Hemodialysis is a treatment option for advanced chronic kidney disease (CKD), which affects more than 1 in 7 adults in the United States. It’s the most common type of dialysis, which is the procedure that filters waste from your blood when your kidneys no longer function properly.

Hemodialysis uses an artificial kidney, or hemodialyzer, to filter the blood. Once the blood is filtered through the artificial kidney, it’s put back in the body by a dialysis machine.

The reasons for doing hemodialysis vary and depend on your particular situation. However, some of the more common factors include:

  • to improve quality of life
  • to improve overall health
  • to address an increase in signs and symptoms of kidney failure, such as vomiting, nausea, fatigue, or swelling

Hemodialysis isn’t appropriate for all situations and is typically reserved for end stage kidney disease when your kidneys are only functioning at 10 to 15 percent.

There are several benefits to using hemodialysis for advanced CKD. However, the medical procedure does come with some risks.

Understanding the risks of doing hemodialysis can help you feel more comfortable and ready to address them should they occur.

According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), these are some possible problems you may experience from hemodialysis:

  • complications related to the access site, such as infection, poor blood flow, or blockage
  • hypotension (low blood pressure)
  • itchy skin
  • muscle cramps
  • blood loss during treatment

First, your doctor will approve you for hemodialysis for advanced CKD. Once you’re cleared, you’ll need to prepare for the procedure several weeks before the first treatment.

One critical step is to care for the blood vessels in your arms. The NIDDK recommends asking healthcare professionals to draw blood and insert intravenous (IV) lines in veins below your wrist to avoid damaging arm blood vessels prior to hemodialysis.

Another step is to create a vascular access site. The access site is the location where the medical team member will place needles during each treatment.

Creating an access site is done with minor surgery, typically in the arm with a fistula, which joins a vein and artery, or a graft, which uses a piece of soft tube to join a vein and artery in your arm.

In rare cases, your doctor may need to place a catheter in your neck if the access sites in your arm or leg don’t work.

You might be wondering what to expect when you start hemodialysis. While each situation is unique, here are some general things to be aware of before starting treatment, per the NIDDK:

  • Treatment can happen in a dialysis center, hospital, or at home.
  • Your doctor will set the schedule, but sessions generally last about 3 to 4 hours, three times per week for treatment in a center.
  • Home hemodialysis is more flexible, allowing for three to seven treatments per week at your convenience. Sessions can vary in length.
  • Your blood pressure and heart rate will be monitored during each treatment.
  • Some people experience mild side effects like abdominal cramps or nausea during the procedure.

Hemodialysis relies on a hemodialyzer or artificial kidney to remove fluid, waste, and chemicals from your blood.

A healthcare professional begins by inserting two needles at the access site, which is the entrance into your blood vessels. Once the needles are in the access site, your blood is run through a filter that acts as an artificial kidney.

The filter removes the excess fluid, chemicals, and waste from your blood. The clean blood is then pumped back into your body.

The results of hemodialysis often depend on the severity of the disease. You’ll generally know whether it’s working based on how you feel.

According to the NIDDK, you may notice:

  • increase in energy
  • better appetite
  • less shortness of breath
  • reduced swelling

Your medical team will monitor treatments and administer blood tests to measure urea reduction ratio and total urea clearance. The results will show how effective the procedure is at removing waste from your body.

Another monitoring tool they’ll use is your weight. This will alert your team if you retain too much fluid between sessions.

If you have severe CKD or kidney failure, you’ll likely need hemodialysis for the rest of your life unless you get a kidney transplant.

Treatments are often scheduled close together, making the in-between time critical for focusing on rest, hydration, and care for the access area.

Pay attention to your diet

The NIDDK recommends limiting foods high in sodium, phosphorus, and potassium. Be cautious of the amount of fluid you’re consuming because fluid can build up in your body between treatments.

Additionally, the NIDDK suggests adding protein to your diet because hemodialysis removes this essential macronutrient.

Care for your access area

Caring for your access area is another important measure to take between treatments. Wash the area around the access area with warm water and soap every day.

You should also monitor the area for infection. Redness and warmth may indicate a problem.

Continue taking medication

Hemodialysis requires a strict schedule of treatment. It also requires following your doctor’s orders and taking any medications they have prescribed.

If you have questions about your medication or are having problems with any specific drugs, make sure to tell your doctor.

How is hemodialysis used to treat CKD?

Hemodialysis is used to treat severe chronic kidney disease when the kidneys can no longer function properly.

During the procedure, an artificial kidney machine filters or cleans your blood. You can have hemodialysis at home, in a hospital, or at a dialysis center.

At what stage of CKD must hemodialysis be started?

Work with your doctor to decide when to start hemodialysis. They’ll take into consideration your kidney function, symptoms, overall health, and quality of life when deciding on a start date.

A person will generally start hemodialysis when they reach stage 5 of CKD or kidney failure, according to the National Kidney Foundation.

When is dialysis needed for CKD?

It’s recommended to start before kidney disease causes life threatening complications.

Hemodialysis is needed when you reach end stage kidney failure or when your kidneys can no longer take care of your body’s needs.

This is typically by the time you lose 85 to 90 percent of kidney function.

What are the 3 types of dialysis?

There are three main types of dialysis. These include:

  • hemodialysis
  • peritoneal dialysis
  • continuous renal replacement therapy (CRRT)