Hemodialysis: Preparation, Treatment, Risks & Benefits

Hemodialysis, also known as renal dialysis, is a life-saving treatment for individuals with kidney disease. It is a process that involves removing waste products, toxins, and excess liquids from the blood when the kidneys cannot perform this function effectively. Hemodialysis uses a special machine called a haemodialyser, which acts as an artificial kidney.

The hemodialysis machine creates a circuit that allows the patient's blood to flow out of their body and into the machine. In the machine, the blood passes through a filter known as a dialyser, which removes waste products and excess fluids. A separate circuit then returns the filtered blood to the patient's body. Hemodialysis sessions typically last several hours and are performed multiple times per week in a clinical setting or hospital under the supervision of trained medical professionals.

Hemodialysis plays a crucial role in managing kidney disease by performing the essential functions of the kidneys. The kidney's primary function is to filter the blood, remove waste products or toxins, and maintain the blood's balance of fluids and electrolytes. When the kidneys cannot perform these functions adequately, hemodialysis becomes necessary.

By removing waste products, toxins, and excess fluids from the blood, hemodialysis helps prevent the build-up of toxins and fluid overload in the body. This procedure also helps maintain the electrolyte balance, such as sodium, potassium, and calcium, which are vital for the proper functioning of various organs and systems in the body.

Before starting hemodialysis, specific preparations are necessary to ensure the procedure is safe and effective, including: 

• Medical evaluation: Medical professionals carefully assess the patient's medical history and current status. The doctors can also perform blood tests to determine the patient's overall health and establish a baseline for monitoring during treatment.
• Vascular access positioning: The patient's vascular access is another crucial aspect of hemodialysis preparation. Vascular access refers to the entry site on the body where the blood can be safely accessed for the procedure. Common types of vascular access include arteriovenous fistulas, arteriovenous grafts, and central venous catheters. The choice of vascular access depends on various factors, such as the patient's overall health, the condition of their blood vessels, and the expected duration of Hemodialysis treatment.
• Education: The doctor will also educate the patient about the hemodialysis procedure, including its benefits, risks, and potential side effects. The patient is encouraged to ask questions and clarify any doubts.
• Dietary modification: the patient's diet and medication regimen may be adjusted to optimise the effectiveness of hemodialysis. Healthcare providers may advise patients to follow a special renal diet that limits certain nutrients, such as sodium, potassium, and phosphorus, to reduce the workload on the kidneys and minimise complications during dialysis.

The doctor will schedule the next dialysis appointment and any additional medical appointments related to their kidney disease management.

Hemodialysis treatment typically takes place at a dialysis centre, where the patient visits on a regular schedule. The repetition and duration of treatment sessions vary and depend on the patient's specific needs and the recommendation of their healthcare team. 

• Patient preparation: During a hemodialysis session, the patient is comfortably seated or lying down. The doctor will make vascular access and insert needles or catheters to connect the patient's bloodstream to the hemodialysis machine. The machine is carefully programmed based on the patient's prescription, considering factors such as blood flow rate, dialysate composition, and treatment time.
• Connection to dialysis machine: The doctors will connect arterial and venous needles to the tubing attached to the hemodialysis machine. Once the hemodialysis session begins, the patient's blood flows out of their body and into the haemodialyser. 
• Filtration: Inside the dialyser, the blood passes through tiny hollow fibres that act as a filter. A diffusion process removes waste products, excess fluids, and electrolytes from the blood. This filtered blood is returned to the patient's body, completing the circuit. 
• Ultrafiltration: If necessary, doctors will perform ultrafiltration to remove additional fluid from the patient's bloodstream to maintain fluid balance.
• Monitoring: The medical staff will closely monitor the patient's vital signs and blood pressure throughout the treatment. They will make any necessary adjustments to the treatment parameters to ensure the patient's safety and well-being. 

Hemodialysis sessions typically last for several hours, during which patients may choose to read, watch television, or engage in other activities to pass the time.

After a hemodialysis session, patients need to take certain precautions and follow specific guidelines to optimise the treatment's benefits. The doctor will monitor the patient's vital signs, including blood pressure, to ensure stability before they leave the dialysis centre.

Maintaining good hygiene is crucial to prevent infections, especially at the vascular access site. Patients should keep the site clean, avoid unnecessary touching or scratching, and follow the recommended dressing changes. Additionally, patients should practice proper hand hygiene before and after any contact with the vascular access site.

Following a balanced diet is another crucial aspect of post-hemodialysis care. The patient's diet may be tailored to their specific needs, considering factors such as their level of residual kidney function, nutritional requirements, and any existing medical conditions. Limiting certain nutrients, such as sodium, phosphorus, and potassium, is essential to prevent complications and maintain overall health.

The healthcare team schedules regular follow-up appointments to monitor the patient's response and make any necessary adjustments to their treatment plan. Periodic blood tests help assess the patient's kidney function, nutritional status, and overall well-being. These appointments also allow patients to discuss any concerns or issues related to hemodialysis.

Hemodialysis offers several benefits to individuals with kidney disease, including:   

• The primary benefit is removing waste products and excess fluids from the blood, which helps prevent complications associated with kidney failure. 
• By maintaining the balance of electrolytes in the body, hemodialysis helps prevent imbalances that can lead to serious health issues.
• In addition to managing kidney disease, hemodialysis alleviates manifestations associated with kidney failure, such as fatigue, nausea, and shortness of breath. 
• It allows individuals to continue leading relatively normal lives by supporting their body's vital functions. 
• Hemodialysis also plays a crucial role in preparing patients for kidney transplantation if deemed suitable. 
• By removing excess fluid, hemodialysis helps control blood pressure and reduce the chance of hypertension-related complications like stroke and heart failure. 
• Regular hemodialysis treatments can slow the progression of kidney disease and delay the need for more aggressive interventions like kidney transplantation.

While hemodialysis is a life-saving procedure, it is not without risks. Some potential risks and complications associated with hemodialysis include: 

• Infections can occur at the vascular access site or in other body parts, requiring prompt medical attention.
• Blood clotting can occur within the hemodialysis machine or at the vascular access site, leading to inadequate treatment and potential damage to the blood vessels. 
• Low blood pressure can occur during or after hemodialysis, causing dizziness, nausea, and fainting symptoms. 
• Muscle cramps may occur due to removing excess fluids and electrolytes during treatment.
• Access site complications, such as infection, bleeding, or poor blood flow, can interfere with the effectiveness of hemodialysis. 

Regular monitoring and proper access site care can help minimise these risks. Patients must understand the potential complications and promptly seek guidance from their healthcare team.

Hemodialysis is unique in its ability to replicate the essential functions of the kidneys, offering a lifeline to individuals with kidney disease. The process of hemodialysis, with its intricate machinery and precise programming, allows for efficiently removing toxins, waste products, and excess fluids from the bloodstream. This technology has revolutionised the management of kidney disease, providing individuals with a means to sustain their health and well-being.

The comprehensive care and support provided by the healthcare team during hemodialysis treatment make it a unique and personalised experience. The doctor will tailor the patient's treatment plan considering various factors, such as their overall health, residual kidney function, and lifestyle. Close monitoring and regular follow-up appointments ensure that any problems or concerns are addressed promptly, optimising the effectiveness and safety of the treatment.

What is Hemodialysis?

Hemodialysis is a medical procedure designed to mimic the kidneys' functions when they can no longer do so. It involves filtering a person's blood to remove toxins, waste products, and excess fluids. This process helps maintain a balanced level of electrolytes in the blood, such as sodium, potassium, and bicarbonate, and helps control blood pressure.

How does hemodialysis work?

The hemodialysis process involves diverting blood into a machine containing a special filter called a dialyser, or artificial kidney, through which blood passes. A solution called dialysate flows on the opposite side of the filter membrane, which helps remove waste, excess chemicals, toxins, and fluid from the blood without letting large molecules like proteins pass through.

Why is hemodialysis necessary?

Hemodialysis is necessary for individuals with end-stage renal disease (ESRD) or acute kidney injury (AKI), where the kidneys cannot filter the blood adequately. Without this intervention, waste products and fluids would accumulate in the body, leading to potentially life-threatening conditions such as hyperkalemia (high potassium levels), hypertension, and uremia (a high concentration of waste products).

What are the different types of hemodialysis machines?

Various types of hemodialysis machines are available, each designed to accommodate specific patient needs. The main types include standard in-centre machines, typically used in hospitals and clinics, and portable home hemodialysis machines, which are smaller and easier to use and allow patients to undergo treatment in the comfort of their homes.

How often is hemodialysis performed?

The frequency of hemodialysis sessions varies depending on the individual's condition and their healthcare provider's recommendations. Typically, hemodialysis is performed three times per week, with each session lasting around four hours. However, some patients may need more frequent or longer sessions.

How long does a hemodialysis session typically last?

A typical in-centre hemodialysis session lasts about four hours, although this can range from three to five hours based on the patient's size, the amount of waste in the body, and how well the kidneys work. During this time, the patient's blood is continuously cycled through the dialyser to clean it before being returned to the body.

What are the main components of a hemodialysis machine?

A hemodialysis machine includes several key components: a dialyser, a dialysate compartment, a blood pump, and monitoring systems. The dialyser is the core component where blood filtration takes place. The dialysate compartment mixes and warms the dialysate solution. The blood pump moves the blood through the dialyser, and the monitors ensure the procedure proceeds safely.

Is hemodialysis painful?

Hemodialysis itself is not usually painful. However, some patients may experience discomfort from the needles used to access their blood vessels. Additionally, some patients may feel a drop in blood pressure or experience muscle cramps during the session, which can cause discomfort.

Who needs hemodialysis?

Individuals with advanced chronic kidney disease (CKD), specifically those with advanced stages of CKD or End-stage Renal Disease, typically require hemodialysis. It is also used for patients with Acute Kidney Injury whose kidneys need support to recover or for those who have been poisoned by certain substances that can be removed by dialysis.

Can hemodialysis be done at home?

Hemodialysis can be done at home using a portable hemodialysis machine. Home hemodialysis requires the patient or a caregiver to be well-trained in using the equipment, monitoring the process, and responding to any issues that may arise during treatment.

What are the benefits of home hemodialysis?

Home hemodialysis offers several benefits, including greater flexibility in scheduling treatments, fewer dietary restrictions, and the comfort of being at home. It also allows for more frequent dialysis, leading to better fluid and waste removal, potentially resulting in improved health results and a better quality of life.

What are the risks associated with hemodialysis?

Like any medical procedure, hemodialysis carries risks. These include infection at the access site, low blood pressure during treatment, muscle cramps, itching, sleep problems, anaemia, bone diseases, and high blood potassium levels. Long-term complications can include cardiovascular disease and damage to the blood vessels. Proper monitoring and care can help mitigate these risks.

What are the dietary restrictions for individuals on hemodialysis?

Individuals on hemodialysis often have dietary restrictions to help manage their fluid and electrolyte levels. These restrictions typically involve limiting potassium, phosphorus, sodium, and fluid intake. A dietitian specialising in kidney health can help tailor a diet plan based on a patient's needs.

How does hemodialysis remove waste products and excess fluid from the body?

Hemodialysis removes waste products and excess fluid through diffusion and ultrafiltration. Waste and excess fluid move across the dialyser's semipermeable membrane from areas of higher concentration in the blood to lower concentration in the dialysate, effectively cleaning the blood.

Can hemodialysis be done on paediatric patients?

Hemodialysis can be performed on paediatric patients, requiring specialised equipment and expertise. Children's smaller size and unique medical needs mandate careful consideration and adjustment of dialysis protocols.

How does hemodialysis affect blood pressure?

Hemodialysis can cause fluctuations in blood pressure. Some patients may experience hypotension during or after treatment due to fluid removal from the blood. Others may have hypertension as a result of fluid retention between sessions or due to underlying health conditions.

Can hemodialysis patients travel?

Patients undergoing hemodialysis can travel, but it requires careful planning. They need to arrange for dialysis at their destination, ensure their dietary and fluid restrictions are maintained, and have a plan in place for any medical emergencies that may arise.

What should patients expect during a hemodialysis session?

During a hemodialysis session, patients can expect to have two needles placed into their access site, which connect them to the dialysis machine. They will sit or lie down for the duration of the treatment and may read, watch TV, or sleep. Healthcare providers will monitor their vital signs throughout the session.

How is the access site for hemodialysis created?

Healthcare providers can surgically create an access site for hemodialysis. The most common types are an arteriovenous (AV) fistula, made by connecting an artery to a vein, an AV graft, a synthetic tube connecting an artery to a vein, or a central venous catheter for temporary access.

What is the difference between hemodialysis and peritoneal dialysis?

The main difference between hemodialysis and peritoneal dialysis is the method of filtration. Hemodialysis uses a machine and an artificial kidney, while peritoneal dialysis uses the patient's peritoneum in the abdomen as the filter, with a dialysate solution to remove waste products and excess fluid.

Can Hemodialysis be done on pregnant women?

Hemodialysis can be done on pregnant women, though it requires careful monitoring and adjustment of treatment schedules and parameters to ensure the health and safety of both the mother and the foetus.

How does hemodialysis impact the quality of life of patients?

Hemodialysis can significantly impact the quality of life. It can improve symptoms of kidney failure and increase energy levels, but the time commitment and physical side effects can also be challenging. Emotional support and lifestyle adjustments are essential.

What should patients do to prepare for a hemodialysis session?

Patients should follow their dietary and fluid restrictions, take medications as prescribed, get adequate rest, and arrive on time for their hemodialysis session. They should also report any changes in their health to the dialysis staff before the treatment.

Can hemodialysis be done on individuals with heart problems?

Individuals with heart problems can undergo hemodialysis, but they require careful monitoring and may need adjustments to their treatment to accommodate their cardiovascular health.

How often should hemodialysis patients have their blood checked?

Hemodialysis patients should have their blood checked regularly to monitor kidney function, electrolyte levels, and haemoglobin. The nephrologist typically determines the frequency of these tests based on the patient's condition.

Can hemodialysis be done on individuals with diabetes?

Individuals with diabetes may require hemodialysis if they develop kidney failure. They need careful management of their blood glucose levels and may have additional dietary and medication adjustments.

How does hemodialysis affect electrolyte levels in the body?

Hemodialysis can help maintain electrolyte levels by removing excess blood potassium, sodium, and phosphorus. However, if not carefully managed, it can also lead to imbalances, necessitating close monitoring and adjustment of dialysate composition.

Can hemodialysis be used to treat acute kidney injury?

Hemodialysis can treat acute kidney injury, particularly when the kidneys are not expected to recover quickly or when the patient is critically ill and requires rapid intervention to manage waste and fluid build-up.

What should patients do if they miss a hemodialysis session?

If patients miss a hemodialysis session, they should contact their dialysis centre immediately to reschedule. Missing treatments can lead to fluid overload and dangerous levels of waste products in the blood.

Can hemodialysis patients still work or go to school?

Many patients undergoing hemodialysis can still work or attend school. They may need to arrange their dialysis schedule around their other commitments and work closely with their healthcare team to manage their energy levels and health needs.

How does hemodialysis affect sleep patterns?

Hemodialysis can affect sleep patterns due to changes in the body's chemistry and the schedule of treatments. Patients may experience insomnia or sleep apnea. Good sleep hygiene and medical interventions can help manage these issues.

What is the cost of hemodialysis treatment?

The cost of Hemodialysis treatment varies greatly and depends on the country, healthcare system, and whether the patient receives treatment at a centre or home. 

Can hemodialysis be used as a long-term treatment for kidney failure?

Hemodialysis can be used as a long-term treatment for kidney failure for patients who are not candidates for a kidney transplant or who are waiting for a transplant. It can sustain life and manage symptoms for many years.

How does hemodialysis impact the bone health of patients?

Patients on hemodialysis may develop bone issues due to calcium and phosphorus metabolism changes. Medications and dietary adjustments help prevent bone disease and maintain bone health.

Can hemodialysis patients still exercise?

Exercise is encouraged for patients on hemodialysis to improve cardiovascular health, muscle strength, and overall well-being. With the guidance of healthcare professionals, an appropriate exercise program should be developed.

How does hemodialysis affect the immune system?

Hemodialysis can affect the immune system, potentially increasing the risk of infections. Good hygiene practices and monitoring infection signs are essential for managing this risk.

Can hemodialysis be used to remove toxins from the blood in cases of poisoning?

Hemodialysis can effectively remove certain toxins from the blood in cases of poisoning, mainly if the substances are known to be dialysable.

What is the lifespan of a hemodialysis machine?

A hemodialysis machine's lifespan typically ranges from 5 to 10 years, depending on the model and maintenance. Regular servicing is crucial to ensure the machine's reliability and safety.

How does hemodialysis affect the nutritional status of patients?

Hemodialysis can affect the nutritional status by removing some nutrients from the blood. Patients often need to follow a special diet and may require supplements to maintain proper nutrition.

Can hemodialysis be used to treat fluid overload?

Hemodialysis is highly effective in treating fluid overload by removing excess fluid from the body, which helps prevent complications such as hypertension, heart failure, and pulmonary oedema.

How does hemodialysis affect the risk of infection?

The possibility of infection is higher in patients on hemodialysis due to the vascular access needed for treatment. Strict adherence to aseptic techniques and proper access site care can reduce this risk.

Can hemodialysis be done on individuals with liver disease?

Individuals with liver disease can undergo hemodialysis, but they may require additional monitoring and adjustments to their treatment plan due to potential complications and the interplay between liver and kidney function.

What advancements are being made in hemodialysis technology?

Advancements in hemodialysis technology include the development of more efficient dialysis machines, portable systems for home use, and innovations to enhance patient comfort and treatment outcomes.

How does hemodialysis affect the mental health of patients?

Hemodialysis can impact mental health, leading to conditions such as depression or anxiety. Support from healthcare providers, mental health professionals, and support groups is crucial for managing these challenges.