Dialysis - hemodialysis
Artificial kidneys - hemodialysis; Dialysis; Renal replacement therapy - hemodialysis; End-stage renal disease - hemodialysis; Kidney failure - hemodialysis; Renal failure - hemodialysis; Chronic kidney disease - hemodialysis
Dialysis treats end-stage kidney failure. It removes waste from your blood when your kidneys can no longer do their job.
There are different types of kidney dialysis. This article focuses on hemodialysis.
Your kidneys are in charge of filtering wastes out of your blood. But, if your kidneys don't work as well as they should, you may need a procedure called dialysis, a process that removes wastes in place of your kidneys. Let's talk about dialysis. Your kidneys have several important jobs. In addition to filtering your blood, they help maintain just the right balance of water, acids, and minerals in your body. They also function as part of the endocrine system producing hormones. If you've had kidney disease for many years, or your kidneys have suddenly failed because of disease or injury, your doctor may recommend that you have dialysis, a treatment that replaces some of what the kidneys do, removing waste and excess fluid from your blood. It is sometimes used as a holding treatment while awaiting a kidney transplant. Here's how dialysis works. First, your doctor will need to create an access to reach your blood vessels. If you need dialysis only for a short period of time, that access will be made using a hollow tube, called a catheter. Usually the catheter is placed into a large vein in your neck, chest, or leg near your groin. If you're having dialysis for a longer period of time, you'll need a more permanent access. To create this access, your doctor will connect one of your arteries to one of your veins. Then whenever you have dialysis, a needle is simply placed into this access area. During each dialysis session, your blood is removed from your body through the needle. It's sent across a special filter, which removes harmful substances from your blood. Then, your clean blood is sent back into your body. Often, you'll visit a special center for dialysis about three times a week. Each session lasts three to four hours. Or, you may be able to do dialysis right at home three times a week or even daily. Home sessions are shorter, about 2 to 3 hours, and they're easier for your body to tolerate. Before you perform dialysis at home, a nurse will teach you how to place the needle, how to clean the machine, and monitor your blood pressure during treatment. It's important when you're having dialysis that you do all of your scheduled sessions. Also, call your doctor right away if you have any problems, like swelling, redness, fever, a drop in blood pressure, or bleeding. These could be signs that you've developed an infection or other complication from your dialysis, and need medical attention.
What is Hemodialysis?
Your kidneys' main job is to remove toxins and extra fluid from your blood. If waste products build up in your body, it can be dangerous and even cause death.
Hemodialysis (and other types of dialysis) does some of the job of the kidneys when they stop working well.
- Remove extra salt, water, and waste products so they don't build up in your body
- Keep safe levels of minerals and vitamins in your body
- Help control blood pressure
- Help produce red blood cells
During hemodialysis, your blood passes through a tube into an artificial kidney or filter.
- The filter, called a dialyzer, is divided into 2 parts separated by a thin wall.
- As your blood passes through one part of the filter, special fluid in the other part draws out waste from your blood.
- Your blood then goes back into your body through a tube.
Your doctor will create an access where the tube attaches. Usually, an access will be in a blood vessel in your arm.
When to Start Dialysis
Kidney failure is the last stage of long-term (chronic) kidney disease. This is when your kidneys can no longer support your body's needs. Your doctor will discuss dialysis with you before you need it. Usually, you will go on dialysis when you have only 10% to 15% of your kidney function left.
You also may need dialysis if your kidneys suddenly stop working due to acute renal failure.
Dialysis at a Treatment Center
Hemodialysis is most often done at a special dialysis center.
- You will have about 3 treatments a week.
- Treatment takes about 3 to 4 hours each time.
- You may feel tired for several hours after the dialysis.
At a treatment center, your health care providers will handle all your care. However, you do need to schedule your appointments and follow a strict dialysis diet.
Dialysis at Home
You may be able to have hemodialysis at home. You do not have to buy a machine. Medicare or your health insurance will pay for most or all of your treatment costs at home or in a center.
If you have dialysis at home, you can use one of two schedules:
- Shorter (2 to 3 hours) treatments done at least 5 to 7 days per week
- Longer, nightly treatments done 3 to 6 nights per week while you sleep
You also may be able to do a combination of daily and nighttime treatments.
Because you have treatment more often and it happens more slowly, home hemodialysis has some benefits:
- It helps keep your blood pressure lower. Many people no longer need blood pressure medicines.
- It does a better job of removing waste products.
- It's easier on your heart.
- You may have fewer symptoms from dialysis such as nausea, headaches, cramps, itching, and tiredness.
- You can more easily fit treatments into your schedule.
You can do the treatment yourself, or you can have someone help you. A dialysis nurse can train you and a caregiver on how to do home dialysis. Training can take a few weeks to a few months. Both you and your caregivers must learn to:
- Handle the equipment
- Place the needle into the access site
- Monitor the machine and your blood pressure during treatment
- Keep records
- Clean the machine
- Order supplies, which can be delivered to your home
Home dialysis is not for everyone. You will have a lot to learn and need to be responsible for your care. Some people feel more comfortable having a provider handle their treatment. Plus, not all centers offer home dialysis.
Home dialysis may be a good option if you want more independence and are able to learn to treat yourself. Talk with your provider. Together, you can decide what type of hemodialysis is right for you.
When to Call Your Doctor
Call your provider if you notice:
- Bleeding from your vascular access site
- Signs of infection, such as redness, swelling, soreness, pain, warmth, or pus around the site
- A fever over 100.5°F (38.0°C)
- The arm where your catheter is placed swells and the hand on that side feels cold
- Your hand gets cold, numb, or weak
Also, call your doctor if any of the following symptoms are severe or last more than 2 days:
- Trouble sleeping
- Diarrhea or constipation
- Nausea and vomiting
- Drowsiness, confusion, or problems concentrating
Kotanko P, Kuhlmann MK, Chan C. Levin NW. Hemodialysis: principles and techniques. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 93.
Misra M. Hemodialysis and hemofiltration. In: Gilbert SJ, Weiner DE, eds. National Kidney Foundation's Primer on Kidney Disease. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 57.
Yeun JY, Young B, Depner TA, Chin AA. Hemodialysis. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 63.
Last reviewed on: 1/15/2020
Reviewed by: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.