Caring for a Dialysis Patient at Home: Haemodialysis, Peritoneal Dialysis and How Families Can Help

Caring for a dialysis patient at home comes down to four jobs for the family: getting your parent to every dialysis session, protecting the fistula or dialysis catheter every day, managing their food and fluid intake as the hospital kidney team has set out, and knowing which symptoms mean calling the kidney unit or going to hospital immediately. The work is very different for someone on machine haemodialysis at a dialysis centre and someone doing peritoneal dialysis at home, so this guide separates the two clearly.

A situation many families face: Dad has started haemodialysis several days a week. One of the children takes leave to drive him early in the morning, and he comes home so drained he barely speaks. His arm has a raised vein the doctor said "never take blood pressure on this side", but no one at home is sure what else to watch for. This guide is written from the perspective of a nurse who works with families. It does not replace advice from your parent's kidney team, Fluid amounts, sodium and limits on particular foods must follow that team's individual advice.

Quick answer

• Most people on machine haemodialysis go 3 times a week for about 4 hours each time at a dialysis centre. Peritoneal dialysis is done every day at home.
• Attending every session matters a great deal. If travel is difficult, plan transport and an escort for the whole month ahead.
• On the fistula arm: check the thrill every day; no blood-pressure cuffs; no blood draws, drips or injections in that arm (other than the dialysis needles the kidney unit uses); nothing tight; no sleeping on it; no heavy bags.
• Peritoneal dialysis: follow only the steps the kidney team taught, wash hands, keep the area clean and look at the drained fluid every time. If it is cloudier than usual or has white flecks, contact the kidney unit straight away, day or night; if you cannot reach them, go to hospital without waiting until the next day.
• Fluid, salt and food limits are individual. Never use figures from someone else or the internet.
• Bleeding from the fistula that will not stop, breathlessness, being unable to lie flat, chest pain or drowsiness: go to hospital or call 1669 immediately.

1. Haemodialysis versus peritoneal dialysis: what changes for the family

Haemodialysis uses a machine to filter the blood at a dialysis centre on a set schedule. Peritoneal dialysis fills and drains fluid through a tube in the abdomen every day at home. The family's role differs: haemodialysis is about travel and protecting the access, while peritoneal dialysis is about cleanliness and watching the fluid.

Machine haemodialysis

• According to the UK NHS, most people have 3 sessions a week of about 4 hours each. Your parent's actual schedule is set by their kidney doctor.
• Needles go into a "fistula" in the arm, made by surgically joining an artery to a vein, or some people use a dialysis catheter in the neck or chest, which needs different care (see section 4).
• The family's main jobs: attending every session, protecting the access arm, and watching how your parent is after coming home.

Peritoneal dialysis

• It is done every day at home. According to the US National Kidney Foundation (NKF), manual exchanges are usually done 3 to 5 times a day, each taking about 30 to 40 minutes; another type uses a machine that exchanges the fluid overnight while your parent sleeps.
• The family's main jobs: keeping the area clean, helping or taking over only if the kidney team has trained and assessed that person, checking the drained fluid and the skin around the tube, and storing supplies.

Either way, ask for written instructions and the kidney unit's out-of-hours number, and keep them by the bed or on the fridge.

Coverage for end-stage kidney disease

According to the NHSO's 2026 Universal Coverage (gold card) handbook (information as of October 2026), gold-card holders with end-stage chronic kidney failure and a medical indication are entitled to kidney replacement therapy free of charge, decided jointly by the doctor, the patient and the family. Four options are covered: peritoneal dialysis done by hand (CAPD) or by an automated machine (APD), with dialysis fluid delivered to the home; haemodialysis (HD) according to medical indication and shared decision; kidney transplantation; and palliative care for those who choose not to have kidney replacement therapy. If you disagree with the method offered, you have the right to appeal for reconsideration. For your parent's details, ask the kidney unit or call the NHSO hotline 1330. For social security or civil servant benefits, check directly with that scheme.

2. Haemodialysis days: what to prepare and how to get there

Prepare for a haemodialysis day the night before, and plan travel so it does not rely on a single person. Missing sessions lets fluid and waste build up in the body; the NHS notes that too much fluid can lead to serious problems such as heart failure.

Checklist before leaving home

1. Medicines: ask the kidney unit exactly which ones to take before dialysis and which to take afterwards. Never stop or delay blood-pressure medicines on your own.
2. The record book the kidney unit asked you to keep, such as weight or home blood pressure.
3. Loose or short sleeves so the access arm is easy to uncover.
4. Snacks or drinks, only of the kind and amount the kidney unit allows.
5. ID card, appointment card and the kidney unit's number.
6. A light layer for chilly rooms.

Getting there

• Book transport and an escort monthly to match the dialysis schedule, rather than one trip at a time.
• If your parent cannot walk far, use a wheelchair and practise safe transfers from bed to wheelchair and into the car. See moving from bed to wheelchair.
• Have at least one back-up person for days when the usual escort is unavailable.
• If family members are taking too much leave, see our guide to hospital escorts for older adults for choosing an escort and what to agree in advance.

3. After haemodialysis: caring for your parent at home

Many people feel drained after dialysis and want to rest; some feel light-headed if they stand up quickly. Let your parent rest, change position slowly and check the needle sites on the arm. If they are unusually exhausted, often light-headed or get cramps every time, tell the kidney team at the next session, because they can adjust the treatment.

• Let them lie or sit somewhere close to the toilet, with someone nearby for the first while after getting home.
• Move from lying to sitting, pause, then stand. Walk alongside them if they are still weak.
• Keep the gauze or plaster on the needle sites for as long as the kidney unit advises. Do not pick or scratch the scabs.
• If your parent feels faint or dizzy after getting home, have them lie down straight away somewhere safe and tell the kidney team. Do not give oral rehydration salts, sports drinks or large amounts of water to "fix low blood pressure" yourself, as this may exceed what the kidney team allows. Fainting, severe weakness, chest pain or difficulty breathing: call 1669 immediately.

Bleeding from the fistula: two different situations

Oozing from a needle site after dialysis can happen. Use your finger to press on a small piece of clean gauze directly over the bleeding spot, holding steady pressure for as long as the kidney unit taught you, without lifting it to look. If it has not stopped after about 10 minutes, treat it as heavy bleeding (below), and tell the kidney unit whenever bleeding is slow to stop.

Heavy, spurting or spontaneous bleeding from the fistula, or bleeding that does not stop with pressure is an emergency. Call someone in the house to help and call 1669, saying the bleeding is from a dialysis fistula. Press firmly with your fingers on a small piece of clean gauze right over the bleeding point. Do not use a towel or a large, thick pad, which spreads the pressure away from the right spot. Have your parent lie down and raise the arm, and keep pressing without letting go to check until the emergency team arrives. Even if the bleeding stops, go to hospital so the fistula can be checked.

4. Looking after the fistula arm: what to do daily and what to avoid

The fistula is a lifeline for someone on haemodialysis. It needs checking every day and protecting at all times. The advice below follows the US National Kidney Foundation (NKF) and should be used together with your parent's kidney unit's advice.

Every day

• Feel for the thrill. Place your fingertips on the fistula; you should feel a continuous vibration or buzz under your fingertips. Ask the team to show you what strength is "normal for your parent" and compare every day. If it is weaker than usual, comes and goes, or has stopped, tell the kidney unit straight away. Some units also teach families to listen with an ear or stethoscope, where you hear a continuous whooshing sound; that is a separate check from feeling.
• Wash your hands and the access arm with soap and water before every dialysis session.
• Look at the skin around the fistula for redness, swelling, warmth, pain or drainage.

Never on the fistula arm

• No blood-pressure cuff. Tell everyone at home and every health worker you see. For measuring blood pressure correctly on the other arm, see home blood pressure monitoring.
• No blood draws, drips or injections in that arm. Tell staff every time you visit a hospital or clinic. The only exception is the dialysis needles the kidney unit uses.
• No tight sleeves, watches, bracelets or jewellery over the fistula.
• No sleeping on that arm.
• No heavy bags or heavy pressure on that arm.
• No scratching or picking scabs on the fistula.

What NKF stresses: if the buzzing stops, feels much weaker or changes from what is normal, call the kidney unit straight away and do not wait for the next session, because the fistula may be clotting.

If your parent has a dialysis catheter in the neck or chest

This type of catheter sits directly in a large vein, so it carries a risk of bloodstream infection and needs different precautions from a fistula. The points below follow the NKF.

• Keep the catheter dressing clean and dry at all times. Do not remove it, and do not open or handle the catheter ends yourself.
• Ask the kidney unit how to bathe or shower safely. In general, no swimming or soaking in a bath unless the kidney team says it is safe. Carers can help with a sponge bath or a shower that keeps water away from the catheter area, as the team teaches.
• If the dressing gets wet, loose, dirty or comes off, tell the kidney unit straight away.
• Look around the catheter for redness, swelling, discharge, pain or bleeding, and tell the kidney unit about any fever, chills or feeling unwell after dialysis.
• Take care that the catheter is not pulled or caught while dressing or turning, and follow any other precautions the unit has given.

5. Peritoneal dialysis at home: how families can help

Families can help a lot with cleanliness, setting up the space and noticing changes, but the exchange itself must follow exactly what the hospital kidney team taught and assessed. This guide does not teach exchange steps, because each unit uses different equipment and sequences.

How families can help

• Keep the exchange area clean: wipe the table, switch off fans and close windows during the exchange, and keep pets out, as the kidney team advises.
• Remind and help your parent to wash their hands every time before touching the tube or supplies.
• Store fluid bags somewhere dry, clean and out of the sun, and check expiry dates as the team taught.
• Look at the drained fluid every time and compare it with your parent's usual "clear".
• Check the skin where the tube leaves the abdomen for redness, swelling, pain or discharge.
• Fill in the record sheet the kidney unit gave you and bring it to every appointment.
• Dispose of drained fluid and used bags the way the kidney unit taught you, and wash your hands afterwards, except for a cloudy bag, which you keep as described below.

Suspected peritonitis: contact the kidney unit immediately

The UK NHS says infection of the abdominal lining (peritonitis) needs treating straight away because it can lead to sepsis. The main sign is drained fluid that is cloudier than usual or has white flecks, sometimes with tummy pain, fever, chills, nausea or vomiting. Contact the kidney unit immediately, day or night. If you cannot reach them, go to hospital straight away rather than waiting until the next day, and keep the cloudy bag to bring with you as the unit instructs, so the doctor can test it for infection.

Other signs to call the kidney unit about

• The skin around the abdominal tube is painful, swollen, red, a different colour or leaking.
• A lump or bulge in the tummy, which in people on peritoneal dialysis can be a hernia. This is a different problem from infection, but the kidney team needs to check it.

Only people who have been taught by the kidney unit should do or help with exchanges. If family members take turns, bring the second person to the kidney unit to learn as well.

6. Fluids, salt and food: follow the kidney team

Most people on dialysis need to limit fluids, salt and certain foods, but the right amounts are individual, depending on how much urine they still pass, blood results, weight and type of dialysis. Families should not use figures from anyone else.

• Ask the kidney doctor or dietitian for written advice on how much your parent may drink each day and which food groups to limit.
• Count fluid from every source as the team teaches, such as curries, soups and ice.
• Help ease thirst without adding fluid, for example by sipping from a small cup and brushing teeth or rinsing the mouth often.
• Cut down on salty food, pickled food and strong seasonings, because salt makes people thirsty.
• Do not buy herbal remedies, supplements or painkillers without asking the kidney doctor or pharmacist first.
• Weigh your parent when the kidney unit asks, and report quickly if weight rises fast with swelling or breathlessness.

Food limits often make older adults feel stressed and controlled. Let your parent choose meals within the limits the team allows, eat together and encourage them when they do well, rather than reminding them at every bite.

7. When to call or rush to hospital: a three-level plan

This plan draws on advice from the UK NHS and the US NKF. Use it alongside your parent's kidney unit's advice; if the unit gives different criteria, follow the unit.

Continue care at home, watch closely

• Tired after dialysis but better after rest.
• The fistula thrill feels the same as usual.
• Drained fluid is as clear as usual; the skin around the tube is dry and healthy.
• A little oozing from a needle site after dialysis that stops with pressure within the time the kidney unit taught.

Call the kidney unit or a nurse today

• The fistula thrill is weaker, gone or different. Call as soon as you notice; do not wait for the next session.
• The skin around the fistula, the neck or chest catheter, or the abdominal tube is red, swollen, warm, painful or leaking.
• The neck or chest catheter dressing is wet, loose or has come off.
• Fever, chills, or feeling hot and shivery.
• A lump in the tummy in someone on peritoneal dialysis.
• A missed haemodialysis session, or knowing your parent cannot make one.
• Unable to pass urine or passing much less than usual, for those who still pass urine.
• A faster heartbeat than usual, or clearly more leg swelling.

Go to hospital or call 1669 immediately

• Bleeding from the fistula that is heavy, spurting, spontaneous or does not stop with pressure. Keep pressing firmly with your fingers on a small piece of gauze over the bleeding point while you wait. The NHS notes that fistula bleeding will not stop without treatment.
• Cloudy peritoneal dialysis fluid or white flecks: call the kidney unit immediately, and if you cannot reach them, go to hospital straight away, without waiting until the next day, taking the cloudy bag with you.
• Breathlessness, being unable to lie flat, or chest pain.
• Fainting, severe weakness, drowsiness, confusion, being hard to wake, or a seizure.

Many people on dialysis also have diabetes. If your parent has a foot wound, see diabetic foot wound care for checks and warning signs.

Common mistakes families make

• Skipping sessions because your parent is tired or no one can take them. Fluid and waste build up, risking breathlessness and strain on the heart. Fix: plan transport and a back-up person a month ahead.
• Taking blood pressure on the fistula arm. This can damage the fistula. Fix: put a reminder up at home and tell every health worker.
• Using someone else's fluid or diet figures. They may be too little or too much for your parent. Fix: get individual written advice from the kidney team.
• Letting someone untrained help with exchanges. This raises the risk of abdominal infection. Fix: take anyone who will help to learn at the kidney unit first.
• Waiting until tomorrow about cloudy fluid. Peritonitis can progress quickly. Fix: call the kidney unit as soon as you see it; if you cannot reach them, go to hospital with the cloudy bag.
• Leaving one child to handle every session. They burn out and sessions get missed. Fix: share the rota or use an escort on some days.

When to bring in professional help

Dialysis is long term. Many families do not lack knowledge; they lack people and time on dialysis days. KIN HomeCare does not perform dialysis or peritoneal dialysis exchanges. Those stay in the hands of the hospital kidney team and family members the team has trained. We can help with everything around them:

• Escort to hospital dialysis (Hospital Escort): a caregiver picks your parent up, stays throughout and brings them home, THB 1,800 for 8 hours, then 200 baht per extra hour. Transport is always charged separately; KIN's ambulance starts at THB 2,000 depending on distance, and staff confirm the total before booking. See hospital escort.
• Caregivers at home to help with walking, transfers, hygiene, preparing food as the kidney team directs and keeping records: 12-hour shift THB 1,800 per day, weekly THB 12,000. See elderly home care.
• Registered nurse home visits to assess your parent, care for wounds according to the doctor's treatment plan and help the family review what the kidney unit taught, THB 1,800 per visit (single procedures such as wound dressing from THB 1,200).
• Wheelchair rental for dialysis days, standard model THB 3,000 per month. See equipment rental.

Frequently asked questions

How much water can a dialysis patient drink a day?

There is no single figure for everyone. It depends on how much urine your parent still passes, blood results and the type of dialysis. Ask the kidney doctor or dietitian for your parent's own figure, and count soups and curries too.

Why can't blood pressure be taken on the fistula arm?

A tight cuff can damage or block the fistula. Measure on the other arm, and do not allow blood draws, drips or injections in the fistula arm either. The only exception is the dialysis needles the kidney unit uses.

What should we do if a dialysis session is missed?

Call the kidney unit as soon as you know your parent cannot go, or on the day it is missed, to arrange a make-up session. The NKF says missing even one treatment can let fluid, potassium, acid and waste build up. In the meantime, do not try to compensate by stopping all fluids, taking extra medicines or changing medicines yourself; follow the kidney team's fluid and food limits strictly. Breathlessness, being unable to lie flat, chest pain, an unusually pounding heartbeat or severe weakness: call 1669 immediately.

What should I do if the fistula is not buzzing?

Call the kidney unit straight away rather than waiting for the next session, because the fistula may be clotting. The sooner you report it, the better the chance the team can fix it in time.

What does cloudy peritoneal dialysis fluid mean?

It can be a sign of peritonitis, an infection of the abdominal lining that needs treatment straight away. Call the kidney unit immediately, day or night, even if there is no tummy pain or fever yet. If you cannot reach them, go to hospital straight away rather than waiting until the next day, and keep the cloudy bag to bring with you as the unit instructs.

Is it normal to be very tired after dialysis?

Many people feel tired after dialysis and improve after rest. If tiredness keeps getting worse, light-headedness is frequent or cramps happen every session, tell the kidney team. Breathlessness, being unable to lie flat or chest pain need hospital care immediately.

Can KIN HomeCare do dialysis or peritoneal dialysis at home?

No. Dialysis and peritoneal dialysis exchanges follow the hospital kidney team's orders and training. KIN HomeCare can escort your parent to hospital dialysis for THB 1,800 per 8 hours, provide caregivers at home and arrange nurse home visits.

Talk to the KIN HomeCare team

If your family is just starting life with dialysis, or cannot cover every session, call and tell us your parent's dialysis schedule and how they travel. Our team will help plan which days need an escort and when a caregiver at home would help most.

• Hospital escort, caregivers and nurse visits: 061-881-9399 (+66 61 881 9399)
• LINE @KINHOMECARE
• Caregiver and nurse quotation form: form.kinhomecare.com
• Free consultation: our team helps you work out which service fits, with home visits nationwide.

This information is general guidance for families and does not replace advice from the doctor caring for your parent.

Written by Orrathai Boontuang, RN (licence 5311192883) · Medically reviewed by Dr. Kamolchat Choktanomsup (licence 40854) · Prices as of October 2026; please confirm with our staff before booking.