Haemodialysis

Haemodialysis is a life-saving treatment that filters wastes and excess water from your blood when your kidneys are no longer able to do this work. This treatment helps control blood pressure and balance important minerals in your blood, allowing you to feel better and live longer with kidney failure.

Table of contents

• What is haemodialysis?
• Who needs haemodialysis?
• How haemodialysis works
• Types of haemodialysis
• Preparing for haemodialysis
• Lifestyle changes with haemodialysis
• If you decide to stop haemodialysis

What is haemodialysis?

Haemodialysis is a treatment that performs the normal work of your kidneys when they are no longer working properly. Your kidneys’ main job is to remove toxins and extra fluid from your blood. If these waste products build up in your body, it can be dangerous and even cause death.^[1]

During haemodialysis, your blood passes through a filter, called a dialyzer, which is sometimes called an “artificial kidney”. The dialyzer removes waste products from your blood when your kidneys can no longer do their job.^[1] This treatment helps to remove extra salt, water, and waste products so they don’t build up in your body. It also helps keep safe levels of minerals and vitamins in your body, helps control blood pressure, and helps produce red blood cells.^[3]

Haemodialysis can help you feel better and live longer, but it’s not a cure for kidney failure.^[1] It is the most common type of dialysis. About 90% of all people who need dialysis receive haemodialysis.^[3]

Who needs haemodialysis?

You may need haemodialysis if you have late-stage kidney disease, end-stage kidney disease (ESKD), or kidney failure.^[3] This is when your kidneys can no longer support your body’s needs. Kidney failure is the last stage of long-term (chronic) kidney disease.^[5]

Your doctor will discuss dialysis with you before you need it. Usually, you will go on dialysis when you have only 10% to 15% of your kidney function left.^[1] Your doctor will help determine when you should start haemodialysis based on several factors, including your overall health, kidney function, signs and symptoms, quality of life, and personal preferences.^[5]

You might notice signs and symptoms of kidney failure, such as nausea, vomiting, swelling, or fatigue.^[5] You also may need haemodialysis if your kidneys suddenly stop working due to acute kidney injury. In this case, haemodialysis can be temporary while your kidneys heal from an injury.^[3]

You may also need haemodialysis if you’re waiting for a kidney transplant.^[3]

How haemodialysis works

At the start of a haemodialysis treatment, a dialysis nurse or technician places two needles into your arm. You may prefer to put in your own needles after you’re trained by your health care team. A numbing cream or spray can be used if placing the needles bothers you.^[1]

Each needle is attached to a soft tube connected to the dialysis machine. The machine removes blood from your body, filters it through the dialyzer, and then returns the cleaned blood to your body.^[3] During the process, the dialysis machine checks your blood pressure and controls how quickly blood flows through the filter and how quickly fluid is removed from your body.^[1]

Inside the dialyzer, blood enters at one end of the filter and is forced into many very thin, hollow fibres. As your blood passes through the hollow fibres, dialysis solution passes in the opposite direction on the outside of the fibres. Waste products from your blood move into the dialysis solution. The filtered blood remains in the hollow fibres and returns to your body.^[1]

The dialysis solution contains water and chemicals that are added to safely remove wastes, extra salt, and fluid from your blood. Your doctor, called a nephrologist (a doctor who specializes in kidney problems), will prescribe a dialysis solution to meet your needs. Your doctor can adjust the balance of chemicals in the solution.^[1]

Types of haemodialysis

There are two main types of haemodialysis: in-centre haemodialysis and home haemodialysis. Talk to your healthcare provider about what type of haemodialysis is best for you.^[3]

In-centre haemodialysis

For this type of haemodialysis, you go to a special healthcare facility that specializes in providing haemodialysis. A haemodialysis nurse or technician performs the procedure.^[3] Haemodialysis is most often done at a special dialysis centre.^[1]

Most people get in-centre haemodialysis at least three times per week. Each session takes between three and four hours to complete. You may feel tired for several hours after the dialysis.^[3] At a treatment centre, your health care providers will handle all your care. However, you do need to schedule your appointments and follow a strict dialysis diet.^[1]

Home haemodialysis

This type of haemodialysis takes place in your home. You may be able to have haemodialysis at home. You do not have to buy a machine. Medicare or your health insurance will pay for most or all of your treatment costs at home or in a centre.^[1]

Over several weeks or months, your healthcare providers will teach you how to perform haemodialysis and resolve common problems that may develop. You then perform the procedure yourself on your own schedule.^[3] Both you and your caregivers must learn to handle the equipment, place the needle into the access site, monitor the machine and your blood pressure during treatment, keep records, clean the machine, and order supplies, which can be delivered to your home.^[11]

There are three types of home haemodialysis:^[3]

• Conventional home haemodialysis: You perform conventional home haemodialysis three times a week. Each session lasts at least three to four hours.
• Short daily home haemodialysis: Short daily home haemodialysis uses new technology that allows for shorter procedures. You perform the procedures five to seven days a week. Each session lasts around two hours.
• Nocturnal (overnight) home haemodialysis: This type of haemodialysis takes place at night while you’re asleep. You perform the procedure four to six nights per week. Each session lasts between six and eight hours. This type of haemodialysis removes more waste from your blood because you spend more hours each week on dialysis than the other types.

Home dialysis is not for everyone. You will have a lot to learn and need to be responsible for your care. Some people feel more comfortable having a provider handle their treatment. Plus, not all centres offer home dialysis.^[1] Home dialysis may be a good option if you want more independence and are able to learn to treat yourself.^[11]

Preparing for haemodialysis

You must prepare for your first haemodialysis session weeks or even months in advance.^[3] Before you start haemodialysis, a surgeon will enlarge some of the blood vessels (an artery and vein) in your arm. Your doctor will create an access where the tube attaches. Usually, an access will be in a blood vessel in your arm.^[1] This is done to make dialysis access easier and to allow blood to flow in and out of your body faster.^[3]

Lifestyle changes with haemodialysis

With haemodialysis, you’ll need to follow a strict treatment schedule, take medications regularly, and make changes in your diet.^[5] Haemodialysis is a serious responsibility, but you don’t have to shoulder it alone. You’ll work closely with your health care team, including a kidney specialist and other professionals with experience managing haemodialysis.^[5]

If you decide to stop haemodialysis

If you choose not to start or decide to stop haemodialysis, toxins will build up in your blood and your kidneys will eventually fail. Kidney failure is fatal. You may survive a few days or weeks without haemodialysis if you have kidney failure.^[3]

Refusing or stopping haemodialysis is a personal choice. Before making a decision, you should share your feelings with your healthcare provider and family.^[3]