Dialysis is a life-sustaining treatment for individuals whose kidneys can no longer effectively filter waste and fluid from the blood. Starting this therapy marks a significant transition, and it is natural to have questions about the process. This article addresses the practical aspects of beginning dialysis, preparing you for your first treatment and the lifestyle changes that follow.
Understanding Your Dialysis Options
When kidney failure progresses, two primary methods of dialysis are available to replace the kidney’s filtering function. The most common choice is hemodialysis (HD), which uses an external machine to clean the blood. This process typically requires visiting a clinic or center for treatment three times a week. Each in-center session generally lasts about three to four hours, and the fixed schedule means less flexibility in daily life.
The alternative is peritoneal dialysis (PD), a treatment that utilizes the natural lining of the abdomen, the peritoneum, as an internal filter. PD offers greater flexibility because it is a home-based therapy performed without traveling to a clinic. Treatment is done daily, either manually throughout the day with short exchanges or overnight using an automated cycling machine. PD often means a gentler, more continuous form of filtration, but it requires patient training and dedication to perform the process correctly.
Establishing Treatment Access
Before dialysis can begin, a specific access point must be established to efficiently connect to the filtration process. For hemodialysis, this involves creating a vascular access to handle the high volume of blood flow needed for the machine. The preferred method is an arteriovenous (AV) fistula, a surgical connection between an artery and a vein, most often in the arm. While associated with the lowest rates of infection, an AV fistula requires several months, typically six to nine, to mature enough for repeated needle insertion.
If a fistula is not possible or access is needed sooner, an AV graft may be placed, using a synthetic tube to connect the artery and vein. Grafts can usually be used within two to eight weeks after placement, offering a quicker option. For urgent, immediate dialysis, a central venous catheter (CVC) is placed in a large vein, often in the neck or chest. This method carries the highest risk of infection and is usually a temporary solution, while PD requires the surgical placement of a soft, flexible catheter into the abdomen for fluid infusion and drainage.
The Experience of a Dialysis Session
For in-center hemodialysis, the session begins when two needles are placed into the vascular access point to draw blood out and return the cleaned blood. Patients are seated in a comfortable chair in the clinic environment, and the process of filtering the entire blood volume takes between three and four hours. During the treatment, blood pressure and heart rate are monitored frequently, as removing fluid can cause fluctuations.
Common physical sensations during hemodialysis include muscle cramps, particularly in the legs, and low blood pressure, which can cause dizziness or nausea. These side effects are often related to the speed or volume of fluid removal, and communicating discomfort to the nursing staff allows for machine adjustments. Fatigue is also widely reported during or immediately after a session, often requiring patients several hours to recover their energy.
The experience of peritoneal dialysis is significantly different, as it does not involve needles or an external blood circuit. During a manual PD exchange, a sterile dialysate solution flows into the abdominal cavity through the catheter, a process called filling. The fluid remains, or “dwells,” inside the abdomen for a prescribed time, where the peritoneum acts as the filter, absorbing waste and excess fluid.
The final step is draining the used solution from the abdomen, and the entire exchange process takes about 30 to 40 minutes. A common complaint with PD is a feeling of fullness or bloating due to the fluid in the abdominal cavity, and there is a risk of infection at the catheter site if sterile procedures are not followed.
Managing Life Around Treatment
Integrating dialysis into life involves managing dietary and fluid intake to keep waste products and fluid volume in check between treatments. Since the kidneys can no longer regulate mineral levels, a kidney-friendly diet often requires limiting potassium, which can lead to dangerous heart rhythms. Phosphorus is another mineral that must be managed, as high levels can weaken bones, often requiring patients to take binder medications with meals to control absorption.
Controlling fluid intake is a major challenge for many patients, as drinking too much fluid between sessions can cause swelling, high blood pressure, and strain on the heart. Most in-center hemodialysis patients are asked to limit their total daily fluid consumption, often to 32 ounces or less, depending on residual kidney function. Small, practical changes like using smaller cups, sucking on hard candy, or chewing gum can help manage thirst throughout the day.