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By Mayo Clinic staffYou can receive hemodialysis in a dialysis center, at home or in a hospital. Many people get hemodialysis three times a week in sessions of three to five hours each. This is known as conventional dialysis. Daily dialysis involves more frequent, but shorter sessions — usually six days a week for about two to three hours each time. Although conventional dialysis is more common, some studies suggest that more frequent dialysis is linked to better quality of life, increased well-being and reduced symptoms. Your appetite, sleeping patterns, energy level and ability to concentrate may improve, while symptoms such as cramping, headaches and shortness of breath are less likely.
In recent years, smaller, simpler dialysis machines have made home dialysis less cumbersome, so that with special training and someone to help you, it's possible to do hemodialysis at home. Benefits include saving time on travel to and from the dialysis center and having more flexibility about when to do your treatments. You may even be able to do the procedure at night while you sleep.
Before the procedure
When you arrive at the dialysis center, a member of your health care team checks and records your weight, blood pressure, pulse and temperature. If you choose, you may be able to do this yourself. The skin covering your access site — the point where blood leaves and then re-enters your body during treatment — is cleansed.
During the procedure
During hemodialysis, two needles are inserted into your arm through the access and taped in place to remain secure. Each needle is attached to a flexible plastic tube that connects to a machine called a dialyzer. The dialyzer filters your blood a few ounces at a time, allowing wastes and extra fluids to pass from your blood into a cleansing fluid called dialysate. The filtered blood returns to your body through another needle.
During treatments, you sit or recline in a chair while your blood flows through the dialyzer. You can use the time to watch television, read, nap or make phone calls. If you receive dialysis at night, you can sleep in your bed during the procedure.
Hemodialysis itself doesn't hurt. But you may experience nausea and abdominal cramps as excess fluid is pulled from your body — especially if you undergo hemodialysis three times a week (conventional hemodialysis) rather than six times a week (daily hemodialysis). If you're uncomfortable during the procedure, ask your care team about adjusting your medication or changing your diet or fluid intake to minimize side effects.
Because blood pressure and heart rate can fluctuate as excess fluid is pulled from your body, your blood pressure and heart rate will be checked several times during each treatment.
When hemodialysis is complete, the needles are removed from your access and a pressure dressing is applied to the site to prevent bleeding. Your weight may be recorded again. Then you're free to go about your usual activities until your next session.
- Treatment methods for kidney failure: Hemodialysis. National Institute of Diabetes and Digestive and Kidney Diseases. http://kidney.niddk.nih.gov/Kudiseases/pubs/hemodialysis. Accessed Dec. 5, 2008.
- Dialysis in the treatment of renal failure In: Fauci AS, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. United States of America: The McGraw-Hill Companies Inc.; 2008. http://www.accessmedicine.com/popup.aspx?aID=2881062&print=yes. Accessed Aug. 24, 2008.
- Hemodialysis. National Kidney Foundation. http://www.kidney.org/ATOZ/atozItem.cfm?id=35. Accessed Aug. 24, 2008.
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- Berns JS. Patient information: Chronic kidney disease. http://www.uptodate.com/home/index.html. Accessed Sept. 10, 2008
- Kliger AS. Frequent nocturnal hemodialysis - A step forward? Journal of the American Medical Association. 2007;298:1331.
- Mailloux LU. Dialysis modality and patient outcome. http://www.uptodate.com/home/index.html. Accessed Aug. 26, 2008.
- Ricci Z, et al. Dose and efficiency of renal replacement therapy: Continuous replacement therapy versus intermittent hemodialysis versus slow extended daily dialysis. Critical Care Medicine. 2008;36(suppl):S229.
- McFarlane PA, et al. The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis. Kidney International. 2003;64:1004.
