Preparing for dialysis starts months before your first treatment, not days. The most important early steps involve creating a vascular access point for your blood, adjusting your diet, understanding your insurance coverage, and getting comfortable with the type of dialysis you’ve chosen. Each of these has its own timeline, and starting early gives you more options and better outcomes.
Choose Your Dialysis Type Early
The two main types of dialysis work differently and require different preparation. Hemodialysis filters your blood through a machine, typically at a clinic three times per week for about four hours per session. Peritoneal dialysis uses the lining of your abdomen as a natural filter, and you can do it at home, either manually during the day or with a machine overnight while you sleep.
Your nephrologist will help you decide which type fits your health and lifestyle, but it’s worth having this conversation as early as possible. The type you choose determines what kind of surgical access you’ll need, how long you’ll need to heal before starting, and whether you’ll need training.
Plan Your Vascular Access Months Ahead
If you’re starting hemodialysis, you’ll need a permanent access point where the machine connects to your bloodstream. This is the single most time-sensitive piece of preparation, and the best option takes the longest to be ready.
An AV fistula is the preferred choice. A surgeon connects an artery directly to a vein, usually in your forearm, creating a stronger blood vessel that can handle repeated needle insertions. The catch is that a fistula needs 2 to 3 months to mature before it’s usable. Before surgery, you’ll have an ultrasound of both arms to map your blood vessels. This scan measures the diameter of your arteries and veins, checks for blockages or narrowing, and identifies any anatomical variations that could change the surgical approach. The surgeon uses this map to pick the best location.
An AV graft is the next option. Instead of connecting your own vessels, the surgeon uses a synthetic tube to bridge an artery and vein. Grafts heal faster, typically ready in 2 to 3 weeks, but they don’t last as long as fistulas and are more prone to clotting.
If your kidney function declines suddenly and there’s no time for either option, a venous catheter placed in your neck or chest can serve as a temporary access for weeks or months while a fistula or graft heals. Catheters carry a higher infection risk, so they’re a bridge, not a long-term solution.
Protect the veins in your non-dominant arm starting now. Ask medical staff to draw blood and place IVs in your other arm. Damaged veins make fistula surgery harder or impossible in that location.
Peritoneal Dialysis Catheter Setup
For peritoneal dialysis, a surgeon places a permanent catheter in your abdomen, usually near your belly button, in a minor procedure. You’ll need about two to three weeks to heal before you can start treatments. During that healing period, your care team will train you on how to use the equipment, connect solution bags, and care for the catheter site to prevent infections.
Training for Home Dialysis
If you’re doing dialysis at home, whether peritoneal or hemodialysis, you’ll go through a formal training program at a certified facility. Home hemodialysis training averages 8 to 12 weeks. Peritoneal dialysis training is shorter, often completed during the catheter healing period. Your care partner, if you have one, should attend training with you. The program covers machine operation, troubleshooting, sterile technique, and recognizing signs of infection or complications.
Completing home dialysis training also has a financial benefit, covered in the insurance section below.
Adjust Your Diet Before You Start
Dietary changes for dialysis aren’t something to figure out on day one. Starting early lets you build habits gradually rather than overhauling everything at once.
The key nutrients to manage are sodium, potassium, and phosphorus, all of which your kidneys normally filter out. When they can’t keep up, these minerals build up in your blood and cause problems ranging from high blood pressure to bone disease to dangerous heart rhythms.
The general recommendation for sodium is no more than 2,300 milligrams per day, and many people with kidney disease need to go lower than that based on their individual lab work. For potassium and phosphorus, there’s no single universal limit. Your dietitian will set targets based on your blood levels. In practical terms, this often means limiting high-potassium foods like bananas, oranges, potatoes, and tomatoes, and reducing phosphorus from sources like dairy, processed foods, and dark colas.
Ask your nephrologist for a referral to a renal dietitian. They can review your current eating habits and help you build a meal plan that’s actually sustainable, not just a list of restrictions.
Learn Your Fluid Allowance
Once your kidneys produce less urine, fluid accumulates between treatments and puts strain on your heart and lungs. Your daily fluid allowance is calculated as 500 milliliters (about 2 cups) plus whatever volume of urine you still produce in 24 hours. If you’re still making 500 ml of urine per day, your total allowance is 1,000 ml. If you produce no urine, you’re limited to 500 ml.
Remember that fluid isn’t just water. Soup, ice cream, gelatin, ice cubes, and even some fruits count toward your daily total. Sucking on ice chips, chewing gum, or using a small cup can help manage thirst without blowing through your allowance.
Review Your Medications
Dialysis removes small molecules from your blood, and that includes many common medications. This means some drugs will be cleared out during treatment, making them less effective, while others that are normally processed by the kidneys can build up to dangerous levels.
Several categories of medication need adjustment or replacement. Metformin, widely used for diabetes, is contraindicated on dialysis due to the risk of lactic acidosis. Newer blood thinners like dabigatran and rivaroxaban are also contraindicated because they rely on kidney clearance. Certain pain medications, particularly codeine, should be avoided entirely. Others like gabapentin and pregabalin require large dose reductions.
The general rule for hemodialysis patients taking once-daily medications: take them after your treatment session, not before. Dialysis would otherwise strip the drug from your blood before it has time to work. Bring a complete list of every medication, supplement, and over-the-counter product you take to your nephrologist so they can adjust doses and timing before your first session.
Understand Your Insurance Coverage
Medicare covers dialysis for people with end-stage renal disease regardless of age, but there’s a waiting period. Coverage typically starts on the first day of the fourth month of dialysis treatments. If you begin dialysis on July 1, Medicare kicks in on October 1. That three-month gap matters because Medicare does not cover the preparatory surgeries (like fistula creation) that happen before your coverage begins.
There is one important exception. If you enroll in a home dialysis training program at a Medicare-certified facility during those first three months, your coverage can start as early as the first month of regular treatments. This retroactive start date can also cover the access surgery costs. If home dialysis is a possibility for you, this is worth discussing with your care team early.
If you’re covered by an employer group health plan, that plan typically pays during the first three months. After that, Medicare becomes primary and your employer plan becomes secondary. Contact both your current insurer and Medicare to understand what’s covered during the transition so you’re not caught off guard by bills for access surgery or training.
Prepare Your Mental Health
Starting dialysis is a major life change, and the emotional weight of it deserves the same attention as the medical preparation. Feelings of grief, anger, anxiety, and loss of control are common and normal. You’re adjusting to a new schedule, new physical limitations, and a treatment that will be part of your routine for the foreseeable future.
The National Kidney Foundation runs a peer mentoring program called NKF Peers, where you can speak by phone with a trained mentor who has been through dialysis themselves. Hearing from someone who’s already navigated the transition can be more reassuring than any pamphlet. They also offer NKF Cares, a support line for patients, family members, and care partners. Many dialysis centers have social workers on staff who can connect you with local counseling and support groups.
If you have a care partner, involve them in the preparation process from the beginning. They’ll have their own questions and anxieties, and the training and lifestyle adjustments affect them too.
Preparation Timeline at a Glance
- 6+ months before: Discuss dialysis type with your nephrologist, protect arm veins, get vessel mapping ultrasound
- 3 to 6 months before: Schedule AV fistula surgery, meet with a renal dietitian, begin dietary changes
- 2 to 3 months before: Allow fistula to mature, or schedule AV graft or PD catheter placement, review medications
- 1 month before: Begin home training if applicable, sort out insurance coverage details, connect with peer support
- 2 to 3 weeks before: Heal from AV graft or PD catheter surgery if recently placed