Did you know?
Another option of
dialysis therapy.

●Table目 次of Contents

Introduction‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ P 4

Q&A ● What is HHD?‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ P 6●

Benefits of HHD‥ ‥‥‥‥‥‥‥‥‥‥‥‥‥‥ P 7●

Points concerning HHD that need special attention‥‥ P 8●

Vessel puncture and vascular access‥‥‥‥‥‥ P 9●

Helpers and attendants‥‥‥‥‥‥‥‥‥‥‥‥ P 10

or policies stipulated by medical or scientific associations,●

Costs of HHD‥ ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ P 11

research groups, other medical institutions, etc.

●

Training before introduction of HHD‥‥‥‥‥‥ P 12●

Environmental improvements for HHD‥‥‥‥‥ P 13●

Preview visit/training completion,

・This guide is based on the policy of home hemodialysis preparedby Reiseikai Medical Corporation. Therefore, some descriptions
may differ from the general interpretation of home hemodialysis

・ Due consideration has been given to the medical validity andfairness of the content, however some content has been
simplified for ease of understanding. If you are considering
adoption of or performance of home hemodialysis, please consult●

Follow-up system via phone‥‥‥‥‥‥‥‥‥‥ P 15

・M e d i c a l t e c h n i q u e s a n d e n v i r o n m e n t s , i n c l u d i n g t h o s e●

Delivery of materials and waste disposal‥ ‥‥‥ P 16

concerning home hemodialysis, are continually changing. Thus,●

Examination of blood samples sent by mail‥ ‥‥ P 17●

Outpatient visits of HHD patients‥ ‥‥‥‥‥‥ P 18●

Periodic inspection of equipment‥ ‥‥‥‥‥‥ P 20●

Safety measures for HHD‥‥‥‥‥‥‥‥‥‥‥ P 21

with your physician and confirm each item again.

the current situation may differ from the time at which this guide
was issued. For the latest information, please contact any Reiseikai
clinic directly.
・Shinagawa Garden Clinic is a Saitama Medical University Hospitalaffiliated home hemodialysis facility.

※ The content of this guide can be downloaded from the website of Shinagawa Garden
Clinic (http://www.gardenclinic.org).

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		 equipment installation, first visit‥‥‥‥‥‥‥‥ P 14

Reiseikai Medical Corporation

Information about the clinic‥ ‥‥‥‥‥‥‥‥‥‥‥‥‥ P 22
Access ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥ P 23
＊HHD＝home hemodialysis

Reiseikai Medical Corporation

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Introduction

Home hemodialysis (HHD) is a treatment option that allows patients to perform
hemodialysis at home under the supervision of physicians.
I often hear patients saying that they do not have a clear picture of this therapeuticmodality, but the illustration on the left will provide an image of the reality andpossibility of HHD.
This illustration was drawn by a painter with profound knowledge of HHD, and showsthat dialysis can be woven into the fabric of daily life. With this modality, it is possible
to dialyze a large volume of blood any time at home, and improved QOL and patient
prognosis can be expected.
Actually, HHD is a traditional therapy which has been used safely and eﬀectively bymany patients and healthcare professionals for more than thirty years. In honor of
their consistent efforts, Reiseikai has actively introduced new systems and beenpromoting HHD as a second-generation of HHD community.
I have prepared this guide for patients as part of our project to promote HHD.
I sincerely hope that this guide will contribute to your understanding of HHD.

Haruki Wakai, M.D.

President of Reiseikai Medical Corporation
Director of Shinagawa Garden Clinic
Assistant director of Gotanda Garden Clinic
Director and vice secretary general of NGO Ubiquitous Blood Puriﬁcation
International
Guest professor of Sen Sok International University
Japanese Society of Internal Medicine: Board certiﬁed member
Japanese Urological Association: Board certiﬁed urologist
Japanese Society for Dialysis Therapy: Fellow (Board certiﬁed member)
Japanese Society for Transplantation: Board certiﬁed transplant physician
Japanese Society for Clinical Renal Transplantation: Board certiﬁed member
Japanese Society for Home Hemodialysis: Council member and Secretaryof the Society
Japanese Society of Nutrition and Renal Insuﬃciency: Inspector of theSociety
Japan medical Association: Certiﬁed occupational health physician
Member of International Society of Nephrology (ISN) and International
Society of Blood Puriﬁcation (ISBP)

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What is HHD?

Benefits of HHD

Q What kind of therapy is HHD?

Q What are the benefits of HHD?

AA

HHD is a treatment option that allows patients to perform
hemodialysis at home under the supervision of physicians.
A hemodialysis machine is installed in the home, and the

HHD has various beneﬁts. It allows dialysis to be performed
at home at any time, and the biggest benefit is that it ispossible to dialyze a large volume of blood, which is known

patient performs hemodialysis by manually assembling the circuit,to yield a good prognosis. Dialysis should be performed gradually over

performing shunt puncture, monitoring his/her condition during

time. It can loosen food restriction, improve nutrition, and help physicaldialysis, and retransfusion.

conditioning. Since it can be performed at home at any time, it allows alarge volume of blood to be dialyzed more easily. Outpatient dialysis isprovided up to fourteen times a month in principle, while HHD can be
performed every day or every other day. When the number of dialysis
days is increased, adequate dialysis can be provided “more frequently”,
which helps in stabilizing the physical condition of the patient.

Q Are there any benefits of HHD?
Q
A

What is the difference between
HHD and peritoneal dialysis (PD)?
PD is a treatment in which a catheter is inserted into theA

Here is a list of beneﬁts of HHD.
①It allows a large volume of blood to be dialyzed moreeasily (gradually, over time, and frequently).

②Patients can have more time with family members and friends, andless restriction on working.

peritoneal cavity, and the dialysis fluid is infused. Both PD③The burden of outpatient visits will be substantially reduced.

and HHD are home dialyses, but they are completely④Since the patient can use a hemodialysis machines exclusively, it isdiﬀerent methods and involve completely diﬀerent mechanisms.

easy to change the dialysate, etc. (prescribed dialysis).
⑤There is a lower risk of hospital-acquired infection (influenza,
infectious enteritis, hepatitis, HIV, etc.).

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Points concerning HHD that require special attention

Vessel puncture and vascular access

Q Can everyone perform HHD?

Q Who will perform puncture?

A

A

Basically, HHD is safe. However, in terms of emergency
responses, it is associated with more risks than outpatient
hemodialysis, where healthcare professionals are always on

The patient must perform the puncture by himself/herself.
However, if a family member is a qualiﬁed physician, nurse
or clinical engineering technologist, he/she can also

standby. Therefore, outpatient dialysis is recommended for patients

perform the puncture. Many patients feel anxious about self-puncture,with cardiac disease, who are at a high risk of heart attack or large

but patients rarely give up HHD because of diﬃculty in self-puncture.

fluctuations in blood pressure during dialysis. Also, since HHD is

If the patient can become used to self-puncture, he/she will be

provided at home, self-management skills are very important. HHD is

responsible for the puncture, and can perform the puncture more

not recommended for those with inadequate self-management skills.

stably, with few errors.

Q
A

Is it possible to perform HHD
alone at home?
Reiseikai trains and instructs patients so that they can
perform all the procedures related to HHD. However, toensure safety, HHD alone, in the absence of an attendant, is

QA

Can an artificial vessel, a subcutaneously
fixed superficial artery, or an indwelling
catheter be used for HHD?
Patients with an artificial vessel graft serving as a shunt canadopt HHD, but adequate care is needed for the punctureand hemostasis. Since it is necessary to detect and respond toprohibited. There should always

any problems, such as infection of the artificial vessel graft as early as

be someone available to attend topossible, HHD is associated with a high level of difficulty and risks. For

the patient during HHD.

the case of a subcutaneously fixed superficial artery, self-puncture andself-hemostasis are considered to be extremely diﬃcult, and HHD cannot
be performed, in principle. If there is an indwelling catheter, HHD may bepossible, but adequate attention to infection control is required as sameas the case of artificial vessel grafts. Patients with ordinary shunts whoface extreme diﬃculty in puncture may also not be able to adopt HHD.

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Helpers and attendants

QA

Is a helper needed?
Reiseikai trains and instructs patients so that they can
perform all the procedures related to HHD. Therefore, itwould be helpful to have a helper who can be trained with

Costs for HHDQ
AApproximately how much does
HHD cost?
As with the case of outpatient hemodialysis, HHD is also covered byhealth insurance. Therefore, the patient can perform HHD “with noco-pay” or “with a certain amount of co-pay, depending on income

the patient and would understand all the procedures, but it is not(usually 10,000 to 20,000 yen/month). However, the patient should bear the

essential. However, the patient should have someone to attend toinitial costs of installation of the dialysis-related equipment and also the utility

him/her during the dialysis sessions to ensure his/her safety. The

costs after the start of HHD. The initial costs include costs for increasing theattendant should meet all of the four conditions listed below.

electrical capacity (usually, several thousand yen), installing a grounding wire to①Should be in the same home as the patient, and be in relatively
close proximity to the patient during treatment.
②Should be able to make an ambulance call or contact the clinic incase of any emergency.

an electrical outlet (usually, several thousand to 10,000 yen), installing a circuit
breaker for the dialyzer (optionally, and usually 10,000 to 20,000 yen), preparing
a water supply and drainage system for the HHD room (about 20,000 to 400,000
yen, which varies widely according to the conditions and methods selected),③Should be able to stop bleeding by applying pressure in the event

and installing a valve or pump to adjust the running water pressure (usually, 0 toof bleeding, and also be able to immediately stop the dialysis

100,000 yen, which varies according to the water pressure). In addition,

machines.

installation of an alarm system for water leakage, should the patient choose to④Should fully agree with the patient to perform HHD.

have one, will incur separate costs. No maintenance costs other than the utility

An attendant for the patient who meets all of the above conditions iscosts are usually required after the start of HHD. Utility costs will diﬀer according

essential for the adoption of HHD.

to the frequency of dialysis, but the costs are expected to be 1.2 to 1.5 times
higher than the costs incurred before the start of HHD.
In general, it is not necessary for the patient to bear the cost of installing,changing and removing the equipment, but if the patient moves the installationsite for personal reasons, such as moving homes, the expense will be borne by
him/her, in principle. While it seems that HHD will incur a lot of costs, it must be
remembered that the cost of outpatient visits will be considerably decreased.
HHD will enable patients to work and live smoothly, and provide substantial
economic beneﬁts. This point should be carefully taken into account.

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Training before the introduction of HHD

Q
AWhat is the length of the training
period before HHD can beinitiated?
Adequate training is essential prior to the initiation of HHD;
starting HHD without adequate training is very dangerous.

Environmental improvement for HHDQ
A

Is it necessary to renovate thehome?
Depending on the position that the patient might wish to
adopt (seated, lying, etc.) during the HHD, at least a twotatami mat room (about 2m×2m) is necessary. In addition,

Reiseikai utilizes its own manual, etc., to allow transition toanother two-tatami mat room is necessary for the storage of materials.

HHD after the shortest training period, but usually training should be

The electrical capacity should be increased to 60A or higher, however,conducted at least three times a week for two months. A longer period

this is usually possible even without much construction work. Ifof training may be required depending on the circumstances. The

possible, use of a circuit breaker exclusively for the HHD equipment

patient should visit the clinic three times a week, and receive

would be preferable. In regard to the water supply and drainage

outpatient dialysis during the training period.

system, it would be preferable for the system to be connected to the
HHD equipment, but use of the water supply and drainage system forthe washing machine is feasible as well.

Q
A

Is it possible to perform HHD atrental apartments?
It is certainly possible to perform HHD at rental apartmentswith minimal renovations of the apartment. In fact, many
patients perform HHD at rental apartments.

However, prior consultation with the owner or the condominium
association is necessary to avoid potential problems.

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Preview visit/training completion,equipment installation, ﬁrst visit

Q
A

What will be done at the preview
visit?

Follow-up system via phone

Q

Situations where HHD cannot be performed because of
inadequate environmental improvement at home should
be avoided. Therefore, when the training proceeds to acertain stage, the clinic staﬀ will make a preview visit. At the preview
visit, our medical staﬀ and a responsible person from the equipment

A

In the event of trouble or the patientneeding to consult the clinic after
the start of HHD, how should thepatient proceed?
Usually, questions should be posed to our medical staﬀ at
the time of the outpatient consultation for HHD, but any
inquiries in the event of an emergency or trouble can be

manufacturer will visit the patient to carefully inspect the electricalmade over the phone.

connections, the water supply and drainage system, the installation

Since there is a 24-hour follow-up system via phone on all 365 days ofsite, etc. At the preview visit, we can make adequate preparations forthe year in Reiseikai, the patient can feel safe performing HHD at any

the installation and provide appropriate advice according to thetime. We always keep two satellite-based mobile phones to stay incircumstances of the patient.

contact with patients in emergencies.

HHD be started soon after
Q Can
completion of the training period?

Will your staff help in the initiation?

A

When training is completed, and our medical staff judges
after the preview visit that the patient can safely perform
HHD, the patient is considered ready for the initiation of

HHD. Usually, HHD is started soon after completion of their training. On
the day of initiation of HHD, our medical staﬀ and a responsible personfrom the equipment manufacturer will install the equipment, andperform the ﬁrst HHD after installation. At the time of the ﬁrst HHD, themedical staff will stay until they confirm that the dialysis can be
operated without any problems. Thereafter, the second and subsequent
HHD sessions will be performed by the patient and his/her attendant.
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Delivery of materials and waste disposal

Q
A

Will the necessary materials bedelivered to the patient?
How about waste disposal?
The necessary materials will be delivered to the patientʼs
house free of charge (except for small materials such as

Examination of blood sent by mailQ
A

How will periodic blood
examinations be done?
The patient should collect blood samples periodically andsend them by mail. This way, all the examination results will
be ready by the time the patient makes an outpatient visit,

containers for blood examination, recording paper, etc.)

which will enable treatment to be corrected based on the latest

However, it will not be possible to designate delivery times. The

examination results. In addition, since it will enable blood sampling

patient can designate the desired delivery day, however such requests

before and after dialysis, as in the case of outpatient dialysis, it would

cannot always be meet. With regard to the disposal of medical waste,

be possible to calculate the efficiency of the dialysis. The centrifuge

except for dangerous materials such as needles, the responsible

necessary to process the collected blood specimens will be lent to themunicipal authority would collect the waste, in principle. If thepatients free of charge.

municipal authority cannot collect the waste for any reason, our clinic
will. The patient should bring hazardous materials, such as needles,
directly to our clinic at the time of the outpatient visits.

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Outpatient visits of HHD patientsQA

How often should the patient visit
the clinic after the start of HHD?
At the beginning, the patient should visit the outpatient
department once every two weeks; thereafter, the frequency
can be reduced to once a month. Outpatient visits for HHDQ
A

How will the schedule for HHD be
drawn up?
Physicians and patients will discuss and decide the schedulefor HHD at the time of the training or outpatient visit.
Reiseikai advises that dialysis be performed “gradually”,

patients are very important. Reiseikai sets an appointment time-frame of“over time”, and “frequently”. Therefore, we advise prolongation of theabout one hour for each patient to ensure provision of adequate treatment.

duration of dialysis per week while ensuring that it does not result inPatients may need to make unscheduled outpatient visits for trouble

excessive dialysis. Next, we advise that the dialysis be performed in as

associated with the vascular access (shunt), changes in physical condition,

many divided sessions as possible. Under ordinary circumstances, HHD

more frequent administration of a hematopoietic agent for aggravatedwould involve four to six dialysis sessions a week at two to six hours

anaemia, etc. Also, the patient or his/her family member would need toper session. If the patient ensures adequate dialysis, then excessive

stay at home on other days than the visit days, such as the days of material

trouble can be avoided when it becomes impossible to perform

delivery, collection of waste, periodic inspection, etc. Therefore, they should

dialysis due to vascular access (shunt) trouble, physical deconditioning,keep several days of the month open for activities associated with HHD .

equipment trouble, etc., and unscheduled outpatient dialysis sessions

Q

can be avoided at a higher rate.

A

What will be done at HHD
outpatient visits?
Each outpatient visit will involve history-taking, physicalexamination, confirmation of HHD records, confirmation of
the results of the examination of blood sent by mail, etc., andalso checking of the situation and physical condition of the patient during
HHD. Additional examinations (X-ray, ultrasound, examination of the
body composition, etc., will be performed depending on the situation.
Based on the results, the patient will be advised on any changes in dialysis
settings, oral medication, administration of the hematopoietic agent, etc..
Also, the patient can receive re-training for the procedure.
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19Periodic inspection of equipment

Q
A

Will the equipment beperiodically inspected?
Our medical staff or a responsible person from theequipment manufacturer will visit the home for periodic
inspection every three months. Since we always keep a

Safety measures for HHDQ
APlease explain the safetymeasures for HHD.
Slow dialysis can ensure the safety of HHD. Therefore, thefluid removal rate per hour (amount of redundant waterand sodium to be removed per hour) should be set at lower

portable measuring instrument, the dialysate can be adjusted at home.

levels. Removal of a large amount of fluid within a short time may

In the event of any equipment trouble, staff from the equipment

cause hypotension and is dangerous; therefore, it should be avoided,

manufacturer will visit the home for equipment maintenance/repairs.

or the patient has to deal with his/her hypotension by himself/herself.

However, it may be diﬃcult to resolve equipment trouble immediately,

Excessive food and drink intake should be treated by increasing theand in such circumstances the patient will be required to undergo

duration of dialysis and gradually removing the toxins. It is importantunscheduled outpatient dialysis until the trouble is resolved. Suchto allow an adequate time-frame for the dialysis.

cases, however, are very rare.

should be done if the patient
Q Whatbecomes sick during HHD?

A

If oneʼs physical condition deteriorates during the HHD, thepatient should immediately consult a medical institution.
This is why the presence of an attendant is important. It isadvisable for the patient to always keep a mobile phone ready.
Reiseikai will also install an “Emergency Report System for HHD”* athome free of charge.

* We will install a security system provided by SECOM at the patientʼs home. Thissecurity system can be used to report any emergencies during HHD. An emergency
dispatcher from SECOM will rush to the patientʼs house in case of emergency.

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Information of clinic

AccessReiseikai Medical Corporation

Home Care Support Clinic

Shinagawa Garden Clinic

Imas Osaki Bldg. 2F, 1-20-3, Osaki,
Shinagawa-ku, Tokyo, 141-0032, Japan(across the Yamate-dori from Gate City Ohsaki)◦2 minute walk from Osaki Station,
JR Yamanote Line
◦2 minute walk from Osaki Station,
JR Saikyo Line
◦2 minute walk from Osaki Station,
JR Shonan Shinjuku Line
◦2 minute walk from Osaki Station,
Tokyo Waterfront Area Rapid
Transit Rinkai LineTEL…03-3779-4970◦FAX ……… 03-3779-2345◦E-MAIL … Please use the contact form on the following website.
◦Website … http://www.gardenclinic.org※Accessible from Tokyo, Kanagawa, Chiba, Saitama,
Shizuoka, etc.
◦2 minutes from Shinagawa to Osaki by YamanoteLine◦11 minutes from Tokyo to Osaki by Yamanote Line
◦17 minutes from Yokohama to Osaki by Shonan
Shinjuku Line
◦18 minutes from Shinkiba to Osaki by Rinkai Line
◦25 minutes from Akabane to Osaki by Saikyo Line
◦40 minutes from Omiya to Osaki by Shonan
Shinjuku Line
◦About 70 minutes from Shizuoka to Osaki via
Shinagawa by Shinkansen◦About 25 minutes from Haneda Airport to Osaki
via Shinagawa

an introduction to Home Hemodialysis (1st version)・Issued by : Reiseikai Medical Corporation
・Clay work by : Haruki Wakai (Reiseikai Medical Corporation): Rika Yamanaka (Reiseikai Medical Corporation): Secretariat of Reiseikai Medical Corporation※All rights reserved.

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Reiseikai Medical Corporation

Shinagawa Garden Clinic
Imas Osaki Bldg. 2F, 1-20-3, Osaki, Shinagawa-ku, Tokyo, 141-0032 Japan
http://www.gardenclinic.org