Most people with advanced kidney disease undergo hemodialysis as a treatment. It can help to know how to prepare for sessions, what side effects to expect, and what your other treatment options are.
Hemodialysis is a treatment option for advanced chronic kidney disease (CKD), which affects more than
Keep reading to learn more about hemodialysis and its role in managing advanced CKD.
Dialysis functions as the kidneys for people with advanced CKD. Hemodialysis uses an artificial kidney, or hemodialyzer, to filter your blood. Once the hemodialyzer filters your blood, the dialysis machine puts it back in your body.
It also helps regulate your electrolyte balance and your blood pressure.
The reasons for doing hemodialysis vary and depend on your particular situation. However, some of the more common factors include:
- to improve quality of life
- to improve overall health
- to address an increase in signs and symptoms of kidney failure
Hemodialysis isn’t appropriate for all situations. Doctors typically reserve it for end stage renal disease (ESRD) when your kidneys are only functioning at less than 15%.
While hemodialysis offers several benefits to people with advanced CKD, the procedure does come with some risks.
The
- hypotension (low blood pressure)
- muscle cramps
Other potential risks or side effects include:
- complications related to the access site, such as infection, reduced blood flow, or blockage
- itchy skin
- blood loss during treatment
- restlessness and confusion (especially after the first treatment)
- headache
- nausea and vomiting
Rare but serious complications may include:
- anaphylactic reactions to the hemodialyzer
- air embolism
First, a doctor will need to approve you for hemodialysis. Once cleared, you’ll need to prepare for the procedure several weeks before the first treatment. In severe cases, some people may require hospitalization and an urgent start to hemodialysis.
One critical step is to care for the blood vessels in your arms. The
Another step is to create a vascular access site. The access site is where the medical team member will place needles during each treatment.
Creating an access site requires minor surgery, typically in the arm with a fistula, which joins a vein and artery, or a graft, which uses a piece of soft tube to join a vein and artery in your arm.
In rare cases, your doctor may need to place a catheter in your neck if the access sites in your arm or leg don’t work or if you require urgent hemodialysis in a hospital setting.
While each situation is unique, here are some general things to be aware of before starting treatment, per the
- Treatment can happen in a dialysis center, hospital, or at home.
- Your doctor will set the schedule, but sessions in a treatment center generally last about 3 to 4 hours, three times per week.
- Home hemodialysis is more flexible, allowing for three to seven treatments per week at your convenience. Sessions can vary in length.
- Your blood pressure and heart rate will be monitored during each treatment.
- Some people experience mild side effects like abdominal cramps or nausea during the procedure.
A healthcare professional begins by inserting two needles at the access site. One needle allows unfiltered blood to leave the body and enter the dialyzer, and the other allows filtered blood to re-enter the body.
Once the needles are in the access site, your blood is run through a filter that acts as an artificial kidney. The filter removes excess fluid, chemicals, and waste from your blood. The machine then pumps clean blood back into your body.
You can’t move about very much while hooked up to a dialysis machine. However, you can still engage in other activities during this time, like reading, watching TV, or working on a laptop.
The results of hemodialysis often depend on the severity of the disease. You’ll generally know whether it’s working based on how you feel.
According to the
- increased energy
- better appetite
- less shortness of breath
- reduced swelling
Your medical team will monitor treatments and administer blood tests to determine how effectively the procedure removes waste from your body.
Another monitoring tool they’ll use is your weight. This will alert your team if you retain too much fluid between sessions.
Hemodialysis is a life-preserving treatment for people with ESRD, but it’s not a cure for kidney failure. While it can effectively remove waste from your blood, it can’t function like a real kidney.
If you have severe CKD or kidney failure, you’ll likely need hemodialysis for the rest of your life unless you get a kidney transplant.
Treatments are often scheduled close together, making the in-between time critical for focusing on rest, hydration, and care for the access area.
Pay attention to your diet
You may need to make some changes to your diet while on dialysis. The National Kidney Foundation (NKF) recommends limiting foods high in sodium, phosphorus, and potassium. You may also need to add more protein to your diet because hemodialysis removes this essential macronutrient.
Also, be cautious of the amount of fluid you’re consuming because fluid can build up in your body between treatments.
Your medical team may include a dietitian to help you navigate your nutritional needs while on dialysis.
Care for your access area
Caring for your access area is another important measure to take between treatments. Wash the area around it with warm water and soap every day.
You should also monitor the area for infection. Warmth and redness or other color changes may indicate a problem.
Continue taking medication
Hemodialysis requires a strict treatment schedule. It also requires following your doctor’s orders and taking any medications they have prescribed.
If you have questions about your medication or are having problems with any specific drugs, make sure to tell your doctor.
The cost of hemodialysis depends on several factors, such as your insurance status and what your plan covers.
Most U.S. adults who require dialysis qualify for Medicare, even if they’re not 65 years old. Medicare covers 80% of the cost of dialysis sessions.
The Medicare base cost for a dialysis session in 2025 is $273.82, though private insurers pay a much higher rate. A typical year includes 156 sessions.
At what stage of CKD must you start hemodialysis?
Work with your doctor to decide when to start hemodialysis. They’ll take into consideration your kidney function, symptoms, overall health, and quality of life when deciding on a start date.
A person will generally start hemodialysis when they reach stage 5 of CKD or kidney failure, according to the NKF. This is typically by the time your kidney function is around 10% to 15%.
What are the three types of dialysis?
The three main types of dialysis are:
- hemodialysis
- peritoneal dialysis
- continuous renal replacement therapy (only in intensive care units in hospitals)
How does hemodialysis compare to other types of dialysis?
According to the NKF, all types of dialysis are equally effective. What matters most are the specifics of your condition and your personal preferences.
Work with your doctor to determine which dialysis mode is best for you. If you’re not satisfied with one, you can always switch to a different one later.
Hemodialysis is an important treatment option for people with advanced CKD. While it’s not the same as having a real kidney, it effectively filters waste from your blood and helps regulate your electrolyte balance and blood pressure.
Though effective and life-sustaining, hemodialysis is time consuming and may have several side effects. You’ll also need to adjust your diet and make other lifestyle changes. Talk with your doctor about steps you need to take to ensure hemodialysis is a successful treatment option for your advanced CKD.