Hemodialysis is the most common method used to treat advanced and permanent kidney failure. Since the 1960s, when hemodialysis first became a practical treatment for kidney failure, we’ve learned much about how to make hemodialysis treatments more effective and minimize side effects. In recent years, more compact and simpler dialysis machines have made home dialysis increasingly attractive. But even with better procedures and equipment, hemodialysis is still a complicated and inconvenient therapy that requires a coordinated effort from your whole health care team, including your nephrologist, dialysis nurse, dialysis technician, dietitian, and social worker. The most important members of your health care team are you and your family. By learning about your treatment, you can work with your health care team to give yourself the best possible results, and you can lead a full, active life.


When Your Kidneys Fail


Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.


How Hemodialysis Works
In hemodialysis, your blood is allowed to flow, a few ounces at a time, through a special filter that removes wastes and extra fluids. The clean blood is then returned to your body. Removing the harmful wastes and extra salt and fluids helps control your blood pressure and keep the proper balance of chemicals like potassium and sodium in your body. One of the biggest adjustments you must make when you start hemodialysis treatments is following a strict schedule. Most patients go to a clinic—a dialysis center—three times a week for 3 to 5 or more hours each visit. For example, you may be on a Monday-Wednesday-Friday schedule or a Tuesday-Thursday-Saturday schedule. You may be asked to choose a morning, afternoon, or evening shift, depending on availability and capacity at the dialysis unit. Your dialysis center will explain your options for scheduling regular treatments. Researchers are exploring whether shorter daily sessions, or longer sessions performed overnight while the patient sleeps, are more effective in removing wastes.

 

Illustration of a dialyzer.

Newer dialysis machine make these alternatives more practical with home dialysis. But the Federal Government has not yet established a policy to pay for more than three hemodialysis sessions a week. Several centers around the country teach people how to perform their own hemodialysis treatments at home. A family member or friend who will be your helper must also take the training, which usually takes at least 4 to 6 weeks. Home dialysis gives you more flexibility in your dialysis schedule. With home hemodialysis, the time for each session and the number of sessions per week may vary, but you must maintain a regular schedule by giving yourself dialysis treatments as often as you would receive them in a dialysis unit.

Adjusting to Changes
Even in the best situations, adjusting to the effects of kidney failure and the time you spend on dialysis can be difficult. Aside from the “lost time,” you may have less energy. You may need to make changes in your work or home life, giving up some activities and responsibilities. Keeping the same schedule you kept when your kidneys were working can be very difficult now that your kidneys have failed. Accepting this new reality can be very hard on you and your family. A counselor or social worker can answer your questions and help you cope. Many patients feel depressed when starting dialysis, or after several months of treatment. If you feel depressed, you should talk with your social worker, nurse, or doctor because this is a common problem that can often be treated effectively.

 

To see the video on hemodialysis , click on the picture to the left. Once you are transferred to the new web site, click the word at the top of the window 'undefined' to drop down the menu. Select kidney dialysis, then click on slides to view the slides. Once done viewing the slides, click on video to allow the video to load and play. Once you are done watching the video, click your browser's exit button to close out that page and return here.

 

Getting Your Vascular Access Ready


One important step before starting hemodialysis is preparing a vascular access, a site on your body from which your blood is removed and returned. A vascular access should be prepared weeks or months before you start dialysis. It will allow easier and more efficient Arm with an arteriovenous fistula.
removal and replacement of your blood with fewer complications. For more information about the different kinds of vascular accesses and how to care for them, see the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) fact sheet Vascular Access for Hemodialysis.

 

Illustration of a looped graft.

Dialysis Machine


The dialysis machine is about the size of a dishwasher.

This machine has three main jobs:

  • Pump your blood and monitor the flow for safety.

  • Clean waste products from your blood.

  • Monitor your blood pressure and the rate of fluid removal from your body.
     

The dialysis machine is nothing more than a very fancy blood pump. The pump is responsible for moving your blood from your body to the dialyzer and back again safely. The rest of the machine is made up of monitoring devices that will monitor the system for:

  • Air leaks.

  • Venous pressure.

  • Arterial pressure.

  • Transmembrane pressure.

  • Administration of heparin.

  • Blood pressure.

  • Conductivity of electrolytes.

  • Blood pump speed.

  • Amount of blood processed.

  • Some machines can manage the patients pulse rate.

  • Some machines can monitor the patient's hematocrit online.

Various parameters and alarms can be set by the staff to monitor your treatment.

Dialyzer

Illustration of a hollow fiber dialyzer.

The dialyzer is a large canister containing thousands of small fibers through which your blood is passed. Dialysis solution, the cleansing fluid, is pumped around these fibers. The fibers allow wastes and extra fluids to pass from your blood into the solution, which carries them away. The dialyzer is sometimes called an artificial kidney.

 

 

 

Reuse.

Your dialysis center may use the same dialyzer more than once for your treatments. Reuse is considered safe as long as the dialyzer is cleaned before each use. The dialyzer is tested each time to make sure it’s still working, and it should never be used for anyone but you. Before each session, you should be sure that the dialyzer is labeled with your name and check to see that it has been cleaned, disinfected, and tested.

Dialysis Solution


Dialysis solution, also known as dialysate, is the fluid in the dialyzer that helps remove wastes and extra fluid from your blood. It contains chemicals that make it act like a sponge. Your doctor will give you a specific dialysis solution for your treatments. This formula can be adjusted based on how well you handle the treatments and on your blood tests.

Needles

Many people find the needle sticks to be one of the hardest parts of hemodialysis treatments. Most people, however, report getting used to them after a few sessions. If you find the needle insertion painful, an anesthetic cream or spray canbe applied to the skin. The cream or spray will numb your skin briefly so you won’t feel the needle. Most dialysis centers use two needles—one to carry blood to the dialyzer and one to return the cleaned blood to your body. Some specialized needles are designed with two openings for two-way flow of blood, but these needles are less efficient and require longer sessions. Needles for high-flux or highefficiency dialysis need to be a little larger than those used with regular dialyzers.
 


Some people prefer to insert their own needles. You’ll need training on inserting needles properly to prevent infection and protect your vascular access. You may also learn a “ladder” strategy for needle placement in which you “climb” up the entire length of the access session by session so that you don’t weaken an area with a grouping of needle sticks. A different approach is the “buttonhole” strategy in which you use a limited number of sites but insert the needle back into the same hole made by the previous needle stick. Whether you insert your own needles or not, you should know these techniques to better care for your access.

 

Tests to See How Well Your Dialysis Is Working
About once a month, your dialysis care team will test your blood by using one of two formulas—URR or Kt/V—to see whether your treatments are removing enough wastes. Both tests look at one specific waste product, called blood urea nitrogen (BUN), as an indicator for the overall level of waste products in your system. For more information about these measurements, see the NIDDK fact sheet Hemodialysis Dose and Adequacy.

 

Your hemodialysis treatment.

 

Most patients arrive about 30 minutes prior to their scheduled treatment time and wait in a lobby. Most dialysis units operate Monday through Saturday with schedules for Monday, Wednesday and Friday or Tuesday, Thursday and Saturday. Units can have from 1 to 4 shifts per day and some dialysis units may stagger starting times to make taking patients of and on dialysis smoother and more timely.

Once you arrive you should cleanse your cannulation site if you use a graft or fistula. If you use a catheter, you should not manipulate it.

You should also weigh in to obtain your pre-dialysis weight. Your pre-dialysis weight will be subtracted from your dry weight (established by your doctor) to obtain your fluid removal goal for your treatment (having lower fluid removal goals is better for your body and treatment).

You will then be called into the dialysis treatment center to begin your treatment. You will sit in your chair and will be prepared for cannulation of your access (dialysis needles are inserted into your access). You can pre-treat your skin with an anesthetic gel (such as Emla cream) 30 minutes prior to cannulation to make the skin puncture more comfortable.

Once you are cannulated, you will be connected to the dialysis machine and your treatment will start. Usually the staff will start your blood flow slow to make sure that your access is stable and increase your blood flow to your prescribed blood flow as your treatment progresses. Make sure that the staff turns your blood flow up to insure that you get the best treatment. The dialysis machine may clamp off if your system pressures exceed safe limits. When the machine clamps off, the treatment time clock will stop. The clock only runs when your blood is actually being rinsed. Therefore, a four hour treatment time may actually take longer if the machine clamps off.

Once your treatment is completed, you will be disconnected from the machine and you will hold pressure on your access site to prevent bleeding.

The average dialysis treatment time is about 4 hours. Most people are at the dialysis unit about 90 minutes longer than their treatment time.