Dialysis - Hemodialysis

When to Start Dialysis

Kidney failure is the last stage of chronic kidney disease. This is when your kidneys can no longer support your body's needs. Your doctor will discuss dialysis with you before you need it. Usually you will go on dialysis when you have only 10 to 15% of your kidney function left.

You also may need dialysis if your kidneys suddenly stop working due to acute renal failure.

Dialysis at a Treatment Center

Hemodialysis is most often done at a special dialysis center.

• You will have about 3 treatments a week.
• Treatment takes about 3 to 4 hours each time.
• You may feel tired for several hours after the dialysis.

At a treatment center, your health care providers will handle all your care. However, you do need to schedule your appointments and follow a strict dialysis diet.

Dialysis at Home

You may be able to have hemodialysis at home. You do not have to buy a machine. Medicare or your health insurance will pay for most or all of your treatment costs at home or in a center.

If you have dialysis at home, you can use one of two schedules:

• Shorter (2 to 3 hours) treatments done at least 5 to 7 days per week
• Longer, nightly treatments done 3 to 6 nights per week while you sleep

You also may be able to do a combination of daily and nighttime treatments.

Because you have treatment more often and it happens more slowly, home hemodialysis has some benefits:

• It helps keep your blood pressure lower. Many people no longer need blood pressure medicines.
• It does a better job of removing waste products.
• It's easier on your heart.
• You may have fewer symptoms from dialysis such as nausea, headaches, cramps, and tiredness.
• You can more easily fit treatments into your schedule.

You can do the treatment yourself, or you can have someone help you. A dialysis nurse can train you and a caregiver on how to do home dialysis. Training can take a few weeks to a few months. Both you and your caregivers must learn to:

• Handle the equipment
• Place the needle into the access site
• Monitor the machine and your blood pressure during treatment
• Keep records
• Clean the machine
• Order supplies, which can be delivered to your home

Home dialysis is not for everyone. You will have a lot to learn and need to be responsible for your care. Some people feel more comfortable having a provider handle their treatment. Plus, not all centers offer home dialysis.

Home dialysis may be a good option if you want more independence and are able to learn to treat yourself. Talk with your doctor. Together, you can decide what type of hemodialysis is right for you.

When to Call Your Doctor

Call your doctor if you notice:

• Bleeding from your vascular access site
• Signs of infection, such as redness, swelling, soreness, pain, warmth, or pus around the site
• A fever over 100.5°F (38.0°C)
• The arm where your catheter is placed swells and the hand on that side feels cold
• Your hand gets cold, numb, or weak

Also call your doctor if any of the following symptoms are severe or last more than 2 days:

• Itching
• Trouble sleeping
• Diarrhea or constipation
• Nausea and vomiting
• Drowsiness, confusion, or problems concentrating

References

Daugirdas JT, Blake PG, Ing TS, eds. Handbook of Dialysis. 5th ed. Philadelphia, PA: Wolters Kluwer Health; 2015.

Yeun JY, Ornt DB, Depner TA. Hemodialysis. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 65.