Hemodialysis is the most common method used to treat advanced and permanent
kidney failure. Since the 1960s, when hemodialysis first became a practical
treatment for kidney failure, we’ve learned much about how to make hemodialysis
treatments more effective and minimize side effects. But even with better
procedures and equipment, hemodialysis is still a complicated and inconvenient
therapy that requires a coordinated effort from your whole health care team,
including your nephrologist, dialysis nurse, dialysis technician, dietitian, and
social worker. But the most important members of your health care team are you
and your family. By learning about your treatment, you can work with your health
care team to give yourself the best possible results, and you can lead a full,
When Your Kidneys Fail
Healthy kidneys clean your blood by removing excess fluid, minerals, and
wastes. They also make hormones that keep your bones strong and your blood
healthy. When your kidneys fail, harmful wastes build up in your body, your
blood pressure may rise, and your body may retain excess fluid and not make
enough red blood cells. When this happens, you need treatment to replace the
work of your failed kidneys.
How Hemodialysis Works
In hemodialysis, your blood is allowed to flow, a few ounces at a time,
through a machine with a special filter that removes wastes and extra fluids.
The clean blood is then returned to your body. Removing the harmful wastes and
extra salt and fluids helps control your blood pressure and keep the proper
balance of chemicals like potassium and sodium in your body.
One of the biggest adjustments you must make when you start hemodialysis
treatments is following a rigid schedule. Most patients go to a clinic—a
dialysis center—three times a week for 3 to 5 or more hours each visit. For
example, you may be on a Monday-Wednesday-Friday schedule or a
Tuesday-Thursday-Saturday schedule. You may be asked to choose a morning,
afternoon, or evening shift, depending on availability and capacity at the
dialysis unit. Your dialysis center will explain your options for scheduling
A few centers teach people how to perform their own hemodialysis treatments
at home. A family member or friend who will be your helper must also take the
training, which usually takes at least 4 to 6 weeks. Home dialysis gives you a
little more flexibility in your dialysis schedule, but a regular schedule is
still important. With home hemodialysis, the time for each session and the
number of sessions per week may vary.
Adjusting to Changes
Even in the best situations, adjusting to the effects of kidney failure and
the time you spend on dialysis can be difficult. Aside from the “lost time,” you
may have less energy. You may need to make changes in your work or home life,
giving up some activities and responsibilities. Keeping the same schedule you
kept when your kidneys were working can be very difficult now that your kidneys
have failed. Accepting this new reality can be very hard on you and your family.
A counselor or social worker can help you cope.