Hemodialysis procedure: Dialysis (Hemodialysis): Purpose, Procedure, and Complications
Hemodialysis | NIDDK
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Hemodialysis is a treatment to filter wastes and water from your blood, as your kidneys did when they were healthy. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium, and calcium, in your blood.
Hemodialysis can help you feel better and live longer, but it’s not a cure for kidney failure.
What happens during hemodialysis?
During hemodialysis, your blood goes through a filter, called a dialyzer, outside your body. A dialyzer is sometimes called an “artificial kidney.”
At the start of a hemodialysis treatment, a dialysis nurse or technician places two needles into your arm. You may prefer to put in your own needles after you’re trained by your health care team. A numbing cream or spray can be used if placing the needles bothers you. Each needle is attached to a soft tube connected to the dialysis machine.
During hemodialysis, your blood is pumped through a filter, called a dialyzer.
The dialysis machine pumps blood through the filter and returns the blood to your body. During the process, the dialysis machine checks your blood pressure and controls how quickly
- blood flows through the filter
- fluid is removed from your body
What happens to my blood while it’s in the filter?
Blood enters at one end of the filter and is forced into many, very thin, hollow fibers. As your blood passes through the hollow fibers, dialysis solution passes in the opposite direction on the outside of the fibers. Waste products from your blood move into the dialysis solution. Filtered blood remains in the hollow fibers and returns to your body.
In the filter, your blood flows inside hollow fibers that filter out wastes and extra salt and water.
Your nephrologist—a doctor who specializes in kidney problems—will prescribe a dialysis solution to meet your needs. The dialysis solution contains water and chemicals that are added to safely remove wastes, extra salt, and fluid from your blood. Your doctor can adjust the balance of chemicals in the solution if
- your blood tests show your blood has too much or too little of certain minerals, such as potassium or calcium
- you have problems such as low blood pressure or muscle cramps during dialysis
Can the dialyzer do everything my kidneys once did?
No. Hemodialysis can replace part, but not all, of your kidney function. Dialysis will help improve your energy level, and changes you make to your diet can help you feel better. Limiting how much water and other liquid you drink and take in through foods can help keep too much fluid from building up in your body between treatments. Medicines also help you maintain your health while on dialysis.
Where can I have hemodialysis?
You can receive treatment at a dialysis center or at home. Each location has its pros and cons.
Most people go to a dialysis center for treatment. At the dialysis center, health care professionals set up and help you connect to the dialysis machine. A team of health care workers will be available to help you. You will continue to see your doctor. Other team members may include nurses, health care technicians, a dietitian, and a social worker.
You’ll have a fixed time slot for your treatments, usually three times per week: Monday, Wednesday, and Friday; or Tuesday, Thursday, and Saturday. Each dialysis session lasts about 4 hours. When choosing a dialysis schedule, think about your work and child care or other caregiving duties.
Some dialysis centers offer nighttime treatments. These treatments occur at the dialysis center 3 nights a week while you sleep, which takes longer. Getting longer overnight dialysis treatments means
- your days are free.
- you have fewer diet changes.
- your liquid allowance (how much liquid you can drink) is closer to normal.
- you may have a better quality of life than with a standard hemodialysis schedule. Longer treatment sessions may reduce your symptoms.
How do I find a dialysis center?
Your doctor, nurse, or social worker can help you find a dialysis center that’s convenient for you. Under Medicare rules, you have the right to choose the dialysis center where you’ll receive treatment. You may want to use Dialysis Facility Compare, which rates all dialysis centers according to quality. Your doctor will give your medical information to the dialysis center you choose.
Most large cities have more than one dialysis center to choose from. You can visit the centers to see which one best fits your needs. For example, you can ask about a center’s rules for laptop and cellphone use, as well as for having visitors. You may want the center to be close to your home to save travel time. If you live in a rural area, the closest dialysis center may be far from your home. If you’d have a hard time getting to the dialysis center, you may want to consider home dialysis treatments such as home hemodialysis or peritoneal dialysis.
Home hemodialysis lets you have longer or more frequent dialysis, which comes closer to replacing the work healthy kidneys do—usually three to seven times per week, and with treatment sessions that last between 2 and 10 hours. Machines for home use are small enough to sit on an end table.
If you choose to have your treatments at home, you’ll still see your doctor once per month.
You can choose a schedule that fits the way you live. You can use
- standard home hemodialysis—three times a week or every other day for 3 to 5 hours
- short daily hemodialysis—5 to 7 days per week for 2 to 4 hours at a time
- nightly home hemodialysis—three to six times per week while you sleep
Your doctor will decide how many treatments you need each week for daily or nightly home hemodialysis.
More dialysis filters your blood more thoroughly
Compared with a standard hemodialysis schedule, daily or nightly home hemodialysis will let you
- eat and drink more normally
- take fewer blood pressure medicines
Healthy kidneys work 24 hours a day, 7 days a week. Getting more hemodialysis feels more like having healthy kidneys and lowers your chances for problems that are common with a standard hemodialysis schedule, such as
- painful muscle cramps from removing too much fluid too quickly
- high blood pressure, which can cause a headache or, in rare cases, a stroke
- low blood pressure, which can make you faint, feel sick to your stomach, or be more likely to fall
- high phosphate levels, which can weaken bones and make your skin itch
Better quality of life
Standard hemodialysis can make you feel tired or washed out for several hours after each treatment. People who have switched from standard hemodialysis to longer or more frequent hemodialysis report they feel better, with more energy, less nausea, and better sleep. They also may report a better quality of life.1
Training for home hemodialysis
Most dialysis centers require that you have a trained partner in your home during hemodialysis treatments, so you must ask a family member or friend to go through the training with you. The clinic’s home-training nurse will teach you important safety skills.
During training, you and your care partner will learn to
- set up the machine
- take steps to prevent infection
- place needles into the vascular access
- respond to any alarms from the machine
- check your weight, temperature, blood pressure, and pulse
- record treatment details for the clinic
- clean the machine
- throw out used supplies safely
- track used supplies and order new ones
Training may take 4½ to 6 hours, 5 days a week, for 3 to 8 weeks. If you already know how to place the needles into your access, training may take less time.
The home-training nurse may visit your home to help with your first at-home treatment.
The home-training nurse will make sure that you and your partner feel confident and may visit your home to help with your first at-home treatment. In addition to providing training and a hemodialysis machine that stays in your home, the dialysis center also provides 24-hour support if you have a question or problem. Some programs also monitor treatments over the internet.
Dialysis center and home hemodialysis comparison
Use the following chart to help you choose between treatment in a dialysis center or at home.
|Dialysis Center and Home Hemodialysis Comparison Chart|
|Schedule||Three treatments a week for about 4 hours. Monday, Wednesday, Friday; or Tuesday, Thursday, Saturday.||Flexible. Three to seven short or long treatments per week at times that work best for you.|
|Availability||Available in most communities; may require travel in some rural areas.||Becoming more widely available as smaller equipment is developed.|
|Machine/supplies||The clinic has the machine and supplies.||The machine and 2- to 4-weeks’ worth of supplies are in the home. You may need minor changes in your home to connect the machine to electricity and water.|
|Training||The clinic teaches about treatments, diet, liquids, medicines, lab tests, etc.||You and a partner must attend 3 to 8 weeks of home hemodialysis training.|
|Diet and liquids||Strict limits on liquids, phosphorus, sodium, and potassium intake.||Fewer limits on liquids or diet, based on the amount of hemodialysis and lab tests.|
|Level of freedom||Less freedom on treatment days. May feel washed out and tired for hours after each treatment.||More freedom because you set the treatment schedule to meet the total amount prescribed. Work and travel are much easier.|
|Amount of work||Center staff members do hemodialysis tasks. They can teach you to do some tasks.||You and your partner must set up, run, and clean the machine; check vital signs; track the treatments and send in forms; and order supplies.|
|Payment||Medicare and most other health plans cover three hemodialysis treatments a week.||Medicare covers three hemodialysis treatments a week and may cover more for medical reasons; other health plans may cover all hemodialysis treatments.|
How do I prepare for hemodialysis?
Dialysis is a complex treatment that takes time to understand. Because most people don’t feel sick until shortly before starting dialysis, you’ll likely still feel well when your doctor first talks to you about getting ready for dialysis. No one wants to start you on dialysis before you need it, but it takes time to prepare for dialysis.
Watch this video to learn why your nephrologist may refer you to a surgeon while you still feel well.
Take care of the blood vessels in your arms
It’s important for you to protect the veins in your arm prior to starting dialysis. If you have kidney disease, remind health care providers to draw blood and insert IV lines only in veins below your wrist; for example, ask them to use a vein in the back of your hand. If an arm vein is damaged by an IV line or by repeated blood draws, that vein may not be able to be used for dialysis.
Watch this video describing how to take care of the blood vessels in your arms in case you need dialysis.
Vascular access surgery
One important step before starting hemodialysis treatment is having minor surgery to create a vascular access. Your vascular access will be your lifeline through which you’ll connect to the dialyzer. Dialysis moves blood through the filter at a high rate. Blood flow is very strong. The machine withdraws and returns almost a pint of blood to your body every minute. The access will be the place on your body where you insert needles to allow your blood to flow from and return to your body at a high rate during dialysis.
Three types of vascular access exist
- an arteriovenous (AV) fistula
- an AV graft
- a catheter
Work closely with your nephrologist and vascular surgeon—a surgeon who works with blood vessels—to make sure the access is in place in plenty of time. Healing may take several months. The goal is for your access to be ready for use when you are ready for dialysis.
Watch a video of a doctor explaining vascular access.
The surgeon connects an artery to a vein to create an AV fistula.
The best type of long-term access is an AV fistula. A surgeon connects an artery to a vein, usually in your arm, to create an AV fistula. An artery is a blood vessel that carries blood away from your heart. A vein is a blood vessel that carries blood back toward your heart. When the surgeon connects an artery to a vein, the vein grows wider and thicker, making it easier to place the needles for dialysis. The AV fistula also has a large diameter that allows your blood to flow out and back into your body quickly. The goal is to allow high blood flow so that the largest amount of blood can pass through the dialyzer.
The AV fistula is a blood vessel made wider and stronger by a surgeon to handle the needles that allow blood to flow out to and return from a dialysis machine.
The AV fistula is considered the best option because it
- provides highest blood flow for dialysis
- is less likely to become infected or clot
- lasts longer
Most people can go home after outpatient surgery. You will get local anesthesia to numb the area where the vascular surgeon creates the AV fistula. Depending on your situation, you may get general anesthesia and not be awake during the procedure.
Watch a video about why the fistula is the best access option.
If problems with your veins prevent you from having an AV fistula, you may need an AV graft instead. To create an AV graft, your surgeon uses a man-made tube to connect an artery to a vein. You can use an AV graft for dialysis soon after surgery. However, you’re more likely to have problems with infection and blood clots. Repeated blood clots can block the flow of blood through the graft and make it hard or impossible to have dialysis.
An AV graft uses a synthetic tube to connect an artery and a vein for hemodialysis.
Catheter for temporary access
If your kidney disease has progressed quickly, or you have not had a vascular access placed before you need dialysis, you may need a venous catheter—a small, soft tube inserted into a vein in your neck, chest, or leg near the groin—as a temporary access. A nephrologist or an interventional radiologist—a doctor who uses medical imaging equipment to perform surgery—places the venous catheter while you’re in a hospital or at an outpatient clinic. You’ll receive local anesthesia and medicine to keep you calm and relaxed during the procedure.
Watch a video about problems with catheters.
What changes will I have to make when I start hemodialysis?
You have to adjust your life to build your dialysis treatment sessions into your routine. If you have in-center dialysis, you may need to rest after each treatment. Adjusting to the effects of kidney failure and the time you spend on dialysis can be hard. You may need to make changes in your work or home life, giving up some activities and responsibilities. Accepting these changes can be hard on you and your family. A mental health counselor or social worker can answer your questions and help you cope.
You will have to change what you eat and drink. Your health care team may adjust the medicines that you take.
Take care of your access
Your access is your lifeline. You will need to protect your access. Wash the area around your access with soap and warm water every day. Check the area for signs of infection, such as warmth or redness. When blood is flowing through your access and your access is working well, you can feel a vibration over the area. Let your dialysis center know if you can’t feel the vibration.
Make changes to what you eat and drink
If you’re on hemodialysis, you may need to limit
- sodium in foods and drinks.
- high-phosphorus foods.
- the amount of liquid you drink, including liquid found in foods. Fluid builds up in your body between hemodialysis treatments.
You may also need to
- add protein to your diet because hemodialysis removes protein
- choose foods with the right amount of potassium
- take vitamins made for people with kidney failure
- find healthy ways to add calories to your diet because you may not have a good appetite
Meet with a dietitian to develop a meal plan that works for you.
Eating the right foods can help you feel better when you’re on hemodialysis. Talk with your dialysis center’s dietitian to find a hemodialysis meal plan that works for you.
How will I know if my hemodialysis is working?
You’ll know your hemodialysis treatments are working by how you feel. Your energy level may increase and you may have a better appetite. Hemodialysis reduces salt and fluid buildup, so you should have less shortness of breath and swelling as well.
This video explains how most people with kidney failure feel better after starting dialysis.
To make the most of your hemodialysis treatment, keep to your ideal “dry weight.” Your ideal dry weight is your weight when you don’t have extra fluid in your body. If you’re careful about the sodium in your diet and the hemodialysis is working, you should be able to reach your ideal dry weight at the end of every hemodialysis treatment. When hemodialysis treatments are working and you keep to your ideal dry weight, your blood pressure should be well controlled.
Keep to your ideal dry weight.
In addition, blood tests can show how well your hemodialysis treatments are working. Once a month, whether you’re on home or dialysis center hemodialysis, your dialysis center will test your blood. Read more about hemodialysis dose and adequacy.
What are possible problems from hemodialysis?
You could have a problem with your vascular access, which is the most common reason someone on hemodialysis needs to go to the hospital. Any type of vascular access may
- become infected
- have poor blood flow or blockage from a blood clot or scar
These problems can keep your treatments from working. You may need to have more procedures to replace or repair your access for it to work properly.
Sudden changes in your body’s water and chemical balance during treatment can cause additional problems, such as
- muscle cramps.
- a sudden drop in blood pressure, called hypotension. Hypotension can make you feel weak, dizzy, or sick to your stomach.
Your doctor can change your dialysis solution to help avoid these problems. The longer and more frequent treatments of home hemodialysis are less likely to cause muscle cramps or rapid changes in blood pressure than standard in-center dialysis.
You can lose blood if a needle comes out of your access or a tube comes out of the dialyzer. To prevent blood loss, dialysis machines have a blood leak detector that sets off an alarm. If this problem occurs at the clinic, a nurse or technician will be on hand to act. If you’re using home dialysis, your training will prepare you and your partner to fix the problem.
You may need a few months to adjust to hemodialysis. Always report problems to your health care team, who often can treat side effects quickly and easily. You can avoid many side effects by following an eating plan you develop with your dietitian, limiting liquid intake, and taking your medicines as directed.
What happens if I have been on dialysis and I decide to stop?
If you’ve been on dialysis and wish to stop, you’ll still receive supportive care. The dialysis social worker may be able to help you develop an end-of-life care plan before you stop dialysis.
 Hall YN, Larive B, Painter P, et al. Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials. Clinical Journal of the American Society of Nephrology. 2012;7(5):782–794.
Dialysis (Hemodialysis): Purpose, Procedure, and Complications
Your kidneys are two bean-shaped organs that lie just below your rib cage, on each side of your spine. They remove waste and fluid from your body, level out your blood pressure, and keep your bones strong. They also ensure that you have the right amount of minerals, like potassium and sodium (salt), in your blood. Finally, they make the hormone that causes your body to create red blood cells.
It’s a treatment that takes over your kidney functions if those organs stop doing their job. There are two types of dialysis:
Hemodialysis: Your blood is put through a filter outside your body, cleaned, and then returned to you. This is done either at a dialysis facility or at home.
Peritoneal dialysis: Your blood is cleaned inside your body. A special fluid is put into your abdomen to absorb waste from the blood that passes through small vessels in your abdominal cavity. The fluid is then drained away. This type of dialysis is typically done at home.
Who Needs Dialysis?
If your kidney disease becomes very severe and crosses a point where there’s not enough function to maintain the body, then you need either a transplant or dialysis.
You typically start dialysis when you have symptoms or your lab tests show toxic levels of waste in your blood. Symptoms of kidney failure include nausea, fatigue, swelling, and throwing up.
When you should start dialysis depends on your age, energy level, overall health, lab test results and how willing you are to commit to a treatment plan. Although it can make you feel better and live longer, it involves a lot of your time.
Your doctor will let you know when you should start treatment. They’ll also explain which type might work best for you.
How Does Hemodialysis Work?
First, you’ll need minor surgery to create direct access to your bloodstream. This can be done in a few ways:
Fistula (also known as arteriovenous fistula or A-V fistula): An artery and vein are joined together under the skin in your arm. Most of the time, this is done in the one you don’t write with. An A-V fistula needs 6 weeks or longer to heal before it can be used for hemodialysis. Then, it can be used for many years.
Graft (arteriovenous graft or A-V graft): A plastic tube is used to join an artery and vein under your skin. This heals in only 2 weeks, so you can start hemodialysis faster. This won’t last as long as a fistula. You’ll likely need another graft after a few years.
The risk of infection is greater with a graft. You’ll also have to see your doctor more often so they can make sure the graft stays open.
Catheter (central venous catheter): This method is an option if you need to start hemodialysis very quickly. A flexible tube (catheter) is put into a vein in your neck, below your collarbone, or next to your groin. It’s only meant to be used for a short time.
During hemodialysis, you’ll sit or lie back in a chair. A tech will place two needles in your arm where the fistula or graft is located. A pump in the hemodialysis machine slowly draws out your blood, then sends it through another machine called a dialyzer. This works like a kidney and filters out extra salt, waste, and fluid. Your cleaned blood is sent back into your body through the second needle in your arm. Or, if there’s a catheter, blood comes out of one port and then is returned via a second port.
You can have hemodialysis in a hospital, a dialysis treatment center, or at home. If you have it in a center, the sessions last 3 to 5 hours, and you’ll likely only need them three times a week. If you have hemodialysis at home, you’ll need treatments 6 or 7 days for 2 to 3 hours each time.
Some people read or watch TV during treatment. If you have hemodialysis at home, you may be able to do it at night while you sleep.
How Does Peritoneal Dialysis (PD) Work?
It uses the lining of your belly to filter your blood. A few weeks before you start treatment, a catheter is placed near your navel. Once the area heals, you’ll be trained on how to do PD since you’ll be doing it yourself.
You’ll use the catheter to transfer dialysis solution from a bag into your belly. This special fluid contains water with salt and other additives. It soaks up waste and extra fluids inside your body. After a few hours, you’ll drain it out into a separate bag. This process is called an “exchange.”
There are two kinds of PD:
Continuous cycling peritoneal dialysis (CCPD): This uses a machine to do your exchanges.
Continuous ambulatory peritoneal dialysis (CAPD): You’ll do your exchanges by hand.
You’ll likely do four to six exchanges each day. Your doctor can help you decide which type fits your lifestyle. Some people do both.
What Can I Expect When I Go Through Dialysis?
It shouldn’t hurt. If you have pain during or after treatment, tell your doctor right away. You may have side effects, though. Low blood pressure is common. You could also have nausea, vomiting, dry or itchy skin, muscle cramps, or feel very tired.
You can lessen side effects by being careful about what you eat and drink. Your doctor can advise how much fluid, protein, and salt you should have.
Hemodialysis patients are also at an increased risk for infections. Try these tips to stay healthy:
- Check your access site daily for redness, pus, and swelling. If you see any, call your doctor.
- Keep the bandage that covers your catheter clean and dry.
Make sure anyone who helps with your treatment washes their hands before and after with soap and water.
What If I Want to Stop Dialysis?
This treatment should maintain or improve your quality of life. But you can choose not to have it or stop at any time. If you do, make sure to talk to your doctor about other treatments that can help you. Changes to your diet or lifestyle may improve your quality of life.
If you want to stop dialysis because you feel depressed or ashamed, your doctor may urge you to speak to a counselor first. Sharing your feelings, taking antidepressants, or doing both of these things may help you make a more informed decision.
Dialysis is not for everyone, particularly for the very elderly and those with very severe medical conditions.
Hemodialysis – Procedure, Dialysis & Diet
This treatment is typically required when less than 15 percent of your kidney function remains.
Hemodialysis is a treatment that performs the job of the kidneys when they stop working properly.
During hemodialysis, a machine removes salt, water, and waste products from your blood.
The treatment can help control blood pressure and balance levels of vitamins and minerals in the body.
Hemodialysis is used in people with end-stage kidney failure, which is the last stage of chronic kidney disease.
It’s also used in people who suffer from acute kidney injury.
Conditions such as diabetes, high blood pressure, kidney cysts, kidney inflammation, and other illnesses can lead to kidney failure.
Typically, your doctor will put you on dialysis when 10 to 15 percent of your kidney function is left.
The Hemodialysis Procedure
Hemodialysis is usually performed at a dialysis center or hospital, or at home.
Two needles are inserted into your arm, and each is attached to a flexible plastic tube that connects to a dialyzer (a filter that cleans your blood).
The dialyzer takes your blood in through one tube. It allows extra fluids and wastes to pass from your blood into a cleansing fluid.
The filtered blood is then returned to your body through a second tube.
You can sit in a chair and watch TV, read, or nap while you receive hemodialysis.
Most people have about three treatments a week, each of which takes about three to four hours.
If you receive hemodialysis at home, you may have shorter treatments more often, and you may receive the therapy while you sleep.
Home dialysis is typically performed six to seven days a week for two to three hours at a time.
A nurse or other expert will train you on how to do your dialysis at home.
Some studies have shown that home dialysis results in a better quality of life and fewer unwanted side effects.
Before you start receiving dialysis, your doctor will need to create an access site that allows blood to travel from your blood vessel to the dialyzer.
This minor surgery is usually performed in the arm.
Before each dialysis treatment, your doctor may check your weight, blood pressure, pulse, and temperature. The skin around your access site will be cleansed.
When a dialysis treatment is complete, the needles are removed, and a pressure dressing is applied to prevent bleeding.
Your doctor may check your weight again.
You’ll probably need blood tests often to check how well the treatment is working. Keep all appointments with your doctor and/or lab.
Be sure to tell your doctor about any unusual or severe side effects.
During or after your treatment, you may experience one or more of the following symptoms:
- Muscle cramps
- Headache, nausea, or dizziness
- Low blood pressure
- High blood pressure
- Trouble sleeping
- Anemia (low red blood cell count)
- Bone diseases
- Fluid overload (too much fluid in the blood)
- Inflammation of the membrane around the heart
- Irregular heartbeat (arrhythmia)
- High potassium levels
- Infection or blockage of your access site
- Amyloidosis (proteins in the blood are deposited on joints and tendons)
Your doctor will probably tell you to follow a special diet while you’re receiving dialysis.
Most people are advised to eat more protein and limit their consumption of potassium, sodium, phosphorus, and fluids.
Talk to your healthcare provider about your individual needs.
Types, How It Works, Procedure & Side Effects
What is dialysis?
Dialysis is a treatment for people whose kidneys are failing. When you have kidney failure, your kidneys don’t filter blood the way they should. As a result, wastes and toxins build up in your bloodstream. Dialysis does the work of your kidneys, removing waste products and excess fluid from the blood.
Who needs dialysis?
People who have kidney failure, or end-stage renal disease (ESRD), may need dialysis. Injuries and conditions like high blood pressure, diabetes and lupus can damage kidneys, leading to kidney disease.
Some people develop kidney problems for no known reason. Kidney failure can be a long-term condition, or it can come on suddenly (acute) after a severe illness or injury. This type of kidney failure may go away as you recover.
There are five stages of kidney disease. In stage 5 kidney disease, healthcare providers consider you to be in end-stage renal disease (ESRD) or kidney failure. At this point, kidneys are carrying out around 10% to 15% of their normal function. You may need dialysis or a kidney transplant to stay alive. Some people undergo dialysis while waiting for a transplant.
What do the kidneys do?
Your kidneys are part of your urinary system. These two bean-shaped organs sit below your ribcage on each side of your spine. They clean toxins from your blood, returning filtered, nutrient-rich blood to the bloodstream.
The waste and extra water make urine, which moves from the kidneys into the bladder. Your kidneys also help regulate your blood pressure.
What are the types of dialysis?
There are two ways to get dialysis:
- Peritoneal dialysis.
What is hemodialysis?
With hemodialysis, a machine removes blood from your body, filters it through a dialyzer (artificial kidney) and returns the cleaned blood to your body. This 3- to 5-hour process may take place in a hospital or a dialysis center three times a week.
You can also do hemodialysis at home. You may need at-home treatments four to seven times per week for fewer hours each session. You may choose to do home hemodialysis at night while you sleep.
What happens before hemodialysis?
Before you start hemodialysis, you’ll undergo a minor surgical procedure to make it easier to access the bloodstream. You may have:
- Arteriovenous fistula (AV fistula): A surgeon connects an artery and vein in your arm.
- Arteriovenous graft (AV graft): If the artery and vein are too short to connect, your surgeon will use a graft (soft, hollow tube) to connect the artery and vein.
AV fistulas and grafts enlarge the connected artery and vein, which makes dialysis access easier. They also help blood flow in and out of your body faster.
If dialysis needs to happen quickly, your provider may place a catheter (thin tube) into a vein in your neck, chest or leg for temporary access.
Your provider will teach you how to prevent infections in your fistula or graft. This provider will also show you how to do hemodialysis at home if you choose to do so.
What happens during hemodialysis?
During hemodialysis, the dialysis machine:
- Removes blood from a needle in your arm.
- Circulates the blood through the dialyzer filter, which moves waste into a dialysis solution. This cleansing liquid contains water, salt and other additives.
- Returns filtered blood to your body through a different needle in your arm.
- Monitors your blood pressure to adjust how fast blood flows in and out of your body.
What happens after hemodialysis?
Some people experience low blood pressure during or immediately after hemodialysis. You may feel nauseous, dizzy or faint.
Other side effects of hemodialysis include:
What is peritoneal dialysis?
With peritoneal dialysis, tiny blood vessels inside the abdominal lining (peritoneum) filter blood through the aid of a dialysis solution. This solution is a type of cleansing liquid that contains water, salt and other additives.
Peritoneal dialysis takes place at home. There are two ways to do this treatment:
- Automated peritoneal dialysis uses a machine called a cycler.
- Continuous ambulatory peritoneal dialysis (CAPD) takes place manually.
What happens before peritoneal dialysis?
About three weeks before you start peritoneal dialysis, you’ll have a minor surgical procedure. A surgeon inserts a soft, thin tube (catheter) through your belly and into the peritoneum. This catheter stays in place permanently.
A healthcare provider will teach you how to perform peritoneal dialysis at home and prevent infections at the catheter site.
What happens during peritoneal dialysis?
During peritoneal dialysis, you:
- Connect the catheter to one branch of a Y-shaped tube. This tube connects to a bag that has dialysis solution. The solution flows through the tube and catheter into the peritoneal cavity.
- Disconnect the tube and catheter after about 10 minutes, when the bag is empty.
- Cap off the catheter.
- Go about your usual activities while the dialysis solution inside the peritoneal cavity absorbs waste and extra fluids from the body. This process can take 60 to 90 minutes.
- Remove the cap from the catheter and use the other branch of the Y-shaped tube to drain the fluid into a clean, empty bag.
- Repeat these steps up to four times a day. You sleep with the solution in your stomach all night.
Some people prefer to do peritoneal dialysis at night. With automated peritoneal dialysis, a machine called a cycler pumps the fluid in and out of the body while you sleep.
What happens after peritoneal dialysis?
The liquid in your belly can make you feel bloated or full. It might feel uncomfortable, but the treatment isn’t painful. Your stomach may stick out more than usual when it’s filled with fluid.
Risks / Benefits
What are the potential risks or complications of hemodialysis?
Some people have problems with the AV fistula or graft. You may develop an infection, poor blood flow or a blockage from scar tissue or a blood clot.
Rarely, the dialysis needle comes out of your arm, or a tube comes out of the machine, during dialysis. A blood leak detection system alerts you or the medical staff to this problem. The machine temporarily shuts off until someone fixes the problem. This system protects you from blood loss.
What are the potential risks or complications of peritoneal dialysis?
Some people develop skin infections around the catheter. You’re also at risk for peritonitis, an infection that occurs when bacteria get inside the abdomen through the catheter. You may experience fever, abdominal pain, nausea and vomiting.
Using the abdominal catheter and pumping your belly full of fluid can weaken abdominal muscles over time. You may develop a hernia. This condition occurs when an organ like the small intestine pokes through the abdominal muscles. You may feel a bulge near the belly button or in the groin area between the abdomen and upper thigh. Your doctor can repair a hernia with surgery.
During peritoneal dialysis, your body absorbs dextrose, a sugar, from the dialysis solution. Over time, this extra sugar can lead to weight gain.
Recovery and Outlook
What’s the outlook (prognosis) for someone on dialysis?
It’s possible to live 10 to 20 years on dialysis. The outlook varies depending on your age, overall health, the cause of kidney failure and other factors. If you get a kidney transplant, you can stop dialysis when your new kidney starts working.
Will I have activity restrictions while I’m on dialysis?
Many people on dialysis continue to live active lives, working, raising families and traveling. When you travel, your healthcare provider can help arrange for you to get dialysis at a center at your new location. If you’re doing either type of self-dialysis, you can take dialysis solution bags and the portable home dialysis machine (if needed) with you.
People who use peritoneal dialysis may need to limit exercise or certain physical activities when the abdomen fills with dialysis solution. Otherwise, exercise is typically OK for people on dialysis. You should ask your provider about participating in specific activities or sports.
When to Call the Doctor
When should I call the doctor?
You should call your healthcare provider if you experience:
- Difficulty urinating.
- Dizziness, fainting, unusual thirst (dehydration) or other signs of low blood pressure.
- Nausea and vomiting.
- Signs of infection, such as fever or oozing and redness at the AV fistula or catheter site.
- Severe abdominal pain.
- Unusual bulge in the abdomen or groin (hernia).
A note from Cleveland Clinic
Dialysis is a lifesaving treatment for people with kidney failure or end-stage renal disease (ESRD). You may stay on dialysis indefinitely or just until you can get a kidney transplant. There are different types of dialysis. Some people prefer to do dialysis at home, while others want to go to a hospital or dialysis center. Your healthcare provider can review dialysis options with you to find the treatment that works best for you.
Dialysis – NHS
There are 2 main types of dialysis: haemodialysis and peritoneal dialysis.
- haemodialysis involves diverting blood into an external machine, where it’s filtered before being returned to the body
- peritoneal dialysis involves pumping dialysis fluid into the space inside your abdomen (tummy) to draw out waste products from the blood passing through vessels lining the inside of the abdomen
These 2 treatments are outlined on this page.
Preparing for treatment
Before haemodialysis can start, you’ll usually need to have a blood vessel called an arteriovenous fistula (AV fistula) created in your arm. This blood vessel is created by connecting an artery to a vein.
Joining a vein and an artery together makes the blood vessel larger and stronger. This makes it easier to transfer your blood into the dialysis machine and back again.
The operation to create the AV fistula is usually carried out around 4 to 8 weeks before haemodialysis begins. This allows the tissue and skin surrounding the fistula to heal.
If your blood vessels are too narrow to create an AV fistula, an alternative procedure known as an AV graft may be recommended. A piece of synthetic tubing is used to connect the artery to the vein.
As a short-term measure, or in an emergency, you may be given a neck line. This is where a small tube is inserted into a vein in your neck.
The haemodialysis process
Most people need 3 sessions of haemodialysis a week, with each session lasting around 4 hours. This can be done in hospital or at home.
2 thin needles will be inserted into your AV fistula or graft and taped into place. One needle will slowly remove blood and transfer it to a machine called a dialyser or dialysis machine.
The dialysis machine is made up of a series of membranes that act as filters and a special liquid called dialysate.
The membranes filter waste products from your blood, which are passed into the dialysate fluid.
The used dialysate fluid is pumped out of the dialyser, and the filtered blood is passed back into your body through the second needle.
During your dialysis sessions, you’ll sit or lie on a couch, recliner or bed. You’ll be able to read, listen to music, use your mobile phone or sleep.
Haemodialysis is not painful, but you may feel a bit sick and dizzy and have muscle cramps during the procedure.
This is caused by the rapid changes in blood fluid levels that happen during the treatment.
After the dialysis session, the needles are removed and a plaster is applied to prevent bleeding.
If you were treated in hospital, you can usually go home shortly afterwards.
Fluid and diet restrictions
If you’re having haemodialysis, the amount of fluid you can drink will be severely restricted.
This is because the dialysis machine will not be able to remove 2 to 3 days’ worth of excess fluid from your blood in 4 hours if you drink too much.
This can lead to serious problems where excess fluid builds up in your blood, tissues and lungs.
The amount of fluid you’re allowed to drink will depend on your size and weight. Most people are only allowed to drink 1,000 to 1,500ml (2 to 3 pints) of fluid a day.
You’ll also need to be careful what you eat while having haemodialysis.
This is because minerals such as sodium (salt), potassium and phosphorus, which would normally be filtered out by your kidneys, can build up to dangerous levels quickly between treatment sessions.
You’ll be referred to a dietitian so a suitable diet plan can be drawn up for you.
Diet plans differ from person to person, but it’s likely you’ll be advised to avoid eating foods high in potassium and phosphorus, and cut down the amount of salt you eat.
There are 2 main types of peritoneal dialysis:
- continuous ambulatory peritoneal dialysis (CAPD) – where your blood is filtered several times during the day
- automated peritoneal dialysis (APD) – where a machine helps filter your blood during the night as you sleep
Both treatments can be done at home once you’ve been trained to carry them out yourself.
Preparing for treatment
Before you can have CAPD or APD, an opening will need to be made in your abdomen.
This will allow the dialysis fluid (dialysate) to be pumped into the space inside your abdomen (the peritoneal cavity).
A cut (incision) is usually made just below your belly button. A thin tube called a catheter is inserted into the incision and the opening will normally be left to heal for a few weeks before treatment starts.
The catheter is permanently attached to your abdomen, which some people find difficult.
If you’re unable to get used to the catheter, you can have it removed and switch to haemodialysis instead.
Continuous ambulatory peritoneal dialysis
The equipment used to carry out CAPD consists of:
- a bag containing dialysate fluid
- an empty bag used to collect waste products
- a series of tubing and clips used to secure both bags to the catheter
- a wheeled stand that you can hang the bags from
At first, the bag containing dialysate fluid is attached to the catheter in your abdomen.
This allows the fluid to flow into the peritoneal cavity, where it’s left for a few hours.
While the dialysate fluid is in the peritoneal cavity, waste products and excess fluid in the blood passing through the lining of the cavity are drawn out of the blood and into the fluid.
A few hours later, the old fluid is drained into the waste bag. New fluid from a fresh bag is then passed into your peritoneal cavity to replace it and is left there until the next session.
This process of exchanging the fluids is painless and usually takes about 30 to 40 minutes to complete.
Exchanging the fluids is not painful, but you may find the sensation of filling your abdomen with fluid uncomfortable or strange at first. This should start to become less noticeable as you get used to it.
Most people who use CAPD need to repeat this around 4 times a day. Between treatment sessions, the bags are disconnected and the end of the catheter is sealed.
Automated peritoneal dialysis (APD)
Automated peritoneal dialysis (APD) is similar to CAPD, except a machine is used to control the exchange of fluid while you sleep.
You attach a bag filled with dialysate fluid to the APD machine before you go to bed. As you sleep, the machine automatically performs a number of fluid exchanges.
You’ll usually need to be attached to the APD machine for 8 to 10 hours.
At the end of the treatment session, some dialysate fluid will be left in your abdomen. This will be drained during your next session.
During the night, an exchange can be temporarily interrupted if, for example, you need to get up to go to the toilet.
Some people who have APD worry that a power cut or other technical problem could be dangerous.
But it’s usually safe to miss 1 night’s worth of exchanges as long as you resume treatment within 24 hours.
You’ll be given the telephone number of a 24-hour hotline you can call if you experience any technical problems.
Fluid and diet restrictions
If you’re having peritoneal dialysis, there are generally fewer restrictions on diet and fluid intake compared with haemodialysis because the treatment is carried out more often.
But you may sometimes be advised to limit how much fluid you drink, and you may need to make some changes to your diet. A dietitian will discuss this with you if appropriate.
Dialysis and pregnancy
Becoming pregnant while on dialysis can sometimes be dangerous for the mother and baby.
It’s possible to have a successful pregnancy while on dialysis, but you’ll probably need to be monitored more closely at a dialysis unit and may need more frequent or longer treatment sessions.
If you’re considering trying for a baby, it’s a good idea to discuss this with your doctor first.
If you’re having home haemodialysis or peritoneal dialysis, the supplies and equipment you need will normally be provided by your hospital or dialysis clinic.
You’ll be told how to get and store your supplies as part of your training in carrying out the procedure.
It’s important to make sure you have enough supplies of equipment in case of an emergency, such as adverse weather conditions that prevent you from obtaining supplies.
Your doctor or nurse may suggest keeping at least a week’s worth of equipment as an emergency backup supply.
You should also let your electrical company know if you’re using home haemodialysis or automated peritoneal dialysis.
This is so they can treat you as a priority in the event that your electrical supply is disrupted.
Page last reviewed: 29 September 2021
Next review due: 29 September 2024
What Is Hemodialysis? – DaVita
While healthy kidneys have several functions in the body, the most well-known job is to produce urine. When kidney function goes below 10% to 15% kidneys are no longer able to filter the blood and make urine. This causes toxins to build up in the body along with excess fluid. Fortunately, we live in a time when there are treatments and medicines that can replace the functions of the kidneys and keep the body alive. One type of renal replacement therapy — meaning a treatment that replaces kidney function — is hemodialysis. Hemodialysis is a therapy that filters waste, removes extra fluid and balances electrolytes (sodium, potassium, bicarbonate, chloride, calcium, magnesium and phosphate).
How is hemodialysis done?
In hemodialysis, blood is removed from the body and filtered through a man-made membrane called a dialyzer, or artificial kidney, and then the filtered blood is returned to the body. The average person has about 10 to 12 pints of blood; during dialysis only one pint (about two cups) is outside of the body at a time. To perform hemodialysis there needs to be an access created to get the blood from the body to the dialyzer and back to the body. There are three access types for hemodialysis: arteriovenous (AV) fistula, AV graft and central venous catheter. The AV fistula is the vascular access most recommended by the dialysis community; however, you and your doctor will decide which access is best for you.
When a patient goes to hemodialysis, a nurse or technician will check vital signs and get the patient’s weight. The weight gain will tell how much excess fluid the patient has to have removed during the treatment. The patient is then “put on the machine”. Patient with a vascular access (AV fistula or AV graft) will get two needle sticks in their access; one needle takes blood out of the body, the other needle puts it back. Patients with a central venous catheter will have the two tubes from their access connected to the blood tubes that lead to the dialyzer and back to the body. Once the patient is “put on the machine”, the dialysis machine is programmed and then treatment begins.
Blood never actually goes through the dialysis machine. The dialysis machine is like a big computer and a pump. It keeps track of blood flow, blood pressure, how much fluid is removed and other vital information. It mixes the dialysate, or dialysis solution, which is the fluid bath that goes into the dialyzer. This fluid helps pull toxins from the blood, and then the bath goes down the drain. The dialysis machine has a blood pump that keeps the blood flowing by creating a pumping action on the blood tubes that carry the blood from the body to the dialyzer and back to the body. The dialysis machine also has many safety detection features. If you visit a dialysis center, you will likely hear some of the warning sounds made by a dialysis machine.
How does hemodialysis work?
The dialyzer is the key to hemodialysis. The dialyzer is called the artificial kidney because it filters the blood — a job the kidneys used to do. The dialyzer is a hollow plastic tube about a foot long and three inches in diameter that contains many tiny filters. (Dialyzers are made in different sizes so doctors can prescribe the best one for their patients.) There are two sections in the dialyzer; the section for dialysate and the section for the blood. The two sections are divided by a semipermeable membrane so that they don’t mix together. A semipermeable membrane has microscopic holes that allow only some substances to cross the membrane. Because it is semipermeable, the membrane allows water and waste to pass through, but does not allow blood cells to pass through.
Dialysate, also called dialysis fluid, dialysis solution or bath, is a solution of pure water, electrolytes and salts, such as bicarbonate and sodium. The purpose of dialysate is to pull toxins from the blood into the dialysate. The way this works is through a process called diffusion. In the blood of the hemodialysis patient, there is a high concentration of waste, while the dialysate has a low concentration of waste. Due to the difference in concentration, the waste will move through the semipermeable membrane to create an equal amount on both sides. The dialysis solution is then flushed down the drain along with the waste. The electrolytes in the dialysis solution are also used to balance the electrolytes in the patient’s blood. The extra fluid is removed through a process called filtration. The fluid is pushed off by higher pressure on the blood side than on the dialysate side.
How often is hemodialysis done?
Blood needs to flow through the dialyzer for several hours to adequately clean the blood and rid the body of excess fluid. Traditional, in-center hemodialysis is generally done three times a week for about four hours each session. Your doctor will prescribe how long your treatments will be, usually between 3 to 5 hours, but most common is 4 hours. Talk to your doctor about how long you should be on hemodialysis. Some people feel that dialysis lasts a long time; however, healthy kidneys work 24 hours a day, 7 days a week and dialysis must do the job in only 12 or so hours a week.
Alternative hemodialysis schedules include nocturnal and short daily. Normally, these treatments are performed by people who do home hemodialysis. With nocturnal hemodialysis, the patient has dialysis for about eight hours overnight while sleeping. This is a longer, gentler treatment so patients say they have fewer problems with cramping and the “washed out” feeling reported after traditional hemodialysis. More dialysis centers are beginning to offer in-center nocturnal hemodialysis based on reports of patients feeling better about their quality of life and having good lab results. Short daily hemodialysis is performed five or six times per week for about two to three hours each treatment. Talk to your doctor if you are interested in home hemodialysis (HHD) or in-center nocturnal dialysis. You may want to ask your social worker if addition treatments, such as the longer nocturnal hemodialysis and short daily hemodialysis will be covered through your insurance.
Advantages and disadvantages of hemodialysis
Hemodialysis is an effective treatment for those with end stage renal disease. However, hemodialysis alone will not provide a complete treatment for those with kidney failure. Diet and fluid restrictions need to be followed, and medicines may need to be taken to replace other functions of the kidneys, such as regulating blood pressure and stimulating production of red blood cells to prevent anemia.
For those who choose in-center hemodialysis, some of the benefits are that they will have their treatments performed in a dialysis center by trained professionals. They can spend their time in dialysis sleeping, reading, writing, watching television, listening to music or doing other quiet activities. There are four days a week when they will not have to go to dialysis. Some of the disadvantages are that they will have to travel to and from hemodialysis three times each week and it takes advanced notice to travel and arrange for dialysis in a visiting dialysis center. The diet restrictions include limiting foods that contain phosphorus, potassium and sodium and drinking a limited amount of fluid. Some people report a “washed out” feeling after hemodialysis and go home to take a nap. Those who perform nocturnal hemodialysis (in center or at home) report that this washed out feeling is not as common. Also, because nocturnal dialysis is performed during nonproductive sleeping hours, many people report they feel that their lives are more “normal” because they don’t have to take time out of their days for dialysis.
People who choose to perform hemodialysis at home say they enjoy the feeling of control they have over their lives. Instead of going to the dialysis center at a certain time, they can choose when to perform hemodialysis around their schedule.
There is another type of dialysis called peritoneal dialysis (PD). PD is done by filling the peritoneum in the abdomen with dialysate and using the peritoneal membrane as a semipermeable membrane. There are diet and fluid restrictions with peritoneal dialysis; however, these are usually not as limited as hemodialysis because this therapy is performed every day. PD treatments are performed at home, and so do not require three visits to a treatment center each week. Peritoneal dialysis also has a nighttime treatment option that makes it easier for patients to work, attend school or travel.
All dialysis treatments have their advantages and disadvantages. Based on your lifestyle and medical needs, you and your doctor can discuss your options and decide which one is right for you.
Hemodialysis – Learn how the treatment works including what to consider before beginning
Hemodialysis (also called “hemo”) is one type of dialysis treatment for kidney failure. It uses a machine to clean your blood.
What happens during hemodialysis?
During hemodialysis, your blood travels through tubes from your body into a dialysis machine. While your blood is in the machine, it goes through a filter called a dialyzer, which cleans your blood by removing some of the waste and extra fluid. Then, the cleaned blood travels through tubes from the dialysis machine back into your body.
To get your blood into the dialyzer, your doctor needs to make an access, or entry, into your blood vessels. This is called vascular access.
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How does my blood flow in and out of my body to the dialysis machine?
Before you can begin hemodialysis, you will need minor surgery to get a vascular access. This is a way for your blood to flow in and out of your body to the dialysis machine.
At the start of each hemodialysis treatment, a dialysis technician will place 2 needles in your arm using the vascular access. Your blood will flow through one needle from your vascular access to the dialysis machine, and then from the dialysis machine back to your body through the other needle.
There are 3 types of vascular access:
- AV (arteriovenous) fistula: The AV fistula is the safest type of vascular access. It can last for years and is least likely to get infections or blood clots. A surgeon connects an artery (a large blood vessel that carries blood from your heart) and a vein (a blood vessel that carries blood to your heart) under the skin in your arm. Usually, they do the AV fistula in your non-dominant arm. For example, if you are right-handed, you would probably get your fistula in your left arm.
Because the fistula needs time to heal after surgery, it’s best to get an AV fistula 2–3 months before you need to start dialysis. After 2-3 months, the fistula will be stronger than a normal artery or vein to allow needles to be put in and taken out many times a week.
- AV graft: An AV graft is the next best vascular access option. It’s more likely to have problems with infections and blood clots. A surgeon uses a plastic tube to connect an artery and vein under the skin in your arm. It’s best to get an AV graft 2–3 weeks before you start dialysis.
- Catheter: A catheter is a Y-shaped plastic tube. Catheters are more likely to have problems with infection, blood clots, and scarring. One end connects to a large vein that is deeper inside your body. The other two ends come out through your skin. There are 2 types of catheters:
- A venous catheter connects to a vein in your neck, chest, or leg and hangs outside your body from an opening in your skin. If you need to start dialysis right away, your doctor may recommend a venous catheter because it can be placed and used the same day. But, it should only be used for short periods of time.
- A tunneled catheter most often connects to a vein in your neck. It is safer and can be used for longer periods of time than a venous catheter.
Talk with your doctor to decide which type of vascular access is best for you. No matter what type of vascular access you get, you must take care of it to protect your health and to make sure it is useful for as long as possible. Learn more about caring for your vascular access.
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Where is hemodialysis done?
If you choose to have hemodialysis, you may do your treatments in a dialysis center or at home, during the day or at night. Learn more about where hemodialysis can be done.
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How much time does each treatment take?
Usually, each hemodialysis treatment lasts about 3–4 hours and is done 3 times a week. The time needed for your dialysis depends on:
- How well your kidneys work
- How much waste and fluid builds up in your body between treatments
- Your height and weight
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Why do I need to weigh myself when on hemodialysis?
Keeping track of your weight is a good way to know if your body is holding on to too much water. Because your kidneys are not working well, your body may hold on to extra water between dialysis sessions.
Your target weight (also called dry weight) is what you should weigh after you have finished each dialysis treatment. Your doctor will work with you to figure out your target weight.
If you are on hemodialysis, you should also weigh yourself every morning and contact your doctor if your weight is much higher or lower than normal. Remember, how closely you follow your food and fluid plan and whether you take your medicines correctly will affect your weight too.
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Things to consider when choosing a hemodialysis treatment plan
When you are deciding on hemodialysis and what schedule is best for you, it is important to consider how the treatment will fit with your life. You know yourself and your daily routine best. Taking this into account can help you follow the plan you choose.
This table will help you compare hemodialysis in a center and at home.
|How often will I have treatments?||Most people have 3 treatments each week. This can be during the day or at night.||Most people have 4–6 treatments each week. Some people choose to do them at night, about every other night. Your doctor will help you create a schedule that Is best for you.|
|Will I have to change the way I eat?||You will need to be stricter with limits on certain foods. If you know that this may be hard for you, a treatment plan that requires such limits might not be right for you.||If you do your treatments every day, you may be able to be less strict with your meal plan.|
|Can I keep working while on hemodialysis?||Yes but you have to schedule work or school around the time you need to travel to the dialysis center and get treatment.||Yes, and because you do not have to travel to a dialysis center, you will have more flexibility to fit dialysis into your daily schedule.|
|Can I travel while on hemodialysis?||Yes, but you need to plan for it. You can do your treatment sessions at a dialysis center in the city you’re visiting. However, there may be a co-pay.||Yes, but you need to plan for it. Certain machines are small enough that you can bring your dialysis machine with you on your trip. You will also need a trained care partner to help you with each treatment.|
|What else should I know?||You will:
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Questions to ask your doctor
Talk with your doctor about which treatment would work best for you, your loved ones and your schedule. Here are some questions you may want to ask your doctor:
- What type of vascular access would be best for me?
- What is my target weight?
- How often and for how long do I need to have hemodialysis?
- What type of hemodialysis is best for me, given my travel, work and the activities I enjoy?
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Hemodialysis is a procedure for cleansing the blood outside your body. In this type of treatment, blood is circulated through a filter (dialyzer) connected to the dialysis machine. Each procedure usually takes 4 to 5 hours and should be done at least three times a week.
How hemodialysis works
The dialyzer is where metabolic waste and fluid are removed from your blood. The key feature of the dialyzer is that it consists of a bundle of thin, semi-permeable membranes.The membranes act as a barrier between the blood and the dialysis solution and allow the selective movement of substances from and into the blood.
The principle seems to be quite complicated, but in fact it is very simple: sterile plastic tubes are connected to the dialyzer; one tube is for transporting blood to the dialyzer, the other for returning it to the body. The tubing and dialyzer (blood supply circuit) are connected to the dialysis machine. The device safely monitors blood flow in the bloodstream, its speed is usually 250-450 ml / min.The total volume of the circuit is 200-300 ml. One full dialysis session usually takes 4-5 hours.
What happens during a dialysis session
Before starting hemodialysis treatment, you need to provide vascular access. At the beginning of each session, it is necessary to carry out a small procedure for preparing the vascular access for connection to the blood supply circuit. Throughout the dialysis session, the patient should sit or lie comfortably in a chair or bed; you can read, listen to music or sleep.You can also work on your computer, watch movies, or surf the Internet.
During your procedure, you may be injected with certain drugs directly into your bloodstream. The nurses will also monitor your condition and the operation of the dialysis machine. At the end of your dialysis session, another small procedure is used to disconnect you from the blood circuit.
You may feel tired after the session
The hemodialysis procedure itself is not painful.However, you may experience some side effects. Typically, after a long dialysis session, patients feel fatigued. Treatments for this symptom include dietary adjustments and regular exercise. It can boost your overall energy levels. Some people may experience nausea, dizziness, or muscle cramps during a dialysis session. If you have such problems, the nursing staff will do everything to help you cope with them.
90,000 indications for conducting, as they are doing, the result after the procedure
Hemodialysis: how to carry out, contraindications, types
Briefly about a famous
Our kidneys have the most direct impact on life expectancy and quality.Therefore, a person is faced with renal failure, he, in fact, begins to poison himself with metabolic waste. In addition, any of us is susceptible to infection from external sources – for example, acetone vapor. It doesn’t go unnoticed, especially when the kidneys fail.
Hemodialysis has been known for a long time. The technique itself is justified by the need to control the course of pathologies that are somehow associated with a sharp increase in the blood of decay products, as well as intermediate products.This is due to hepatic or renal failure, the process of metastasis, poisoning with medicinal products, alcohol-containing substances, and poisons. In oncological practice, one often has to deal with the problem of intoxication due to tumor growth, and this, in turn, triggers the process of increasing the concentration of pathological proteins, which can lead to the death of the patient.
In essence, the procedure is designed to remove harmful substances from the blood.First of all, it is used to treat people with kidney failure. The devices used in the procedure are able to filter out urea, toxins, excess fluid from the blood and help to increase, sometimes significantly, the life of patients. Medical statistics state that more than a thousand people per million people need to purify blood.
How to conduct
So, hemodialysis is the purification of the blood from toxic substances, excess fluid, carried out with the help of an “artificial kidney” apparatus.The principle of operation is simple. The “artificial kidney” membrane allows for the “pumping” of toxins from the blood of patients. They get into a special solution, but proteins do not get there, again thanks to the membrane. Then, ultrafiltration of toxins and excess fluid begins. It is clear that such manipulations must be carried out under conditions of high sterility. The “artificial kidney” is connected by a tube to the patient’s circulatory system. A special pump that drives blood through the apparatus; being cleansed, it enters the patient again.This procedure does not interfere with the patient: for five to six hours, while it is being carried out, he can read or watch TV. An “artificial kidney” performs several functions at once:
- Normalizes electrolyte levels;
- Maintains the balance of acid-base;
- Removes metabolic products;
- Counteracts the formation of blood clots;
- Removes excess water, etc.
The uniqueness of the procedure is that it removes harmful substances from the blood that have got there from the outside or as a result of metabolic processes.In the case of cancer problems, it is able to reduce intoxication and improve the general condition of the patient.
Using hemodialysis, the following is removed from the blood:
- Excess fluid;
- Medicinal preparations;
Indications and Contraindications
As already noted, hemodialysis is applicable for renal failure and for patients with other pathologies.Thanks to him, a person’s life can be saved and its quality is increased. However, there are also contraindications for use:
- Chronic hepatitis;
- Cirrhosis of the liver;
- Serious nervous system problems;
- Active tuberculosis;
- Problems with blood clotting;
- And also age 70+.
The procedure is well recommended for patients with significant tumor intoxication, as well as in preparation for chemotherapy.
Currently, several types of procedures are practiced in the world:
- At home;
- In an outpatient clinic;
- In a hospital setting.
They all have their own advantages and disadvantages. For example, the manipulation practiced in Europe at home is simple and safe, does not make the patient wait for his turn at the clinic, but it is expensive and requires special training.In Russia, they practice the procedure in a hospital or outpatient clinic.
The types of artificial kidney devices differ in the structure of dialyzers:
Both are well established and have inherent advantages.
Today, there are alternative methods of blood purification. In addition to the “artificial kidney”, other methods are used, based on the principle of a membrane of limited permeability.
These are, for example, peritoneal dialysis and intestinal dialysis.
In the first case, the peritoneum plays the role of a filter, in the second – the wall of the colon.
Both techniques can be used if hemodialysis is contraindicated. Both are much cheaper, but their efficiency is less. repeated laboratory diagnostics.
When it comes to how the patient should behave after the procedure, what diet to follow, what lifestyle is worth leading, the main word is for the attending physician or a council of doctors.
The use of hemodialysis can prolong a person’s life by several decades.
Therefore, the doctor’s recommendations, drawn up individually, should be strictly followed.
Onco.Rehab is a modern clinic of integrative oncology, where all your questions will be answered professionally and with help.
Within the framework of the international congress at the university clinic of Kazan University, demonstration operations were performed with broadcast from operating rooms.
Every year there are more and more patients with renal failure in the world. A hemodialysis procedure is required. Hemodialysis – blood purification using the “artificial kidney” apparatus. The device takes over the functions of non-working kidneys, which allows to extend the life of such patients by 15-25 years.
Alexander GURKOV, Chief Surgeon of Fresenius in Russia, Head of the Center for Operative Nephrology, North-Western State Medical University named after Mechnikova I.I. ” Ministry of Health of the Ministry of Health of the Russian Federation, St. Petersburg:
– Today we will turn to the basics of how an arterious fistula is generally formed for hemodialysis, how a catheter is inserted and we will treat a number of complications, because as I understand it, we need to repeat and teach so that over time people will succeed.
During hemodialysis, the blood is purified outside the body using a special filter called a dialyzer. During the hemodialysis procedure, it is required to cleanse a large volume of blood from toxins in a relatively short period of time.
Alexander GURKOV, Chief Surgeon of Fresenius in Russia, Head of the Center for Operative Nephrology, North-Western State Medical University named after Mechnikova I.I. ” Ministry of Health of the Ministry of Health of the Russian Federation, St. Petersburg:
– Patients live for a long time 30, 40 years on hemodialysis, respectively, all this time every other day they receive procedures.Our task is to make such an access so that it would be provided for years, and it would be easy to get treatment on this access.
In Tatarstan, about two thousand such operations are carried out a year. Doctors have a lot of experience. Compared to the year before last, when about 280 such procedures were carried out, last year there are already 360, in other words, the number of patients is growing.
Vladimir LUKANIKHIN, Head of the Department of Vascular Surgery, Kazan Federal University, University Clinic:
– To date, the management of our Kazan University has created all the conditions for these patients to receive adequate assistance.In principle, we have all the conditions, today we provide assistance to these patients almost 7 days a week.
The quality of dialysis improves every year. Patients live no longer 10-15, but 20-30 years.
HEMODILYSIS DEPARTMENT. Our task is to maintain an acceptable quality of life for the patient. -Our news
DEPARTMENT OF HEMODILYSIS. Our task is to maintain an acceptable quality of life for the patient.
The kidneys of a healthy person do a tremendous job every day, filtering hundreds of liters of blood in order to flush the toxins formed in the body with urine. In some diseases, the kidneys cease to perform this task, and the concentration of toxins in the blood and organs becomes dangerously high. This condition is called renal failure. It boils down to the complete or partial loss of the internal organs, primarily the kidneys, of the ability to process and excrete urine. If this problem is not solved, then a person may die from poisoning with his own toxins, excess fluid in the body, or from cardiac arrest caused by potassium retention.Many diseases can cause kidney failure. Among the most common are inflammation of the kidneys (nephritis), diabetes mellitus and long-standing, poorly controlled high blood pressure. There are measures to prevent the onset of kidney failure. However, after its occurrence, a kidney transplant becomes a radical solution, and during the period of waiting or if it is impossible to perform a transplant, patients should receive so-called renal replacement therapy, most often in the form of hemodialysis procedures.
Patients with kidney disease requiring renal replacement therapy are a special category of patients. They are forced to adjust the rhythm of their lives to the schedule of these procedures.
Hemodialysis – a procedure for purifying blood through a semipermeable porous membrane using an artificial kidney apparatus. Hemodialysis is necessary for people with acute renal failure, poisoning with drugs, alcohols, and poisons. But more often people with chronic renal failure need hemodialysis.They undergo programmed hemodialysis – this is a type of hemodialysis in which the patient undergoes dialysis on an ongoing basis, according to an individually selected program, with a previously calculated, known “dry” weight (the patient’s weight without excess fluid in the body). The “artificial kidney” device filters blood through a special membrane, cleans it of water and toxic waste products of the body. It works in place of the kidneys when they are unable to perform their functions.
In our clinic, the hemodialysis department in the day hospital was opened on August 27, 2014.
The department is equipped with the latest equipment: there are 22 artificial kidney machines that allow for both conventional hemodialysis and dialysis in hemodiafiltration mode; centralized concentrate supply system; a computer database of patients with an individual procedure program recorded on an electronic medium.
The main direction of the department’s work is to conduct programmed hemodialysis for outpatients, as well as programmed hemodialysis treatment for patients from a round-the-clock multidisciplinary hospital during their hospitalization with other diseases.On a permanent basis, 90 outpatients are assigned to the hemodialysis department.
The work of the hemodialysis department is organized in 3 shifts, up to 60 procedures are carried out per day.
As a rule, a hemodialysis procedure takes 5-6 hours. During this time, the patient (if the condition allows) can engage in any quiet activities: reading a book or watching TV, which is located right in front of him. In this case, a person is under the supervision of a doctor who can change the settings for the rate of circulation of fluids, control the volume of blood and dialysate, and monitor the pressure and hemoglobin level in the blood.
The availability of programmed hemodialysis in a general hospital for patients with long-term chronic renal failure, gives a chance without serious additional risks to receive treatment for acute diseases, such as myocardial infarction or stroke, to undergo complex, including high-tech, surgical treatment, for example, valve replacement heart or joint replacement. Knowing about this possibility, patients with chronic renal failure are transferred to us almost every day from other hospitals in the city.Moscow.
To realize all the possibilities of the hemodialysis department in a multidisciplinary hospital, it is integrated into a well-functioning nephrological service of the hospital, which includes a nephrological department (with the possibility of accurate morphological diagnosis using kidney biopsy), an intensive care unit with several treatment options for acute renal failure, vascular surgeons providing access for the hemodialysis procedure.
In turn, the nephrological service of the hospital is a part of the nephrological service of a large city, designed to provide high-quality daily care for all patients with kidney diseases.
In the hemodialysis department of the hospital №15 named after OM Filatov, there are 33 employees, most of them have the first and highest qualification category. Doctors and nurses have many years of experience in the field of renal replacement therapy, which, in combination with the use of modern equipment and high-quality consumables, ensures that the world standards for the quality of dialysis procedures are met.
Annually, the department carries out over 15000 hemodialysis procedures, of which about 85 percent are hemodialysis for outpatients (12821 procedures), 15 – for those who are in inpatient departments of the clinic for treatment (2184 procedures).
Hemodialysis, hemosorption and plasmapheresis office – surgical profile
The office for hemodialysis, hemosorption and plasmapheresis of the Federal Research Center of the Federal Medical and Biological Agency of the Federal Medical and Biological Agency of Russia was opened in 2015, on the basis of the hemodialysis department that worked in the hospital since 1986. For a long time, the department was headed by the Honored Doctor of Russia, Doctor of Medical Sciences, Professor Anatoly Nikolaevich Fedoseev, who actively introduced extracorporeal methods of blood detoxification into practical work.
The department has 3 artificial kidney devices, 5 devices for plasmapheresis and hemosorption, the treatment room is designed to provide eight procedures simultaneously.
The office provides assistance to patients with chronic and acute renal failure, allergic and dermatological diseases, demyelinating diseases of the nervous system, myasthenia gravis, patients with miscarriage and gestosis, as well as in preparation for IVF, etc.etc.
More about the branch
Plasmapheresis, hemosorption, immunosorption are used for various metabolic and immune disorders, allergic conditions, intoxication to reduce the concentration of pathological proteins, lipids, hormones, antigens, antibodies, immune complexes, toxic substances of various origins in the plasma. Hemodialysis treatment is carried out for patients with impaired renal function of various origins.
These techniques are modern methods of treatment and prevention of more than 200 diseases, are based on filtration and sorption of blood components and are widely used in all fields of medicine.
– a method of treatment aimed at removing various toxic products from the blood and regulating hemostasis by contacting the blood with a sorbent outside the body.
– a method of treatment, characterized by strict specificity in terms of the effect on the patient’s body, is aimed at selective removal from the blood of pathological immunoglobulins and immune complexes that contribute to the development of various autoimmune diseases.
– This is a blood purification method based on filtering plasma (liquid part of blood) through a special membrane, while blood cells return to the body, and the removed plasma, together with toxic substances, inflammatory elements, immune complexes contained in it, is utilized.
– a method of blood purification in acute and chronic renal failure using a special apparatus “artificial kidney”.During its implementation, all toxic components that accumulate in the body of patients with renal failure are removed.
THERAPEUTIC EFFECTS OF EXTRACORPORAL METHODS APPLICATION:
- Detoxification – reducing the concentration of pathological substances in the blood and body tissues.
- Immunocorrection – normalization of the human immune status by removing allergens, autoantibodies and immune complexes; an increase in the phagocytic activity of leukocytes and a decrease in acute phase proteins.
- Hormonal and vasodilating functions are provided by a decrease in the concentration of hormones such as renin, angiotensin I and II, aldosterone, which is accompanied by an increase in diuresis, sodium excretion and a decrease in blood pressure.
- Improving the viscosity (fluidity) and blood clotting increases blood flow in all organs and tissues.
- Decrease in blood cholesterol levels.
- Increasing the sensitivity of the body to drugs allows you to reduce the dosage of the drugs used and get rid of the effect of “addiction” of the body to drugs used for a long time.
INDICATIONS FOR PLASMAFERESIS AND HEMOSORPTION:
- Allergic diseases (asthma, obstructive pulmonary disease, urticaria, drug and food allergies, hay fever).
- Skin diseases (psoriasis, eczema, toxidermia, herpes, atopic dermatitis, neurodermatitis, furunculosis, pyoderma).
- Rheumatological diseases (rheumatoid arthritis, gout, systemic lupus erythematosus, polyarthritis, dermatomyositis).
- Liver disease (hepatitis, liver cirrhosis, fatty hepatosis, drug and alcoholic liver damage, chronic cholecystitis).
- Kidney disease (pyelonephritis, glomerulonephritis, acute and chronic renal failure).
- Urological diseases (prostatitis, chronic inflammatory diseases of the urogenital sphere).
- Endocrine diseases (diabetes mellitus, diabetic retinopathy, nephropathy, diabetic foot, autoimmune thyroiditis).
- Diseases of the heart and blood vessels (hypercholesterolemia, ischemic heart disease, hypertension, autoimmune cardiomyopathies, obliterating atherosclerosis of peripheral vessels, chronic venous insufficiency).
- Diseases of the nervous system (multiple sclerosis, Guillain-Barré syndrome, discirculatory encephalopathy, myasthenia gravis, depression and chronic fatigue syndrome).
- Gynecological diseases (miscarriage, gestosis, preparation for IVF, chronic inflammatory diseases of the urogenital sphere, antiphospholipid syndrome, menopause, premenstrual syndrome).
- Septic conditions.
- Poisoning of various origins.
ADVANTAGES OF TREATMENT WITH EXTRACORPORAL METHODS:
- the procedure is safe, it is performed with a single-use, sterile, closed circuit, which eliminates the risk of infection;
- The use of a membrane filter for plasmapheresis treatment and biocompatible hemofilters for hemosorption ensures good tolerability of procedures and does not lead to the destruction of blood corpuscles;
- Before the course of treatment, a specialist doctor must be consulted in order to determine the indications and contraindications for the procedure, the choice of the method and treatment regimen individually for each patient.
- after a course of treatment, remission occurs faster, more prolonged, exacerbations are recorded less often;
- acute manifestations of the disease are quickly stopped;
- improves the effectiveness of “traditional” treatment;
- These techniques are an alternative for acute poisoning, familial hypercholesterolemia, autoimmune diseases.
All procedures are carried out both in inpatient and outpatient conditions under the supervision of a doctor and nursing staff, using modern equipment, using biocompatible hemosorbents and disposable consumables and are safe for the patient.
The duration depends on the type of treatment being carried out and takes from 1 hour to 1.5 hours (for plasmapheresis and hemosorption) to 4-5 hours (for hemodialysis). The number of procedures and the mode of their conduct is selected individually for each patient, depending on his disease and the state of the body as a whole.
Contraindications to treatment are:
anemia, blood clotting disorders, thrombocytopenia, bleeding, ulcers or erosion of the stomach, tumors, fever, allergic reactions to the components of procedures.
On World Kidney Day, Ugra residents were told about the blood purification procedure – hemodialysis | Society
In order to live, these patients spend 12 hours a week in hospital wards. Some of them have resigned themselves – this will continue for life. Others hope that after a while they will not have to visit the dialysis center. It all depends on the degree of kidney damage.
Alexey Pyankin, Head of the Center for Acute and Chronic Dialysis, OKB g.Khanty-Mansiysk: “Acute renal is an acute kidney injury, as a rule, it is reversible. During the period when renal function is impaired, the patient receives renal replacement therapy. In the event of chronic diseases, renal function can no longer be restored. ”
The procedure takes at least 4 hours. 3 times a week, patients with acute or chronic renal failure undergo a hemodialysis session. Hemodialysis is the purification of the blood. It enters the complex apparatus “Artificial kidney”, passes through a special filter, is freed from toxins and returns to the body. “The device “Artificial kidney” performs all actions automatically. On the screen you can see what time the procedure started, how long it takes and the patient’s blood pressure.
Listening to music, reading books, discussing the latest news … In such a company, treatment turns into a friendly conversation, where patients at least for a while forget about a common ailment.
People who are eligible for hemodialysis, like everyone else, work and travel.The only difference is that their daily routine is more regulated. You cannot cancel or reschedule the session. Therefore, if patients travel outside the city, they register in advance with other dialysis centers.
Alexander Ernov, patient of the acute and chronic dialysis center of the Khanty-Mansiysk Regional Clinical Hospital: “After dialysis I also continue to live. Do everything: work, house chores, everything. The same life happens. They shouldn’t be afraid of dialysis ”.
There are enough dialysis centers in Ugra.Everyone is given the help they need. Sometimes doctors even have to persuade patients to enroll in the center, while earlier hemodialysis was not performed in the district at all.
“Even 25 years ago, if a patient developed end-stage renal disease, all that remained for him was either to die in his village, or in some way, to break out of the district, where there are dialysis centers. Now there are no problems with this, ”says Alexey Pyankin.
Of course, there is nothing better than being completely healthy.It is possible to get a diagnosis of renal failure even with improper diet. Therefore, it is recommended to visit your doctor at least once a year.
At the hospital. S.S. Yudina updated equipment for hemodialysis
In July 2021, the Yudin Hospital completely renewed the equipment for hemodialysis.
Hemodialysis is a procedure for cleansing the blood outside the body using a special filter, designed for people with acute and chronic renal failure.Such a procedure is necessary for people who have poorly functioning or no kidneys.
– Now the hemodialysis department works with new equipment. The devices allow you to perform the hemodialysis procedure in a comfortable environment and as convenient as possible for patients, fully meeting the most modern standards of this type of medical care. The devices, in addition to excellent ergonomic characteristics, have a sound signal accompanying the change of modes and the moments of completion of the stages of the cycle.The equipment of the highest quality level also includes characteristics that make it possible to use consumables as efficiently as possible – said Olga Papysheva, chief physician of the N. S.S. Yudin.
New devices have the ability to carry out hemodiafiltration (HDF). HDF is a modern method of renal replacement therapy. This method effectively removes a wide range of toxins from the blood. During HDF, the therapeutic (clinical) effect is achieved by the possibility of exchanging a large amount of fluid, and the dialysis procedure itself is as close as possible to the natural work of the kidneys.Currently, this technique is considered one of the best and most effective methods of renal replacement therapy.
According to the head of the hemodialysis department, Oleg Mishin, in total there are 24 “artificial kidneys” installed in the hemodialysis department, which allow to admit about 80 patients daily, in four shifts, 6 days a week. On average, one patient spends about 4 hours in the hemodialysis room three times a week.
Note that the wing of the first floor of the main building of the hospital was repaired to accommodate new devices.The hemodialysis department has been operating in the hospital since 1981.
Yudin Hospital provides comprehensive medical care for people with any kidney disease. In addition to the hemodialysis department, the department for providing assistance to such patients includes two more departments: nephrological and surgical department No. 3. If necessary, specialists from other departments – X-ray endovascular methods of diagnosis and treatment, endocrinologists, cardiologists, etc.
Patients receive therapeutic treatment in the nephrology department. The task of doctors is to help prevent the development of pathological processes and organ death. Also in this department, patients with chronic renal failure are observed using portable automatic dialysis machines for use at home. The appearance of such equipment resembles a small suitcase that can be easily carried in the hand.