Patient education: Hemodialysis (The Basics)

What is hemodialysis? — Hemodialysis is a treatment for kidney failure. Normally, the kidneys work to filter the blood and remove waste and excess salt and water (figure 1). Kidney failure, also called "end-stage kidney disease," is when the kidneys stop working completely.

With hemodialysis, a machine takes over the job of the kidneys. Blood is pumped from the body, filtered through a dialysis machine, and then returned to the body (figure 2).

Where will I have hemodialysis? — Most people can choose between having hemodialysis at a dialysis center (in a hospital or clinic) or at home.

There are downsides and benefits to both options:

●If you have dialysis at a center, you will need to travel there and back. But doctors and nurses at the center can watch you closely during your dialysis.

●If you have dialysis at home, you or someone else will need to learn how to do it. You will also need special equipment and supplies. But people who do home dialysis often feel better and feel more independent and in control of their life. Also, some studies show that people who do home dialysis end up being healthier than those who get dialysis in a center.

How often will I have hemodialysis and how long does it take? — You will have hemodialysis at least 3 times a week. Your schedule will depend on where you have it:

●People who go to a center usually have dialysis 3 times a week. Each treatment usually takes 3 to 5 hours.

●People do home dialysis 3 to 7 times a week, but they have more choice with their schedule. Some people do dialysis during the day. Other people do dialysis overnight while they sleep. Each treatment usually takes 3 to 10 hours.

When will I start hemodialysis? — You and your doctor will decide the right time for you to start hemodialysis. It will depend partly on how well your kidneys work, your symptoms, and your overall health. Your doctor will do blood tests to check how well your kidneys are working.

Before you start hemodialysis, you need surgery to prepare your body. Your doctor will create an "access," which is a way for the blood to leave and return to your body. There are 3 different types of access:

●AV fistula – This is the most common type of access (figure 3).

●AV graft (figure 4)

●Central venous catheter (figure 5)

What happens during hemodialysis? — It depends on your access. If you have an AV fistula or AV graft, the doctor or nurse will put 2 needles into your arm, in your access. If you have a central venous catheter, they will connect the catheter tube to tubes from the dialysis machine.

During hemodialysis, blood leaves your body through the access. The blood travels through and is filtered by the dialysis machine. Then the blood returns to your body.

What problems can happen with hemodialysis? — People can have problems with their access. An access can get infected, get blocked, or stop working.

People can also have problems during dialysis treatments. These can include:

●Feeling lightheaded

●Trouble breathing

●Belly or muscle cramps

●Nausea or vomiting

Let your doctor or nurse know if you have any problems. Many of them can be treated.

Is there anything else I should do? — Yes. If you get dialysis on a regular basis, you will need to:

●Take care of your fistula or graft, if you have one – Wash your fistula or graft with soap and warm water every day and before each dialysis treatment. Don't scratch or pick at the area. Don't let anyone use that arm to take blood or measure blood pressure.

●Check your fistula or graft every day, if you have one – When your fistula or graft is working normally and blood is flowing through it, you can feel a vibration over the area. Let your doctor or nurse know if you don't feel a vibration.

●Keep your catheter protected, if you have one – This is important to help prevent infection. A doctor or nurse will cover your catheter with a bandage and change it at each dialysis session. Do not try to remove or change your bandages at home.

If you have a clear waterproof bandage that sticks to the skin around your catheter site, you can take a shower or bath with it on. But do not put the area underwater. If you have a gauze bandage that is not waterproof, do not get it wet at all.

●Weigh yourself every day – When your kidneys don't work, fluid collects in your body. Let your doctor or nurse know if you gain more weight than usual between dialysis treatments.

●Follow a special diet – You will need to limit the amount of fluids you drink. You might also need to avoid foods with a lot of sodium, potassium, and phosphorus. These are minerals that can build up in your body if you have kidney problems.

Can I travel if I get dialysis? — Probably. If you do home dialysis, you might be able to take your machine with you. If you get dialysis in a center, you will need to find a dialysis center in the place that you want to visit.

More on this topic

Patient education: Preparing for hemodialysis (The Basics)
Patient education: Chronic kidney disease (The Basics)
Patient education: Choosing between dialysis and kidney transplant (The Basics)
Patient education: Dialysis and diet (The Basics)
Patient education: Low-sodium diet (The Basics)
Patient education: Low-potassium diet (The Basics)
Patient education: Acute kidney injury (The Basics)

Patient education: Chronic kidney disease (Beyond the Basics)
Patient education: Hemodialysis (Beyond the Basics)
Patient education: Dialysis or kidney transplantation — which is right for me? (Beyond the Basics)
Patient education: Low-sodium diet (Beyond the Basics)
Patient education: Low-potassium diet (Beyond the Basics)