What is hemodialysis (HD)?

The word “hemo” refers to blood. HD filters your blood outside your body using a machine and a manufactured filter, called a dialyzer. This dialyzer acts as an artificial kidney. The HD machine makes the dialysis solution that is delivered to the dialyzer. The combination of dialysis solution, dialyzer, and machine functions to remove excess water and waste from your blood.

During HD, a machine removes blood from your body using a needle or a central venous catheter. Your blood is then pumped through the dialyzer, where it meets the dialysis solution that the machine produced. It is at this point where the blood is cleaned, and fluid is pulled across the dialyzer from the patient and into the machine. The blood exiting the dialyzer that has been cleaned is returned to your body through a second needle or a second branch of catheter.

Hemodialysis is usually performed during a scheduled time at the hospital or in a dialysis clinic and is referred to as in-center HD. Most people require HD 3 times a week, with each treatment session lasting about 4 hours, depending on the dialysis prescription the doctor has recommended.

Please click here if you would like to read more detailed information about different types of dialysis and different ways of doing dialysis.

How does in-center HD work?

If you are treated with in-center HD, you will typically travel to your hospital or dialysis clinic 3 times a week to receive a 3- to 5-hour treatment each time, depending on the dialysis schedule your clinician has prescribed. There, you will be taken care of by a nurse or clinician throughout your treatment.

Before each in-center HD treatment, a member of your care team will give you a short physical examination and weigh you to determine how much fluid needs to be removed from your body. Your treatment access site will be cleaned, the needles required for treatment will be inserted, and the tubing that connects your access site to the HD machine will be set up. Your HD treatment will then begin, and you will be looked after by a nurse or technician. When your treatment is done and you’ve been disconnected from the machine, your blood pressure will be measured and you can leave the center.

It is a good idea to arrive early for your in-center HD appointments to allow enough time for your healthcare team’s preparation. Wear comfortable clothing. Bring a book or another form of entertainment. During and after your HD treatments, you may feel tired or experience uncomfortable leg cramps or nausea. Thus, it is common to want to go home and rest. If you experience unusual symptoms during or after your treatment, talk to your clinical team about your symptoms.

In terms of how the therapy feels, you should expect to feel some mild pain during the needle insertion phase, and as mentioned before, you may feel tired or experience uncomfortable leg cramps or nausea after therapy. The therapy itself should not be painful.

Preparing for in-center HD

Before in-center HD treatments start, you may also need to have a surgical procedure that creates a dialysis access site under your skin called a fistula. Once two needles are inserted in the fistula and blood tubing is attached, unfiltered blood flows from your blood vessels to the HD machine and dialyzer, and then the clean blood flows back into your blood vessels.

There are 3 different types of HD access: fistula, graft, and HD catheter. Each has its own benefits and drawbacks, and you should discuss these with your care team to determine which will be the safest and most effective access option for you. Typically, a fistula is considered the best option where possible.

No matter which kind of access type you choose, you’ll have to protect your access site from excess pressure, germs, and infection. Remember to clean your hands before touching your access site and consistently check it for signs of swelling and irritation. If you suspect these issues, contact your nurse immediately. This is true for all dialysis treatment options.

Benefits of in-center HD

In-center HD is performed under the supervision of a supportive clinical team, meaning that you can let others take care of you during treatment. You can use your treatment time to sleep, read, work on your laptop, listen to music, or do something else you enjoy. You will also have the opportunity to talk to other dialysis patients.

There may be other benefits to receiving in-center HD. For example, it might be favorable for you to receive treatment outside your home. It gives you the opportunity to get out of the house, may be less invasive for your family, and may help you keep your dialysis life separate from your home life.

While in-center HD has certain benefits, it also has special considerations. You should consider the following before speaking with your clinician about whether in-center HD is right for you:

• If you live far from your dialysis clinic, you may need to build transportation time into your treatment schedule 3 times per week.
• If you require hospital-/clinic-provided transport to get to your appointments, they may pick you and other patients up early, and you may have to wait for transport after dialysis to return home.
• Depending on your access, needles must be inserted during each treatment, which may be uncomfortable for you if you are afraid of needles.
• During and after your HD treatments, you may feel tired or nauseated.
• It may be difficult to plan your daily schedule around your treatment sessions.