What is Dialysis?: Treatment and Aftercare

Understanding Dialysis

What Is Dialysis?

Dialysis is a medical treatment that filters waste products, toxins, and excess fluids from your blood for those with low kidney function (less than 15%).

What Does Dialysis Do for the Kidneys?

Dialysis filters out waste, removes excess fluid, and balances the chemicals in your blood when your kidneys cannot do it on their own.

It removes elements such as metabolic waste, toxins, and urea from the bloodstream. Dialysis can also balance out electrolytes and minerals, such as potassium, sodium, and bicarbonate.

Why Do People Need Dialysis?

People need dialysis when their kidneys cannot filter waste and extra fluid from their blood, which can be caused by a number of conditions.

One cause is End-Stage Renal Disease (ESRD), the final stage of chronic kidney disease (CKD), which occurs when kidney function is at 10%–15% or less. Diabetes, high blood pressure, and acute injury to the kidneys can also make dialysis a necessity.

How Does Dialysis Replace Kidney Function?

Dialysis replaces failing kidney function by artificially filtering waste products, toxins, and excess fluids from the blood.

Types of dialysis include hemodialysis and peritoneal dialysis.

Is Dialysis a Cure for Kidney Failure?

No, dialysis does not cure kidney failure, but only artificially replaces the filtering function of kidneys once they can no longer do so.

The kidneys do not have improved function after dialysis; it only maintains the condition until an individual receives a successful kidney transplant.

 

When Dialysis Is Needed

At What Stage of Kidney Disease Is Dialysis Needed?

Dialysis is required at stage 5 of chronic kidney disease (CKD), which is also referred to as end-stage renal disease (ESRD) or kidney failure.

What Is Stage 5 Kidney Failure?

In stage 5 kidney disease, the eGFR (glomerular filtration rate, or kidney function) falls below 15 mL/min. 

This indicates that the kidneys function at 15% or less of their normal capacity.

How Do Doctors Know When Someone Needs Dialysis?

Doctors know when a person needs dialysis when their kidney function drops to 15% or less (an eGFR of 15 mL/min or lower), or when symptoms appear.

Fluid overload can cause swelling (edema) in the legs, ankles, or feet, or fluid buildup in the lungs causing shortness of breath. Muscle weakness, fatigue, muscle cramps, or irregular heartbeat can also occur due to high potassium levels. Other ESRD symptoms include nausea, vomiting, loss of appetite, weight loss, fatigue, or confusion.

Can Kidney Disease Lead to Kidney Failure?

Yes, chronic kidney disease (CKD) can lead to kidney failure (end-stage renal disease (ESRD)).

ESRD is the 5th of five stages of CKD and occurs when the eGFR falls below 15% of normal function.

Can Kidney Stones Cause Kidney Failure?

Yes, kidney stones can lead to kidney failure, though it is rare when the kidney stones are normal-sized.

 

Types of Dialysis

What Is Hemodialysis?

Hemodialysis is a medical procedure that uses a machine with an artificial kidney filter to clean the blood.

It typically occurs when CKD reaches stage 5.

What Is Peritoneal Dialysis?

Peritoneal dialysis is a kidney failure treatment that filters waste products, toxins, and excess fluids through the peritoneum, or abdominal lining.

What Is the Difference Between Hemodialysis and Peritoneal Dialysis?

Hemodialysis uses a dialyzer, or artificial filter, to clean the blood, while peritoneal dialysis uses a dialysate, or cleansing fluid. 

Hemodialysis usually takes place in a dialysis center, while peritoneal dialysis is usually done at home.

What Is In-Center Hemodialysis?

In-center hemodialysis is the name for traditional hemodialysis, which takes place in a dialysis center.

Hemodialysis takes place 3 times a week for approximately 4 hours per session. The access point is an arm fistula or graft, which uses needles.

What Is Home Dialysis?

Home dialysis takes place at home instead of at a dialysis center, which provides more flexibility for patients and fewer dietary restrictions.

Dialysis at home may be either peritoneal dialysis (more common) or home hemodialysis (less common).

What Is Home Hemodialysis?

Home hemodialysis is the same medical treatment as hemodialysis, but it uses a portable machine in your own home instead of at a dialysis center.

For home dialysis, a trained care partner is often required for safety purposes, while patients and their partners are trained for anywhere from 4 to 8 weeks before beginning home hemodialysis.

 

How Hemodialysis Works

How Does a Dialysis Machine Work?

A dialysis machine removes roughly a pint of blood at a time with a dialyzer, which removes waste products and toxins before returning the clean blood to the body.

Blood moves from the body at a vascular access point (usually a fistula, graft, or catheter). Then, a dialyzer filter uses a cleaning fluid (dialysate) to remove waste products, along with excess fluid and minerals. The purified blood is returned to the body.

What Is a Dialyzer?

A dialyzer is an artificial device, also known as an artificial kidney, used during hemodialysis to filter waste products, excess fluids, and toxins from the blood.

What Is Dialysate?

Dialysate is a chemical cleaning solution used during dialysis to filter waste products, remove excess fluid, and balance electrolytes.

What Is Vascular Access?

Vascular access is a surgically created route that allows blood to leave and re-enter the body during dialysis.  

The three main types of vascular access include an Arteriovenous (AV) fistula (most common), an arteriovenous (AV) graft placed under the skin, and a central venous catheter (CVC), which may be placed into a large vein in the neck, chest, or groin.

 

Dialysis Access and Catheters

What Is Dialysis Access?

Dialysis access is a surgically created site in the body that allows blood to safely leave and return during hemodialysis treatments.

Also called vascular access, it also allows fluid to return and leave during peritoneal dialysis.

What Is an AV Graft?

An arteriovenous (AV) graft is a surgically created bridge used to connect an artery to a vein during hemodialysis.

It consists of a soft, synthetic, or biological tube that is chosen in lieu of a fistula when a patient’s veins are too small.

When Is a Dialysis Catheter Used?

A dialysis catheter is used for hemodialysis when a patient develops sudden acute kidney failure, is waiting for their permanent AV fistula to heal, or cannot support a fistula or a graft.

 

Peritoneal Dialysis

How Does Peritoneal Dialysis Work?

Peritoneal dialysis cleans the blood by using the inner abdominal lining (called the peritoneum) as a natural filter.

A catheter is placed inside the abdominal cavity, and dialysate (cleansing fluid) moves through the catheter into the belly. It removes waste products, toxins, and excess fluid from the blood vessels before being drained out into a collection bag.

What Is the Peritoneum?

The peritoneum is a large, smooth membrane that lines the abdominal and pelvic cavities and is used during peritoneal dialysis.

What Is Dialysate in Peritoneal Dialysis?

Dialysate is a sterile cleansing fluid used in peritoneal dialysis that filters out waste products and excess fluid from the blood through the abdominal lining (peritoneum).

It includes an osmotic agent (typically sugar) to draw out excess fluid from the blood vessels, electrolytes such as sodium, calcium, magnesium, and chloride, and buffers such as lactate or bicarbonate to regulate blood pH.

What Is the Difference Between CAPD and APD?

Continuous Ambulatory Peritoneal Dialysis (CAPD) is performed without a machine, while Automated Peritoneal Dialysis (APD) or Continuous Cycling Peritoneal Dialysis (CCPD) uses a cycler. 

Both are typically done at night while you sleep.

 

Dialysis Treatment

How Long Does a Dialysis Treatment Take?

The length of a dialysis session depends on the specific type of treatment.

In-center hemodialysis lasts about 3 to 4 hours per session and typically occurs 3 times a week. At-home hemodialysis lasts roughly 3 to 8 hours per session and occurs 3 to 7 days a week.

What Happens During a Dialysis Session?

For hemodialysis, needles are placed into the arm via an AV fistula or graft so blood can be removed, cleaned, and returned. 

Once the blood flows out, is cleaned, and returned, the needles are removed so a bandage can be placed upon the access point.

Is Kidney Dialysis Very Painful?

Dialysis is not generally painful, except for a brief pinch when needles are inserted into the vascular access point.

How Do People Feel After Dialysis?

It’s common to feel drained or fatigued after finishing dialysis, while some people feel more energetic once fluids or toxins are removed.

What Can You Do During Dialysis?

Dialysis is a good time to watch TV or movies, listen to music or a podcast, play games, take a nap, or meditate over the usually 3- to 4-hour session.

 

Side Effects and Complications of Dialysis

What Are the Most Common Side Effects of Dialysis?

Common dialysis side effects include fatigue, low blood pressure, muscle cramps, itchy skin, restless leg syndrome, or feelings of depression.

Why Can Dialysis Cause Low Blood Pressure?

Blood pressure drops during hemodialysis (known as intradialytic hypotension) because the dialysis machine removes fluid from your blood faster than your body can replace it.

What Are the Possible Complications of Peritoneal Dialysis?

Peritoneal dialysis brings possible risks of peritonitis infection, as well as infections at the access site. 

Peritonitis occurs when the peritoneum, or abdominal lining, becomes infected. When the access site gets infected, it can cause redness, swelling, or pus. The catheter can become clogged, fluid can also leak out around the insertion site, or a hernia may occur.

 

Living With Kidney Failure and Dialysis

How Serious Is Going on Dialysis?

Dialysis is a serious medical condition because the kidneys are no longer able to drain excess fluid from the body by themselves.

How Long Can a Person on Dialysis Live?

The average time for a person on dialysis to live is 5 to 10 years, although many patients live for 20 to 30 years or more with stable, ongoing treatment.

Can Someone Live a Normal Life on Dialysis?

Yes, someone can live normally on dialysis, including working, going to school, taking care of their family, and traveling.

In-center dialysis typically requires 4 hours per session, 3 times a week, while home hemodialysis or peritoneal dialysis (often done overnight) offers more time flexibility.

Can Kidneys Start Working Again After Dialysis?

The kidneys can begin working again after dialysis only with acute kidney injury and not due to chronic kidney disease.

How Long Can Someone With Stage 5 Kidney Failure Survive Without Dialysis?

Someone with stage 5 kidney failure (ESRD) typically survives from a few days to a few weeks without dialysis.

 

Dialysis, Diet, and Kidney Health

Why Is Nutrition Important During Dialysis?

Nutrition matters during dialysis because it helps maintain health by increasing daily protein and limiting potassium, phosphorus, and sodium.

At LifeSpring Home Nutrition, we deliver medically tailored meals (MTM) for people on dialysis.

How Does Sodium Affect Kidney Health?

Eating too much sodium can cause swelling, excess fluid in the lungs, and high blood pressure, which is why it’s important to limit sodium when on dialysis.

Why May Potassium Need to Be Monitored?

Potassium needs to be monitored because failing kidneys cannot filter out potassium by themselves.

Potassium can build up between dialysis sessions due to certain foods, drinks, and medications, which can cause heart rhythm changes or a heart attack. Low potassium may occur when dialysis removes it from the blood quickly, causing levels to drop.

What Is the Role of Phosphorus in a Kidney-Friendly Diet?

Phosphorus levels should be monitored in a dialysis-friendly diet because failing kidneys cannot filter it out properly.

High phosphorus foods include processed meats, fast food, and dark sodas, which should all be avoided on a kidney-friendly diet.

LifeSpring Home Nutrition’s renal-friendly meals can help support your needs with your nephrologist’s approval.

Do People on Dialysis Need More Protein?

Yes, people on dialysis need more protein than those with healthy kidneys or those with chronic kidney disease (CKD) who are not yet on dialysis.

When dialysis filters waste and excess fluid from the blood, it also removes many essential amino acids and proteins.

 

Aftercare and Kidney Care After Dialysis

How Should Dialysis Access Be Cared For?

To care for your dialysis access point, keep your hands and the site clean and look for any signs of infection.

How Can People Manage Fatigue After Dialysis?

You can manage dialysis fatigue by talking to your nephrologist about your fluid-removal rate, post-dialysis target weight, or treatment time.

It’s also important to keep your fluid gains low between sessions to prevent too much fluid removal during treatment. Many dialysis patients have anemia, which also needs to be monitored.

How Important Is Blood Pressure Management?

Blood pressure management matters since hypertension damages the heart, brain, kidneys, and blood vessels without apparent symptoms.

What Follow-Up Care Is Needed for People on Dialysis?

Follow-up care includes sticking to your assigned treatment schedule, monitoring your fluids and medications, along with regular blood lab work and access site care.

When Should You Contact Your Dialysis or Nephrology Team?

Contact your dialysis or nephrology team right away if you experience severe swelling and/or sudden weight gain, shortness of breath, chest pain, very high blood pressure, or an increase in blood creatinine.

 

Dialysis and Kidney Transplant

Is a Kidney Transplant an Alternative to Dialysis?

Yes, a kidney transplant is the main alternative to dialysis for end-stage renal disease (ESRD).

Can Someone Stop Dialysis After a Kidney Transplant?

Yes, a successful kidney transplant allows a person to stop dialysis permanently, as long as the transplanted kidney filters out waste and fluids from the blood.

Can Everyone on Dialysis Receive a Kidney Transplant?

No, not everyone on dialysis can receive a kidney transplant. 

The following factors may disqualify someone as a successful candidate for a kidney transplant:

• Active or recent cancer
• Severe heart or lung disease
• Active infections
• Substance abuse issues
• Advanced age or limited life expectancy
• Lack of a caregiver or support system

 

Frequently Asked Questions About Dialysis

Is dialysis permanent?

Yes, dialysis can be permanent as long as you do not receive a kidney transplant (or your kidneys recover from acute kidney injury).

Can you travel while on dialysis?

Yes, you can travel while on dialysis with medical clearance from your doctor.

Can you work while on dialysis?

Yes, you can work while on dialysis, especially with peritoneal or home hemodialysis.

In-center hemodialysis is possible for working people when coordinating your schedule with the most flexible hours.

Can you drink water while on dialysis?

Yes, you can drink water during dialysis, but you usually need to limit your fluids to a total of 32 ounces (1 liter or 4 cups) per day.

What happens if you miss a dialysis treatment?

Missing a dialysis treatment can cause a buildup of excess fluid, toxins, and minerals in the blood, leading to severe heart problems, breathing difficulties, and death.

Dialysis centers will typically reschedule your session within 24 hours after you miss one.

Is dialysis the same as kidney transplantation?

No, dialysis is a medical procedure that artificially filters waste, excess fluids, and toxins from your blood, while a kidney transplant means getting a new kidney from a donor.

Can dialysis reverse chronic kidney disease?

No, dialysis cannot reverse chronic kidney disease (CKD) and is required permanently or until you receive a kidney transplant.

What is the difference between CKD and kidney failure?

Chronic kidney disease (CKD) describes long-term damage to the kidneys, while kidney failure (ESRD) is the end-stage point of kidney disease.