center treatments 3 times per week. A nurse or clinician will administer your treatments for you, so you won’t have to do them yourself.

Nocturnal in-center HD

For some patients, nocturnal HD may be a therapy option. If it will be difficult for you to fulfill your professional or personal responsibilities while receiving daytime HD, nocturnal HD may be the right therapy for you. Nocturnal HD is hemodialysis performed while you sleep at the hospital or clinic. Because it is a longer, slower form of dialysis, it filters your blood in a way that more closely resembles what a natural kidney would do. Because nocturnal HD is done while you sleep, it may fit more easily with a busy daytime schedule. Keep in mind that nocturnal HD is not available to many patients; your clinical team will tell you if it’s an option for you.

If you opt for nocturnal HD, or it is recommended by your clinician, be sure to choose a hospital or clinic that offers it.

Preparing for ICHD

Before your ICHD treatments start, you will need to have a surgical procedure that creates a dialysis access site under your skin. There are three different types of HD access: fistula, graft and HD catheter. Each has its own benefits and drawbacks, and you should discuss these with your care team in order to determine which will be the safest and most effective access option for you.

Typically, a fistula is considered the standard of care in most dialysis centers. The fistula lets unfiltered blood flow from your blood vessels through the HD machine and lets clean blood flow back into your blood vessels. Read on for more information on the three HD access options.

Depending on the strength of your veins and your overall health, your clinician will be able to decide what type of access option is best suited to you. If your clinician decides that you need a fistula or graft, they will need to schedule the surgery in advance of your dialysis start date.

No matter which kind of access type you choose, you’ll have to protect your access site from excess pressure, germs and infection. Remember to clean your hands before touching your access site and consistently check it for signs of swelling and irritation. If you suspect these issues, contact your nurse immediately. This is true for all dialysis treatment options.

Below is a comparison of the three HD access options.

Fistula

A fistula is often the best choice for HD because it uses your own blood vessels, allowing for good blood flow during therapy, and has the lowest chance of infection.
Access to the fistula is created by inserting two needles into the blood vessels in the fistula.
Your surgeon will connect one of your arteries to a vein under the skin of your upper or lower arm.
During dialysis, unfiltered blood will flow from your blood vessels through one needle, connected to your fistula, and your clean blood will flow back into your body through a second needle, also connected to your fistula.
This surgery should be done ideally 2-3 months in advance of your dialysis start date.

Graft

To create a graft, your surgeon will use a piece of medical tubing to connect one of your arteries to one of your veins. This graft will be placed under the skin either on your arm or your leg.
During dialysis, unfiltered blood will flow from your blood vessels through one needle, connected to your graft, and your clean blood will flow back into your body through a second needle, also connected to your graft.

Catheter

Catheters are usually temporary and are only used while you’re waiting to receive a fistula or a graft.
A catheter will be placed inside a vein, either in your neck or your chest. The other end of the tube will exit your skin and be attached to the HD machine tubing.
Catheters are not recommended for long-term use because they can put you at higher risk of blood clotting and infection and provide a slower blood-flow rate.

Benefits of ICHD

ICHD is performed under the supervision of a supportive clinical team, meaning that you can let others take care of you during treatment. You can use your treatment time to sleep, read, work on your laptop, listen to music or do something else you enjoy. You will also have the opportunity to talk to other dialysis patients, so you can exchange information and stories about dialysis journeys similar to and different from your own.

Additional ICHD benefits include:

Gives you the opportunity to get out of the house
May be less invasive for your family
Ability to keep your treatment life separate from your home life

While ICHD has certain benefits, it also has special considerations. You should consider the following before speaking with your clinician about whether ICHD is right for you:

Depending on how far you live from your dialysis clinic, you may need to build transportation time into your treatment schedule 3-4 times per week.
If you require hospital-provided transport to get to your appointments, they may pick you and other patients up early, and you may have to wait for transport after dialysis in order to return home.
Needles must be inserted during each treatment, which may be uncomfortable for you if you are afraid of needles.
During and after your HD treatments, you may feel tired or nauseated.
It may be difficult to plan your daily schedule around your ICHD sessions.

Doctor explaining the benefits of In-Centre Haemodialysis

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Peritoneal Dialysis (PD) at Home

PD is another type of dialysis which can be done at home.

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Automated Peritoneal Dialysis (APD)

APD allows dialysis to be performed while you sleep.

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Home Hemodialysis (HHD)

HHD is an at-home dialysis option that enables you to adjust your treatment schedule around your daily activities.

Talking to your doctor

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