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Peritoneal dialysis (PD)
You can find extensive information about PD on our website, including the following topics that you may find useful:

  • Your life and PD
  • Continuous ambulatory peritoneal dialysis (CAPD)
  • Automated peritoneal dialysis (APD)
  • Getting started on PD
  • Training for home
  • Problem solving while on PD
  • Choosing the right option
  • Holidays on peritoneal dialysis
  • Health and dialysis

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Technology
You can find detailed information about available equipment for PD in our ‘Technology’ section, which you can find here.

Further reading

Home haemodialysis (Home HD)
You can find extensive information about Home HD on our website, including the following topics that you may find useful:

  • Your life and Home HD
  • How Home HD works
  • Day or night dialysis
  • Getting started on Home HD
  • Training for home
  • Problem solving while on Home HD
  • Choosing the right option
  • Holidays on home haemodialysis
  • Health and dialysis

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You can also find detailed information about:

Water treatment

Technology

Environmental issues

Publications

Research and journals

Setting up a home hemodialysis unit
The International Society for Hemodialysis (ISHD) has developed a complete suite of guidelines for any dialysis unit that is offering home haemodialysis. These include infrastructure, funding, workforce, patient safety, patient selection and training, vascular access, water and machines.

You can download the guidelines here

Recommended weblink

Further reading

Renal study courses

Online Nephrology Education portal (ONE)
ONE is a gateway to peer-reviewed renal education on the Internet. The site is managed by the Nephrology Educators Network. ONE offers a wide range of educational packages about all modalities of renal replacement therapies, which have been developed by a number of participating groups. 

Through ONE we provide packages on supportive care, chronic kidney disease and self-management. There’s also a package on home dialysis by Home Dialysis Firsts. You can visit the ONE site here.

Water
Water is an essential element of life and plays a very important role in haemodialysis. During dialysis, the person’s blood is exposed to a solution called dialysate through the dialyser (filter). The dialysate is made mostly of water and the same salts that are normally found in the body.

If the water is not clean, it’s possible for substances from the water to cross through the filter into the blood, which may have serious consequences for the person receiving treatment.

From the moment water is naturally formed (as rain) it starts becoming contaminated. Water can be contaminated by microorganisms (bacteria and endotoxins) and also by metals and chemicals such as aluminium, copper, calcium, fluoride, chlorine, chloramines and pesticides.

These contaminants are harmful to a person who is on haemodialysis and must be removed from the water prior to use.

Water quality
Sources of water are classified as either treated or untreated. Untreated water includes rainwater, river water, underground water from bores or aquifers, and brackish or sea water.

The World Health Organization has declared that drinking water must be bacteriologically and chemically safe to drink. In order to achieve this, raw water is treated by the local water management authorities with various chemicals, usually chlorine and/or chloramines, which destroy bacteria.

Other processes and chemicals are also used to achieve the standard of cleanliness required for drinking water. If the water is safe to drink, it can be treated and used for haemodialysis. To do haemodialysis at home it’s not essential to be connected to mains or town water.

A higher standard of treatment is required for water for haemodialysis, as approximately 120 to 300 litres of water is required for a single dialysis session. The amount of water used generally depends on the number of hours of dialysis.

The Association for Advancement of Medical Instrumentation (AAMI) has established recommended standards of water quality for haemodialysis, and water and dialysate are regularly laboratory tested to ensure that recommended standards are achieved.

As well as water treatment and adequate filtration, this high standard is maintained by disinfecting dialysis machines prior to each use and by regularly disinfecting the reverse osmosis unit.

Water testing can include bacterial counts, endotoxin testing, chlorine sampling, and heavy metal analysis. Protocols are set by each dialysis unit or state; links to information from New South Wales and Queensland are provided at the end of this section.

Determining required water treatment
To decide what is required for the water treatment system, a sample of cold tap water from the home is analysed in a laboratory. The result of the water sample analysis determines the nature of water treatment required.

The aim of installing water treatment equipment for home haemodialysis is to provide water (from a drinkable or untreated water source) that is of a high quality, using equipment that is simple to operate, cost effective, easy to maintain and reliable.

Components of a water treatment system can include:

  • pre-filter or sediment filter
  • carbon filter
  • water softening
  • reverse osmosis

Pre-filter or sediment filter
Sediment filters are used to remove particles (sand, rocks, mud) from the water. Filters of different pore (hole) sizes and length are available; the smaller the pore size, the smaller the particles trapped and the quicker the filter clogs.

The size and length of the filter depends on the water analysis results. It’s necessary to change the filter on a regular basis.

Carbon filter
Water suppliers use chlorine and chloramines to kill bacteria in water. These chemicals are necessary for safe drinking water but can be harmful for people on dialysis if they are exposed to large quantities.

Activated charcoal (carbon) is used specifically to remove chlorine and chloramines. The charcoal attracts and holds the substances, much like a magnet does. This process is known as adsorption. The adsorption rate is controlled by the size of the pores in the carbon filter.

Whether a small filter or a carbon tank is used depends on the level of chlorine or chloramines in the water supply. The placement of the carbon filters or tank in relation to other components is an important consideration in the design of a water purification system. It’s necessary to change the filter or tank on a regular basis.

Water softening
Water softeners are used when high levels of calcium and magnesium are present in the drinking water. The calcium and magnesium are exchanged for sodium (salt).

Softeners require regeneration using a brine solution on a regular basis, but it’s important this does not occur during dialysis.

Reverse osmosis
The reverse osmosis unit provides pure water for haemodialysis. Water is forced through a membrane (special filter) under pressure, leaving any remaining contaminants behind.

The reverse osmosis membrane removes 99 per cent of contaminants, such as sediment and carbon filtration, that may be present in the water after all other water treatment has been done. The contaminants are ‘rejected’ or expelled down the drain, along with some water.

It’s possible in some circumstances to recycle some of the rejected water. More information on this is available here [Link to ‘Environmental issues’ page]

Further product information
More product information can be found here:

Water quality and testing guidelines
These websites provide more information about water quality and testing guidelines:

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