The job of the kidneys is to remove waste and extra water from the body. The kidneys also balance levels of minerals in the body, called electrolytes. Kidneys are essential for the health of the body. People with severe kidney disease are not able to perform these functions. This may be due to a temporary or a permanent kidney condition. Hemodialysis is a treatment that takes over the essential functions of the kidney until you recover from kidney disease, or get a kidney transplant. If you have end stage renal disease (ESRD) and are not eligible for a transplant, you will need to have hemodialysis for the rest of your life. Peritoneal dialysis is another type of dialysis but is not covered in this article.

Hemodialysis requires access to a strong blood flow. There are 3 ways to do this. 

  • Dialysis catheter. This is a plastic tube put into a large blood vessel, usually for temporary access. If there is no other option, it may be used permanently.

  • AV fistula. Through a minor surgical procedure, an artery in your arm is joined directly to a vein. This creates an arteriovenous fistula or AV fistula. The pressure of the arterial blood flow slowly expands the size of the attached vein. It may take up to 4 to 6 weeks for the fistula to enlarge enough to be ready for dialysis. The AV fistula is the access of choice. This is because there are typically fewer problems and side effects. It also lasts longer than the other options.

  • AV graft. This is an artificial implant that joins an artery and vein in people with small veins. It can also be used when an AV fistula did not work. It can be used for dialysis a few weeks after the surgery.

A connecting tube carries blood from the access point in the body to the dialysis machine where special filters called dialyzers filter and process the blood. The blood is then returned to the body through a separate tube and needle. This takes 3 to 4 hours and is usually done 3 times a week. Home dialysis is an option for some patients.

Arm showing fistula between vein and artery. Dialysis catheters inserted in vein move blood from body to dialyzer and back to body.

Hemodialysis is lifesaving for people with kidney failure, but there are possible side effects. These include infection, low blood pressure, bleeding, electrolyte imbalance, anemia, and heart disease.

Home care

The following guidelines will help you care for yourself at home:

  • Take any medicines as directed.

  • Follow the special diet for kidney failure that your healthcare provider gave you.

  • Don’t wear any clothing or jewelry that could put pressure on the access site.

  • Don’t lie on the access site while sleeping.

  • If the access is in your arm, have blood pressure readings and blood samples taken from the other arm.

  • Check the access site after dialysis for swelling, bleeding, or signs of infection.

  • If you have an AV fistula or graft, check the site regularly to be sure you can always feel the vibration (called the “thrill”) of blood flowing from artery to vein. Don’t put lotions or other products on the access site.

  • If you have an external dialysis catheter, don't do any physical activities that could pull on the catheter.

Follow-up care

Follow up with your healthcare provider, or as advised.

Call 911

Call 911 if any of these occur:

  • External catheter starts bleeding or opens to air

  • Severe weakness, dizziness, fainting, drowsiness, or confusion

  • Chest pain or shortness of breath

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Color of the blood in the external tubing changes from bright red to dark red

  • You don’t feel the “thrill” (vibration) in an AV fistula or graft

  • Nausea or vomiting

  • Unexpected weight gain or swelling in the legs, ankles, or around the eyes

  • Decreased or absent urine output if you previously made urine

  • Fever of 100.4ºF (38ºC) or higher, or as directed by your healthcare provider

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