Hemodialysis for Chronic Kidney Disease

Reviewed by: HU Medical Review Board | Last reviewed: December 2022

Hemodialysis is 1 type of dialysis treatment for advanced chronic kidney disease (CKD) or end-stage kidney disease (ESKD). Hemodialysis does the work that failing kidneys are no longer able to do. It uses a machine that filters extra fluids, salt, and waste from your blood.1,2

How does hemodialysis work?

During hemodialysis, your blood travels through a tube into the dialysis machine. Inside the machine, a filter called a dialyzer filters and cleans your blood. After the dialyzer cleans your blood, it is sent back into your body through a second tube.1-3

You can choose to get hemodialysis in a dialysis center, where a nurse or dialysis technician gives you the treatment. Or you can get your dialysis treatments in the comfort of your home. If you choose home hemodialysis, you and a helper will need the training to do it properly and safely.1-3

How long does hemodialysis take?

The length of time hemodialysis takes varies from person to person. It depends on:1-3

  • How well your kidneys are functioning
  • How much waste buildup you have in your body
  • How much fluid your body gains between treatments
  • Your body size

The entire process usually takes about 2 to 4 hours. Hemodialysis needs to be done at least 3 times a week. Sometimes it needs to be done more often, depending on how advanced your kidney disease is. Talk with your doctor to find out how long and how often your sessions will be.1-3

How do I prepare for hemodialysis?

Before going on hemodialysis, you will have a procedure that will allow for blood to move between your body and the dialysis machine This is called creating a vascular access point. It is a surgery your doctor can do, usually in either your arm or your leg.1-3

There are 3 types of vascular access points your doctor can make to get you ready for hemodialysis: AV fistula, AV graft, and catheter.1,3

Arteriovenous (AV) fistula

This is the safest and most preferred type of vascular access. It is the least likely to get infected.3

For an AV fistula, a surgeon connects an artery and a vein under the skin of your arm. An artery is a large blood vessel that carries blood from your heart, while a vein is a smaller blood vessel that carries blood to your heart. This procedure makes a stronger and safer access point for needles to go in and out during hemodialysis.1,3

Your AV fistula will need some time to heal. For this reason, it is best to get the AV fistula a few months before starting hemodialysis.3

AV graft

For an AV graft, a tube made up of synthetic material connects an artery and a vein under the skin of your arm. While it tends to have more problems with infections than an AV fistula, an AV graft is the second best option.3

This procedure will need some time to heal as well, but not as long as a fistula. It should be done about 2 to 3 weeks before starting hemodialysis.3

Catheter

A catheter is a plastic tube shaped like a Y. One end of the catheter connects to a large vein deep inside your body. The other 2 ends come out through your skin.3

A catheter requires a lot of careful attention to keeping it clean and dry. People with catheters are more likely to have problems with infection, blood clots, and scarring. This is why catheters are considered the third best option for hemodialysis.3

No matter what type of vascular access point you have, you will need to take care of it so it will last as long as possible. Talk to your doctor about what type of access they recommend for you and how best to care for it.3

What are the possible side effects?

Hemodialysis is a critical treatment for many people with ESKD. It does the jobs that their kidneys are not able to do. So, it helps them feel better than they would if they were not on dialysis.1-3

However, there are some side effects of hemodialysis. These side effects can include:1-4

  • Low blood pressure – this can lead to shortness of breath, muscle cramps, and nausea
  • Itchy skin
  • Tenderness or discomfort at the vascular access point
  • Sleep problems
  • Muscle cramps
  • Anemia – this can lead to fatigue, weakness, and dizziness
  • Bone problems
  • Holding onto fluid (fluid retention)
  • Stiffness or fluid in the joints (amyloidosis)
  • Mood changes such as depression

These are not all the possible side effects of hemodialysis. Talk to your doctor about what to expect from dialysis. If you have any concerns about the side effects you are having, tell your doctor.

Other things to know

While on hemodialysis, you will need to keep to a strict treatment schedule. This will help you feel as good as you possibly can. If your job is not too physically demanding, you may be able to continue working around your treatment sessions. You may also still be able to do many of the activities you enjoy.3,4

For instance, you may still be able to travel while on hemodialysis. You will just need to find a dialysis center wherever you are traveling. Or if you do home hemodialysis, you will need to bring your supplies and have someone help you with treatment. How much you are able to do depends on your activity level and how sick you feel.3

Because your kidneys do not work well, you may gain water weight in between treatment sessions. Keep track of your weight in between sessions. Weigh yourself each day, and tell your doctor if your weight is much higher or lower than normal.3

Your doctor may also recommend you follow a strict, kidney-friendly diet. This can help improve how well your treatments work and how well you feel. This diet may include:4

  • Avoiding foods that are high in phosphorus and potassium, such as bananas, dairy, and meats
  • Managing your fluid intake
  • Changing the amount of protein you eat

Is hemodialysis right for you?

Before making the decision to go on hemodialysis for your kidney disease, talk with your doctor. Tell them about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs. Be sure to ask any questions you have. Here are some to consider:3

  • Should I do in-center hemodialysis or home hemodialysis?
  • What type of vascular access point is best for me?
  • Will I have to follow a strict diet?
  • How often will I need treatment sessions?
  • Will this treatment regimen fit with my schedule and lifestyle?

Along with your doctor, you can decide which type of ESKD treatment is right for you.3

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