What Is Hemodialysis? A Complete Guide for Patients and Families

Hemodialysis is the most common form of dialysis, helping over 500,000 Americans manage kidney failure. If you or a loved one has been told you need dialysis, understanding how the treatment works can help reduce anxiety and prepare you for what lies ahead.

How Hemodialysis Works

Your kidneys filter about 120 to 150 quarts of blood daily, removing waste products, excess fluid, and balancing electrolytes. When kidneys fail, hemodialysis takes over this critical function using a dialysis machine and a special filter called a dialyzer (artificial kidney).

During treatment:

1. Blood flows from your body through tubing to the dialyzer
2. The dialyzer filters waste using a semipermeable membrane and dialysate solution
3. Clean blood returns to your body through a second tube
4. Excess fluid is removed to help control blood pressure and prevent swelling

A typical hemodialysis session lasts 3 to 4 hours and is performed three times per week, though schedules vary based on individual needs.

Types of Vascular Access

Before starting hemodialysis, you need a way for blood to flow to and from the dialysis machine. There are three types of vascular access:

Arteriovenous Fistula (AV Fistula)

The preferred access type, created surgically by connecting an artery to a vein in your arm. Benefits include:

• Lowest infection risk
• Longest lasting (can function for decades)
• Best blood flow rates
• Requires 2-3 months to mature before use

Arteriovenous Graft (AV Graft)

A synthetic tube connecting an artery to a vein when your vessels are not suitable for a fistula:

• Can be used within 2-3 weeks
• Higher infection risk than fistula
• May need replacement every 2-3 years
• Good option when fistula is not possible

Central Venous Catheter

A temporary option inserted into a large vein in your neck, chest, or groin:

• Can be used immediately
• Highest infection risk
• Used while waiting for fistula or graft to mature
• Not recommended for long-term use

What to Expect During Treatment

Before Your Session

• Weigh yourself to determine fluid removal needs
• Blood pressure and temperature check
• Access site inspection
• Connection to the dialysis machine

During Dialysis

Most patients relax during treatment. You can:

• Read, watch TV, or use a tablet
• Sleep
• Talk with staff and other patients
• Eat light snacks (facility policies vary)

Common sensations during treatment:

• Mild fatigue
• Occasional muscle cramps (from fluid removal)
• Slight drop in blood pressure
• Feeling cold (blood outside body cools slightly)

After Your Session

• Access site bandaged
• Post-treatment weight recorded
• You may feel tired for a few hours
• Most people resume normal activities the same day

In-Center vs. Home Hemodialysis

In-Center Hemodialysis

Treatment at a dialysis center with trained staff:

Advantages:

• Medical professionals handle everything
• Social interaction with other patients
• No equipment at home
• Emergency support immediately available

Considerations:

• Fixed schedule (typically Mon/Wed/Fri or Tue/Thu/Sat)
• Travel time to and from center
• Less flexibility for work or travel

Home Hemodialysis

Self-administered treatment at home after training:

Advantages:

• More flexible scheduling
• More frequent, gentler treatments possible
• No travel to dialysis center
• Greater independence

Considerations:

• Requires partner or caregiver for most programs
• Training period of 4-8 weeks
• Space needed for equipment
• Responsibility for supplies and maintenance

Potential Complications

While hemodialysis is generally safe, awareness of potential issues helps you respond appropriately:

During Treatment

• Low blood pressure (hypotension): Common; treated by slowing fluid removal
• Muscle cramps: Often related to fluid shifts; stretching and adjusting treatment helps
• Nausea: Usually temporary; anti-nausea medication available
• Access clotting: Requires intervention to restore blood flow

Long-Term Considerations

• Infection risk: Proper access care reduces this significantly
• Cardiovascular stress: Regular monitoring and medication management help
• Bone and mineral disorders: Diet and medications address this
• Anemia: Treated with medications and sometimes iron supplements

Diet and Fluid Management

Hemodialysis patients typically follow dietary guidelines to manage waste buildup between treatments:

Limit These

• Sodium: Causes fluid retention and high blood pressure
• Potassium: Can affect heart rhythm (found in bananas, oranges, potatoes)
• Phosphorus: Affects bones (found in dairy, nuts, colas)
• Fluids: Your care team will advise on appropriate daily intake based on your urine output

Focus On These

• High-quality protein: Eggs, fish, chicken (dialysis removes some protein)
• Heart-healthy fats: Olive oil, fish
• Approved fruits and vegetables: Your dietitian will provide a list

A renal dietitian will create a personalized meal plan based on your lab values and treatment schedule.

Life on Hemodialysis

Many people live full, active lives while on hemodialysis:

• Work: Many patients maintain employment, especially with home or nocturnal dialysis
• Travel: Possible with advance planning; dialysis centers exist worldwide
• Exercise: Encouraged; improves energy and cardiovascular health
• Social life: Continues with schedule adjustments

When to Contact Your Care Team

Reach out immediately if you experience:

• Fever or chills (possible infection)
• Bleeding from access site that does not stop
• Swelling, redness, or drainage at access site
• Chest pain or difficulty breathing
• Severe headache or vision changes
• Unusual weakness or confusion

The Path Forward

Hemodialysis is a life-sustaining treatment that, while requiring commitment, allows many people to maintain quality of life. Working closely with your nephrology team, following dietary guidelines, and taking medications as prescribed all contribute to better outcomes.

At KidneyCare Dialysis, we provide comprehensive hemodialysis services in comfortable, modern facilities with experienced staff dedicated to your care. Whether you are just starting dialysis or looking for a new provider, we are here to support you.

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This article is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. The information provided should not be used as a substitute for professional medical consultation. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read here. If you are experiencing a medical emergency, call your local emergency services immediately.