Dialysis is recommended when your kidney function declines to 15% or less or when you are experiencing symptoms from your kidney disease such as fatigue, excessive sleepiness, nausea/vomiting, confusion, muscle cramping, tremors, loss of appetite, weight loss, itchiness. You and your nephrologist should collaborate in making the decision of when to start dialysis.
Hemodialysis is a treatment option to replace the function of the kidneys by removing wastes and excess fluid from your blood. It is important to understand that hemodialysis is not a cure for kidney disease, nor does it improve the function of your kidneys.
During hemodialysis, a machine circulates your blood through a filter surrounded by a special fluid to pull wastes and excess fluid from your blood.
In preparation for hemodialysis, you will need a dialysis access to receive your treatments. Your nephrologist will help you decide in advance when you should have a dialysis access placed and refer you to a vascular surgeon. A permanent dialysis access can either be a fistula or graft. A fistula is the ideal hemodialysis access due to its low risk of complications and longevity and takes 6-8 weeks to mature and be ready for use.
Fistula placement is usually done as a 90-minute outpatient procedure where your own artery is connected to one of your veins under your skin. If your vascular surgeon determines that your vessels are not sufficient for the placement of a fistula, they may place a graft instead. Graft placement is also usually done as a 90-minute outpatient procedure where a synthetic tubing is used to connect your artery to one of your veins.
During hemodialysis, two needles are inserted into your fistula or graft, one for the machine to pull your blood and send it through the filter and the other to give you back your blood once the wastes and fluids are removed. In the event that you have an emergent need for dialysis and do not have a permanent access, there is a temporary dialysis access called a catheter. A catheter is the least favorable hemodialysis access due to its high risk of infection and complications.
When deciding to start your hemodialysis, you will need to choose a dialysis clinic that best suits your needs because there are different ways that hemodialysis can be done:
You should also discuss possible clinic options with your physician as they may be able to recommend nearby clinics where they have visiting rights. In-center hemodialysis is done at a dialysis clinic, usually 3 days per week Mon, Wed, Fri or Tues, Thurs, Sat for approximately 3-4 hrs.
Home hemodialysis is done in your home, usually 5 days per week for approximately 2.5 hrs. It requires you to have a care partner to assist with your dialysis.
When you start hemodialysis, whether it is in-center or at home, you want to make sure that you are confident and comfortable with your health care team and your support system at home. Your nephrologist will help oversee your care, monitor your health, educate you about kidney disease and hemodialysis, and guide you through decision-making. Your nurse will also help monitor your health and oversee your dialysis treatments. Your dietician will help guide you with the changes in your nutritional needs that occur when you start dialysis. Your social worker will help you navigate the financial and emotional changes that you may experience. Last, but definitely not least, as you prepare to start hemodialysis you want to make sure that you have a strong support system at home as requiring hemodialysis is a lifestyle change.