What is Hemodialysis?

Hemodialysis is a type of dialysis, which is a treatment that performs the work of your kidneys when they are no longer working correctly. Its primary purpose is to clean your blood by removing waste products and extra fluid. Common waste products include nitrogen waste (urea), muscle waste (creatinine), and acids.

During a hemodialysis session, a special machine takes blood from your body, filters it through an artificial kidney (called a dialyser), and then returns the clean blood to you.

How does hemodialysis work?

The dialyser is the part of the hemodialysis machine that cleans your blood. As your blood flows through tiny mesh tubes inside the dialyser, waste products and excess fluids pass from your blood into a special cleaning fluid called dialysate. This dialysate is a liquid made of water, salts, and electrolytes.

Once your blood is cleaned, it's circulated back into your body. The dialyser also disposes of the used dialysate, along with the waste products and extra water that were removed from your blood.

What are the two types of hemodialysis?

There are two main types of hemodialysis. You should discuss with your doctor which is best for you.

The primary types are:

In-center hemodialysis: For this type, you go to a medical facility specifically for dialysis. A trained nurse or technician performs the procedure. Most people on this type of dialysis have treatments at least three times a week, with each session lasting three to four hours.
Home hemodialysis: This is done at home. Your healthcare team will train you over several weeks or months on how to perform the procedure yourself and handle common problems. You can then schedule the treatments.

There are three different schedules for home hemodialysis:

Conventional home hemodialysis: You do this three times a week, and each treatment takes at least three to four hours.
Short daily home hemodialysis: This uses newer technology to make sessions shorter. You have treatments five to seven days a week, each taking about two hours.
Nocturnal (overnight) home hemodialysis: This is done at night while you are sleeping. You have sessions four to six nights a week, each lasting six to eight hours. Compared to the other types, this procedure removes more waste from your blood since you spend more hours on dialysis overall each week.

Who is the best candidate for hemodialysis?

You will need hemodialysis if you have late-stage kidney disease, end-stage kidney disease (ESKD), or kidney failure. It is also a necessary treatment if you are on the waiting list for a kidney transplant.

What happens if I don't have hemodialysis?

If you do not start or continue with hemodialysis, harmful toxins will build up in your blood, a condition called uremia, and your kidneys will fail completely. Kidney failure is a life-threatening condition. Without treatment, you can only survive for a few days to a few weeks. The decision to refuse or stop hemodialysis is a very personal one, and you should discuss your feelings with your doctor and family before making a choice.

How common is hemodialysis?

Hemodialysis is the most common form of dialysis. Around 90% of all people who need dialysis receive hemodialysis.

What happens before hemodialysis?

You'll need to prepare weeks or even months before your first hemodialysis treatment. If you plan to have home hemodialysis, your doctor will teach you how to perform the procedure and handle any issues that come up.

First, you'll need to have a small surgery to make it easier to connect to your bloodstream. You will have one of two types of procedures:

Arteriovenous fistula (AV fistula): Your surgeon will join an artery and a vein in your arm.
Arteriovenous graft (AV graft): If the artery and vein in your arm are too short to be joined directly, your doctor will use a soft, tube-like structure (a graft) to connect them.

These procedures create an access point that makes it easier for the hemodialysis machine to quickly take blood and return it to your body.

In an emergency when you need to start hemodialysis right away, your doctor might temporarily place a flexible, hollow tube called a catheter in a vein in your leg, chest, or neck.

Your doctor will also show you how to keep your fistula or graft clean to prevent infection. An infection can cause pain, tenderness, swelling, discoloration (red, gray, pink, brown, or black), and fever. To protect your access site, you should:

Avoid sleeping on the arm with the access.
Not wear jewelry or tight clothing that constricts the area.
Not wear a purse or bag strap over the access site.
Not have your blood pressure taken or blood drawn from that arm.

Accidentally injuring your fistula or graft could make it unusable for future treatments.

Do I need to change my diet if I start hemodialysis?

Yes. What you eat and drink can affect how well hemodialysis works and how you feel overall. Some foods and drinks create a lot of waste in your blood, add extra fluid, raise your blood pressure, and make your heart beat faster.

A renal dietitian will help you create a special diet before you begin hemodialysis. It's a good idea to avoid foods that are high in:

Potassium: Too much potassium can make your heartbeat faster. Foods high in potassium include bananas, avocados, and dried fruits.
Phosphorus: Too much phosphorus can make your bones brittle and your skin itchy. Examples include dairy, chicken, turkey, hot dogs, and canned chili.
Sodium: Too much salt makes you feel thirstier and drink more fluids. Foods and drinks high in sodium include vegetable juice, sports drinks, fast food, and many seasonings.

What happens during hemodialysis?

A hemodialysis nurse or technician will insert two needles into your arm. These are typically 15- or 16-gauge needles larger than a standard ballpoint pen tip. Soft tubes run from these needles to the hemodialysis machine. You can insert the needles yourself if you are doing home hemodialysis and have been trained.

The machine takes blood from one of the needles and sends it through the mesh tubes inside the dialyser. The dialyser then transfers excess waste and fluids into the dialysate solution. Finally, the machine sends your filtered blood back into your body through the second needle.

Throughout the session, the machine constantly monitors your blood pressure and may adjust how blood flows in and out of your body.

Is hemodialysis painful?

You might feel a slight pinch when the needles are inserted into your fistula or graft. However, the hemodialysis process itself is not painful.

Why does hemodialysis take so long?

Healthy kidneys work 24/7 to filter your blood, even while you sleep. While hemodialysis is a life-saving treatment, it cannot fully match healthy kidneys' constant and efficient work. Your kidneys filter about 150 quarts of blood every day, but hemodialysis is only 5% to 10% as effective. Because of this difference in efficiency, sessions usually need to be three to four hours long to get the job done.

What happens after hemodialysis?

After the session, you or your doctor will remove the needles and clean the access sites. You can then return to your daily routine. Most people feel weak or a little sick after a typical hemodialysis session, and these symptoms can last for several hours. However, some people who have more frequent treatments say they have more energy. You should talk with your doctor about which type of hemodialysis is best for you.

What are the benefits of hemodialysis?

The main benefit of hemodialysis is that it acts as your failed kidneys, clearing your blood of toxic waste products and removing excess water. Without this treatment, you would develop uremia, which is fatal without intervention.

Another advantage is that typical sessions are only required three times a week. If you choose home dialysis, you can schedule sessions, even overnight, when and where you want. Nocturnal home hemodialysis allows you to maintain a more normal daily routine.

What are the complications of hemodialysis?

Some people may experience complications with their fistula or graft, including:

Infection.
Scar tissue that can cause a blockage.
Blood clots can stop dialysis from working. A doctor can usually dissolve the clot with a simple procedure, but sometimes, open surgery is needed to remove it.

Though it is rare, a needle might accidentally come out of your arm, or a tube could detach from the machine. In such cases, the machine will sound an alarm and automatically shut down to prevent blood loss until the issue is fixed.

What are the side effects of hemodialysis?

Common side effects of hemodialysis include:

Low blood pressure (hypotension)
Nausea and vomiting
Dizziness
Fainting (syncope)
Chest pain
Back pain
Headaches
Itchy skin (pruritus)
Muscle cramps
Restless legs syndrome

How long can you survive on hemodialysis?

The average life expectancy for someone on hemodialysis is five to ten years. However, some individuals have lived for as long as 30 years on hemodialysis without any significant change in their quality of life.

How long does recovery take?

Most people start to feel better and notice improvements a few weeks after starting hemodialysis. If you feel sick or tired after your sessions, contact your doctor. They can prescribe medications or adjust your treatment to help you feel better.

When can I return to work?

If your job is in an office, you should be able to return to work once you get used to hemodialysis, which usually takes a week or two. If you have a physically demanding job, it might be a good idea to consider finding a less strenuous job.

When should I see my doctor?

You should call your doctor if you have any of the following symptoms:

Signs of low blood pressure, such as dizziness, fainting, or dehydration.
Nausea and vomiting.
Symptoms of infection.
Severe abdominal pain.
A bulge in your abdomen, which could be a hernia.

Why choose Tender Palm Super Speciality Hospital for Hemodialysis in Lucknow, India?

Tender Palm Super-Speciality Hospital is one of the best hospitals for Hemodialysis in Lucknow, India. Our experienced Nephrologists uses advanced technology, and provides patient-focused care, the hospital ensures safer procedures, quicker recovery, and improved long-term outcomes.