Hemodialysis Procedure - Healthnile.com

Overview

Hemodialysis uses a special machine to clean the blood by removing extra waste, salt, and fluids. When the kidneys lose their ability to perform this job, hemodialysis becomes an important form of renal replacement therapy. There are different types of dialysis, but hemodialysis is one of the most common options for people with advanced kidney problems.

Patients can receive hemodialysis at a clinic or sometimes at home, depending on their health and the advice of their health team. During treatment, patients must stick to a regular schedule and follow specific dietary changes. Doctors often prescribe medicines to help control health issues linked to kidney failure. Below is a table showing common aspects of hemodialysis patient care:

Aspect	Description
Treatment Schedule	Set days per week, lasting several hours
Diet	Limited salt, fluids, and certain foods
Medications	Help control blood pressure and minerals
Support Team	Kidney doctor, nurses, dietitian

Hemodialysis is not a cure, but it helps manage symptoms and supports health when the kidneys can no longer work well.

Reasons for Hemodialysis

Doctors use hemodialysis when the kidneys can no longer filter blood well enough to keep the body healthy. They decide when to start hemodialysis by looking at a person’s kidney function, overall health, and how kidney problems affect daily life. Symptoms like swelling, tiredness, nausea, and vomiting often appear as kidney function gets worse.

Key Reasons for Starting Hemodialysis

Chronic or sudden kidney failure due to:
- Diabetes
- High blood pressure
- Kidney infections or inflammation
- Genetic conditions, like kidney cysts
- Certain medications that damage the kidneys
When blood tests, like eGFR, show low kidney function.
Presence of symptoms from uremia (buildup of waste in the blood).

Condition	Possible Trigger	Role of Hemodialysis
Chronic Kidney Disease	Diabetes, hypertension, inherited issues	Removes waste, balances fluids
Acute Kidney Injury	Severe illness, surgery, drug side effects	Temporary support for kidneys

When the kidneys fail, hemodialysis acts as an artificial kidney using a special membrane to filter out wastes and extra fluid from the blood. This process manages mineral levels like potassium and sodium, and helps keep blood pressure in a safe range.

Some people experience acute kidney injury after surgery, illness, or from certain drugs. In these cases, doctors may use hemodialysis for a short time until the kidneys recover. In long-term cases, like chronic kidney disease, it can become a regular part of care.

Some people choose not to start dialysis and instead receive medical support focused on managing symptoms and improving comfort. Others may look into a kidney transplant as another option.

Possible Complications

Hemodialysis helps many people stay alive when their kidneys no longer work. However, this treatment can bring a number of possible complications that affect general health, everyday comfort, and even the heart and blood vessels.

Problem	Possible Effects
Infection	Fever, redness, pain at site
Low blood pressure (hypotension)	Dizziness, fainting, muscle cramps
Elevated potassium (hyperkalemia)	Irregular heartbeat, muscle weakness
Sodium imbalance	Confusion, swelling, headaches
High phosphorus	Itchy skin, weak bones
Aneurysm at access site	Bulge, rupture risk, pain
Clotted or blocked blood flow	Swelling, poor dialysis
Mineral and bone disorder	Joint pain, fragile bones
Peritonitis	Abdominal pain, fever, cloudy fluid
Itching	Uncomfortable skin sensations
Vomiting and nausea	Stomach upset, lack of appetite

Infection is a common concern, especially at the site where the dialysis needle enters the body if the area is not kept clean. Infections can occur both at the access site and inside the bloodstream. Infection at the access site is one of the most serious complications and can require urgent treatment.

Blood pressure problems are frequent. Low blood pressure, or hypotension, may cause dizziness, weakness, or fainting, often during the dialysis session, especially when fluid is removed quickly. High blood pressure can worsen if a person has too much salt or fluid between treatments. Both conditions require careful monitoring.

Muscle cramps often strike the legs and can be painful. Adjusting fluid intake and prescribed dialysis methods help some people get relief. Minerals like potassium, sodium, magnesium, and phosphorus require close monitoring. Too much or too little potassium can cause an abnormal heartbeat or even cardiac arrest.

High phosphorus can cause itchy skin and weaken bones. Sodium and magnesium imbalances may bring swelling, muscle twitches, or confusion. Some people notice itching, especially after dialysis, often linked to high phosphorus or other blood changes. Nausea and vomiting can occur, often together with low blood pressure during treatment.

Some patients also feel restless or have muscle aches or restless legs syndrome, making sleep difficult. Hemodialysis requires an access site—usually a fistula, graft, or sometimes a catheter. These sites can develop narrowing, ballooning in the vessel wall (aneurysm), blood clots, and poor blood flow. If an aneurysm grows or bursts, it is a medical emergency.

Other issues include bone and mineral disorders. The treatment can upset the balance of calcium and vitamin D, resulting in weak bones and joint pain. In some, over time, the buildup of proteins may cause amyloidosis, leading to stiffness and joint pain, especially after years of dialysis. High levels of certain minerals, like phosphorus, can worsen bone problems.

Too much fluid between sessions can cause swelling, shortness of breath, or fluid in the lungs. On rare occasions, severe imbalances of waste products, fluids, and minerals lead to dialysis disequilibrium syndrome, causing headache, nausea, or confusion—more common at the start of dialysis treatments.

Doctors use anticoagulant medications to reduce blood clots during treatment, but if not managed correctly, these can result in bleeding or bruising. Emotional health can also suffer. Many people living with kidney disease who rely on regular hemodialysis experience depression. Close medical supervision, good hygiene, and regular blood tests help patients manage these possible complications.

How You Prepare

Patients usually begin preparing for hemodialysis weeks or even months before the first treatment. The most important step is creating a safe way for blood to leave and return during dialysis, called a vascular access. A vascular surgeon performs this procedure. There are three main types of access:

Type	Description
AV Fistula	A surgeon connects an artery and vein, often in the arm. This is the top choice because it is usually safe, reliable, and lasts a long time.
AV Graft	If the veins are too small, a soft tube (graft) links an artery and a vein. This can be an option when a fistula is not possible.
Central Venous Catheter	For emergencies, a thin tube is put into a vein in the neck. It is only for short-term use.

Preparation Steps

Allow the access site to heal before starting dialysis.
Care for the access by keeping the area clean and checking daily for signs of redness or swelling.
Follow all instructions from the care team to lower the risk of infection or clotting.
Doctors may perform procedures such as angioplasty or stent placement if the access becomes narrowed or blocked.

Patients should report any pain or changes at the access site to their team right away. Good care of the vascular access helps treatments go more smoothly and may prevent problems.

What You Might Experience

How Treatment Takes Place

People typically receive hemodialysis in a special center, at home, or in a hospital. Most go to a dialysis center for treatment three times each week, and each session usually lasts between three and five hours. Some do shorter sessions more often at home, usually six or seven days a week for about two hours at a time.

New, simpler hemodialysis machines make performing dialysis at home easier, and some people choose to do their sessions at night while they sleep. Hemodialysis requires a special access point to the bloodstream. There are three common types of access:

Fistula: A surgeon connects two blood vessels in the arm. Over time, this area becomes stronger to handle the needles used at each treatment.
Graft: Doctors use a small plastic tube to link two blood vessels if a fistula is not possible.
Catheter: A tube is placed into a large vein, often in the neck, for temporary access.

During each session, the patient sits or lies back in a comfortable chair. The care team checks vital signs before starting, including weight, blood pressure, pulse, and temperature. They clean the area around the access site to lower the risk of infection.

The next step is inserting two needles into the access site. The care team tapes these in place and attaches them to soft plastic tubes that connect to the hemodialysis machine. Blood, a few ounces at a time, leaves the body through one tube and travels into a dialyzer. The dialyzer, also called a filter or artificial kidney, clears waste, extra fluid, and unwanted chemicals from the blood.

The dialysis machine controls how fast blood is removed and returned. Inside the machine, blood runs against a special cleansing fluid called dialysate inside the dialyzer. This fluid helps pull out waste products and extra salt or water.

Part	Role in Hemodialysis
Dialyzer (filter)	Removes wastes and fluid
Dialysate	Cleanses blood inside dialyzer
Catheter/Fistula/Graft	Provides access for blood flow
Hemodialysis machine	Powers and regulates filtration

Filtered, clean blood returns to the body through a second tube and the other needle. The process repeats many times throughout the session until enough blood is cleaned.

Patients can use the treatment time to read, watch TV, sleep, or talk with others. Comfort is a priority, but some people may have symptoms, especially when a lot of fluid is removed. This can include nausea, stomach cramps, headaches, dizziness, or muscle cramping.

These are more likely if too much fluid has built up between sessions. If discomfort happens, the care team can often adjust the treatment speed or give medicines to help. During the session, staff check blood pressure and heart rate regularly to watch for any changes, since shifts in fluid levels can affect these.

After treatment, the care team removes the needles and applies pressure to the access site to prevent bleeding. They usually record the patient’s weight again before the patient leaves. Patients can then return to regular activities and will need to come back for their next scheduled session.

If patients need to travel, they can usually find a dialysis center in most regions, including in other countries. The care team can help arrange the treatment schedule ahead of time with a center at the travel destination.

Summary List: Typical Steps in Each Session

Check weight, blood pressure, and pulse
Clean access site
Insert needles and connect to tubes
Blood flows through the dialyzer for cleaning
Regular checks of comfort, blood pressure, and heart rate
Remove needles and apply pressure dressing
Re-check weight before leaving

Findings

Care Between Dialysis Sessions

Being between dialysis sessions plays an important role in overall care for those receiving hemodialysis or peritoneal dialysis. People using either home hemodialysis or center-based programs need to follow their care team’s advice every day, not just during treatment.

Daily Actions for Improved Outcomes

Choose Foods Carefully: Managing dialysis requires following a nutrition plan. People must monitor fluid, protein, sodium, potassium, and phosphorus intake. Dietitians develop meal plans based on each person’s medical needs, current kidney function, and other health conditions like diabetes or high blood pressure.
Take Medications as Directed: Taking scheduled medicines keeps blood pressure, mineral balance, and other symptoms under control. This step is just as important for those on home hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), or in dialysis centers.
Regular Medical Testing: Each month, care teams check blood tests like urea reduction ratio (URR) and total urea clearance (Kt/V) to track how well dialysis removes waste. They also monitor blood chemistry and blood counts. For people using access sites, staff check blood flow. Both home and center-based programs include these steps.
Effective Communication: Patients share questions or concerns with the care team to address challenges or possible problems. Whether people receive treatments at home or in a center, open conversation allows staff to make changes or provide resources when needed.

Sample Weekly Routine Table

Day	Activity
Monday	Dialysis, weight check, monitor for symptoms
Tuesday	Adjust diet, take medications
Wednesday	Dialysis, blood pressure measurement
Thursday	Diet review, communicate with care team
Friday	Dialysis, laboratory tests if scheduled
Saturday	Rest, follow fluid and food guidelines
Sunday	Review medications, plan meals

Dialysis Methods and Between-Session Needs

Home hemodialysis and nocturnal hemodialysis (performed at night at home) often allow for increased flexibility, sometimes leading to fewer symptoms and improved energy. However, people must carefully manage at-home routines and pay close attention to daily tasks.
Peritoneal dialysis and CAPD require ongoing tasks, such as regular exchanges, and depend on following diet and medication instructions.
Center-based programs may have more scheduled times, but daily self-care remains critical for long-term well-being.