Treatment Methods for Kidney Failure: Hemodialysis

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    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,
    active life.


    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
    regular treatments.

    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.

    Illustration of a dialyzer.

    Hemodialysis.


    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.

    Many patients feel depressed when starting dialysis, or after several months
    of treatment. If you feel depressed, you should talk with your social worker,
    nurse, or doctor because this is a common problem that can often be treated
    effectively.

    Arm with an arteriovenous fistula.
    Arteriovenous fistula.


    Getting Your Vascular Access Ready

    One important step before starting hemodialysis is preparing a vascular
    access, a site on your body from which your blood is removed and returned. A
    vascular access should be prepared weeks or months before you start dialysis. It
    will allow easier and more efficient removal and replacement of your blood with
    fewer complications. For more information about the different kinds of vascular
    accesses and how to care for them, see the National Institute of Diabetes and
    Digestive and Kidney Diseases (NIDDK) fact sheet Vascular Access for
    Hemodialysis
    .

    Illustration of a looped graft.

    Graft.

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