What is Hemodialysis?
Hemodialysis (HD) is a treatment that filters your blood using a machine (dialyzer) when your kidneys are no longer able to adequately clean your blood and remove excess fluid. During treatment, your blood is pumped through a dialyzer (artificial kidney) that removes waste products and excess fluid, then returns the cleaned blood to your body.
Most people with kidney failure need dialysis 3 times per week, with each session lasting approximately 4 hours. HD is typically performed at a dialysis center, though home hemodialysis is an option for some patients.
How Hemodialysis Works
The Dialysis Process:
- Blood is removed: Blood flows from your body through one needle in your vascular access (fistula, graft, or catheter)
- Blood is filtered: The dialysis machine pumps your blood through the dialyzer, which contains thousands of tiny hollow fibers
- Waste is removed: As blood flows through these fibers, waste products and excess fluid pass through the membrane into dialysate fluid
- Clean blood returns: The filtered blood is returned to your body through a second needle
- Continuous cycle: This process continues for 3-5 hours, cleaning your entire blood volume multiple times
What Gets Removed:
- Excess fluid (water weight gained between treatments)
- Urea and creatinine (waste products from protein breakdown)
- Excess potassium, phosphorus, and sodium
- Other toxins that healthy kidneys normally remove
Vascular Access Types
You need a vascular access to allow blood to be removed, filtered, and returned to your body during dialysis. There are three main types:
1. AV Fistula (Arteriovenous Fistula) - BEST OPTION
A surgeon connects an artery directly to a vein, usually in your forearm. Over 2-3 months, the vein becomes stronger and larger, making it easier to access for dialysis.
✓ Advantages:
- Lowest risk of infection
- Lasts longest (years, even decades)
- Best blood flow for effective dialysis
- Lower risk of clotting
- Recommended as first choice
✗ Disadvantages:
- Takes 2-3 months to mature before use
- Requires surgery to create
- May not develop properly in everyone
- May be difficult if you have small veins
2. AV Graft (Arteriovenous Graft)
A soft tube (made of synthetic material) is surgically placed under your skin to connect an artery and vein, usually in your arm.
✓ Advantages:
- Matures faster than fistula (2-4 weeks)
- Good option if veins too small for fistula
- Provides good blood flow
- Can be used sooner than fistula
✗ Disadvantages:
- Higher risk of infection than fistula
- More likely to clot
- Doesn't last as long (usually 2-3 years)
- Requires surgery to create
3. Central Venous Catheter (CVC) - TEMPORARY
A flexible tube inserted into a large vein in your neck, chest, or groin. Used for short-term dialysis or while waiting for a fistula or graft to mature.
✓ Advantages:
- Can be used immediately
- No maturation time needed
- No surgery required (inserted at bedside)
- Good for emergency dialysis
✗ Disadvantages:
- Highest risk of infection
- Most likely to clot
- Less effective blood flow
- Not suitable for long-term use
- Requires extra care and dressing changes
Taking Care of Your Access
Fistula and Graft Care:
- Check your thrill daily: You should feel a vibration (thrill) and hear a whooshing sound (bruit) over your access - this means blood is flowing properly
- Keep the area clean: Wash with soap and water before each dialysis session
- Avoid tight clothing or jewelry on your access arm
- Don't carry heavy bags or wear a watch on your access arm
- No blood pressure readings or blood draws on your access arm
- Don't sleep on your access arm
- Exercise your access arm: Squeeze a stress ball to strengthen it (after surgeon's approval)
Catheter Care:
- Keep the dressing dry: Cover with plastic wrap when showering
- Don't touch the catheter or dressing between treatments
- Watch for signs of infection around the exit site
- Dressing changes are done by trained healthcare staff
- Never remove caps from the catheter ends yourself
⚠️ Call Your Doctor Immediately If:
- No thrill or bruit in your fistula/graft
- Redness, swelling, warmth, or drainage around the access site
- Fever or chills
- Increased pain in your access arm
- Access arm becomes cold, pale, or painful
- Fingers become numb or tingle
- Excessive bleeding after dialysis (more than 20 minutes)
- Large hematoma (blood-filled lump) forms after needle removal
Treatment Schedule
Standard In-Center Hemodialysis:
- Frequency: 3 times per week (e.g., Monday-Wednesday-Friday or Tuesday-Thursday-Saturday)
- Duration: Typically 3-5 hours per session (4 hours is most common)
- Location: At a dialysis center with trained staff and equipment
- Consistency: Missing treatments is dangerous - stick to your schedule
Home Hemodialysis Options:
Some patients qualify for home hemodialysis with proper training:
- Short Daily HD: 2-3 hours, 5-6 days per week
- Nocturnal HD: 6-8 hours, 3-6 nights per week while you sleep
- Benefits: More frequent treatment = better fluid control, fewer dietary restrictions, better lab values
- Requirements: Must complete training, have space for equipment, have a care partner
💡 Never skip or shorten dialysis treatments without medical approval - this can be life-threatening
Diet & Nutrition for HD Patients
Diet is critical for HD patients because your kidneys can't remove waste and excess minerals between treatments. Following your renal diet helps you feel better and live longer.
Protein - EAT MORE:
HD patients need MORE protein than PD patients because dialysis removes protein from your blood.
- Aim for 8-10 ounces of high-quality protein daily
- Best sources: fish, chicken, turkey, lean beef, eggs, tofu
- Include protein at every meal
- Your dietitian may recommend protein supplements
Phosphorus - LIMIT STRICTLY:
High phosphorus causes bone disease and heart problems. Dialysis removes some, but not all phosphorus.
❌ High Phosphorus - AVOID:
- Dairy products (milk, cheese, yogurt, ice cream)
- Dark sodas (Coke, Pepsi, Dr Pepper)
- Beer and ale
- Nuts and seeds
- Beans and lentils
- Whole grain breads and cereals
- Chocolate
- Processed foods with phosphate additives
✓ Lower Phosphorus - CHOOSE:
- Fresh fruits and vegetables
- White bread, pasta, rice
- Meat, poultry, fish (fresh, not processed)
- Eggs
- Rice milk, almond milk (unsweetened)
- Lemonade, ginger ale, lemon-lime soda
Important: Take your phosphate binders (phosphorus medications) WITH EVERY MEAL AND SNACK as prescribed
Potassium - LIMIT:
High potassium can cause dangerous heart rhythms and sudden cardiac arrest. Dialysis removes excess potassium, but levels can rise between treatments.
❌ High Potassium - LIMIT:
- Bananas, oranges, kiwi, dried fruits
- Potatoes (all types), sweet potatoes, yams
- Tomatoes and tomato products
- Spinach, Swiss chard, beet greens
- Winter squash, pumpkin
- Avocados
- Beans, lentils, nuts
- Coconut water, sports drinks
- Salt substitutes (contain potassium)
✓ Lower Potassium - CHOOSE:
- Apples, berries, grapes, pears
- Pineapple, watermelon (small amounts)
- Green beans, cauliflower, cabbage
- Cucumbers, lettuce, peppers
- Onions, carrots (raw)
- White bread, white rice, pasta
- Chicken, fish, eggs
Tip: Leach high-potassium vegetables by cutting into small pieces, soaking in water for 2+ hours, then cooking in fresh water to reduce potassium content
Sodium & Fluid - RESTRICT:
Too much sodium makes you thirsty, causing you to drink more fluid. Excess fluid between treatments can overload your heart and lungs.
Sodium Guidelines:
- Limit to 2,000mg (2 grams) sodium per day
- Don't add salt to food while cooking or at the table
- Read food labels - choose items with less than 200mg sodium per serving
- Avoid: canned soups, deli meats, frozen dinners, fast food, chips, pickles, olives
- Use herbs and spices instead of salt for flavor
Fluid Guidelines:
- Most HD patients should limit fluids to 32-48 ounces (4-6 cups) per day
- Includes ALL liquids: water, coffee, tea, soup, ice cream, gelatin, etc.
- Try not to gain more than 2-2.5kg (4-5 lbs) between dialysis sessions
- Tips: use small cups, freeze fluids into ice chips, rinse mouth with water without swallowing, chew sugar-free gum
⚠️ Warning: Gaining too much fluid between treatments can cause shortness of breath, swelling, high blood pressure, heart failure, and stroke
Work with a Renal Dietitian
Every patient is different. Your renal dietitian will create a personalized meal plan based on YOUR lab results, weight, and dialysis prescription. Meet with them regularly to adjust your diet as needed.
Managing CKD Symptoms
Chronic kidney disease and dialysis can cause various symptoms. Here's how to recognize and manage them effectively.
Fatigue & Low Energy:
Most common symptom - caused by anemia, toxin buildup, and poor nutrition.
What Helps:
- Get adequate dialysis - don't skip or shorten treatments
- Take EPO injections as prescribed for anemia
- Eat enough protein and calories
- Stay as physically active as you can tolerate
- Get 7-8 hours of quality sleep
- Pace yourself - balance activity with rest
Itching (Pruritus):
Can be severe and affect quality of life - often caused by high phosphorus or dry skin.
What Helps:
- Control phosphorus levels - take binders with meals
- Keep skin moisturized - use fragrance-free lotions
- Take lukewarm (not hot) showers
- Use mild soaps without fragrances
- Keep nails short to prevent scratching damage
- Ask doctor about prescription medications if severe
Nausea & Poor Appetite:
Common when toxins build up - can lead to malnutrition if not addressed.
What Helps:
- Ensure adequate dialysis - may need prescription adjustment
- Eat small, frequent meals instead of 3 large meals
- Avoid strong food odors that trigger nausea
- Try cold or room temperature foods
- Ask about anti-nausea medications
- Consider nutritional supplements if appetite is poor
Shortness of Breath:
Can be caused by fluid overload, anemia, or heart problems.
What Helps:
- Strictly limit fluid intake between treatments
- Limit salt to reduce thirst and fluid retention
- Take blood pressure medications as prescribed
- Treat anemia with EPO and iron
- Sleep with head elevated if you get short of breath lying flat
- Report worsening breathlessness to your team immediately
Muscle Cramps:
Especially during or after dialysis - very common and uncomfortable.
What Helps:
- Don't gain too much fluid between treatments
- Tell staff if cramping occurs during dialysis
- Gentle stretching before and after dialysis
- Stay hydrated (within your fluid limits)
- Consider magnesium supplements (ask doctor first)
- Apply heat to cramping muscles
Sleep Problems:
Insomnia, restless legs, and poor sleep quality are very common.
What Helps:
- Maintain a regular sleep schedule
- Avoid caffeine after noon
- Create a cool, dark, quiet sleep environment
- Limit screen time before bed
- Treat restless leg syndrome if present
- Consider sleep study if snoring or gasping at night
Depression & Anxiety:
Very common in dialysis patients - not a sign of weakness, but a medical condition that needs treatment.
What Helps:
- Talk openly with your healthcare team
- Consider counseling or therapy
- Join a dialysis support group
- Stay connected with family and friends
- Medication can help if needed
- Stay as active as possible - exercise helps mood
When to Call Your Doctor:
- Symptoms suddenly get worse
- New symptoms appear
- Symptoms interfere with daily life
- You feel unsafe or have thoughts of self-harm
- You're unable to eat or drink
- You have severe chest pain or difficulty breathing
Common Complications & Side Effects
During Dialysis:
- Low blood pressure (hypotension): Most common side effect - may cause dizziness, nausea, cramping. Tell staff immediately.
- Muscle cramps: Usually in legs - often caused by fluid removal. Staff can adjust treatment.
- Nausea and vomiting: Can occur from low blood pressure or removing fluid too quickly.
- Headaches: May happen during or after treatment.
- Itching: Common in kidney disease - may improve with good dialysis and phosphorus control.
- Chest or back pain: Tell staff immediately - may indicate heart or access problems.
Long-Term Complications:
- Anemia: Low red blood cells causing fatigue - treated with EPO injections and iron
- Bone disease: High phosphorus and low vitamin D weaken bones - controlled with diet and medications
- Heart disease: Kidney disease increases heart risk - control blood pressure, follow diet, take medications
- High blood pressure: Requires fluid control, low sodium diet, and blood pressure medications
- Restless leg syndrome: Uncomfortable leg sensations - may improve with good dialysis
- Sleep problems: Common in dialysis patients - practice good sleep hygiene
- Depression and anxiety: Normal reaction to chronic illness - talk to your healthcare team
💡 Preventing Complications:
- Don't miss or shorten dialysis treatments
- Follow your fluid and diet restrictions
- Take all medications as prescribed
- Care for your access properly
- Keep all doctor appointments
- Report any new symptoms to your team
- Stay physically active as able
- Ask for help when you need it
Living Well on Hemodialysis
You Can Still Have a Full Life:
- Work: Many people continue working while on dialysis - talk to your social worker about flexible schedules
- Travel: You can travel! Arrange guest dialysis at centers near your destination in advance
- Exercise: Regular physical activity improves energy, mood, and health - ask about safe exercises for you
- Social life: Stay connected with friends and family - dialysis doesn't have to stop you from enjoying life
- Hobbies: Continue activities you love (with modifications if needed)
- Sexual activity: Safe to continue - talk to your doctor if you have concerns
Your Healthcare Team:
You're not alone - your dialysis team is here to help:
- Nephrologist: Kidney doctor who oversees your care
- Dialysis nurses: Provide treatment and monitor you during dialysis
- Dialysis technicians: Help set up and run your dialysis treatments
- Renal dietitian: Helps you follow your meal plan
- Social worker: Helps with financial, emotional, and practical concerns
- Vascular surgeon: Creates and maintains your access
Future Options:
- Kidney transplant: Best long-term treatment if you qualify - talk to your doctor about evaluation
- Home hemodialysis: More frequent, flexible dialysis at home - ask if you're a candidate
- Peritoneal dialysis: Another type of dialysis done at home - may be an option to switch
Important Reminders
✓ Do:
- ✓ Attend all dialysis treatments on time
- ✓ Follow your fluid and diet restrictions
- ✓ Take medications as prescribed
- ✓ Check your access daily
- ✓ Keep a weight log
- ✓ Ask questions when unsure
- ✓ Report new symptoms promptly
- ✓ Stay positive and active
✗ Don't:
- ✗ Skip or shorten dialysis
- ✗ Ignore your diet
- ✗ Drink too much fluid
- ✗ Miss medications
- ✗ Ignore access problems
- ✗ Use your access arm for blood pressure
- ✗ Give up hope
- ✗ Suffer in silence - ask for help
Questions?
Never hesitate to ask your dialysis team about anything you don't understand. They're here to help you succeed on dialysis.