One treatment for kidney failure is called hemodialysis, or “hemo” for short. This type of treatment uses a machine to clean your blood.
Hemodialysis does some of the work that your kidneys did when they were healthy. During treatment, your blood travels through tubes from your body into the dialysis machine. While your blood is in the machine, it goes through a filter called a dialyzer, which removes waste and extra fluid. Once it has been cleaned, the blood travels through tubes from the dialysis machine back into your body.
Before you can begin hemodialysis, you will need a vascular access. This is an area on your body where two needles will be inserted before each dialysis session to allow your blood to flow in and out of your body. Your blood will flow through one needle from your vascular access to the dialysis machine, and then and from the dialysis machine back to your body through the other needle.
There are two types of vascular access that are best for dialysis. Work with your doctor to figure out which one is best for you.
The AV fistula is the safest and most reliable type of vascular access. AV stands for arteriovenous. An AV fistula is a connection between an artery (a large blood vessel that carries blood from your heart) and a vein (a blood vessel that carries blood to your heart). In order to make an AV fistula in your body, you will need to have a minor surgery to connect your artery to your vein. This is most often done in your non-dominant arm. For example, if you are right-handed, you would probably get your fistula in your left arm.
Once the artery and vein are connected, more blood is able to flow through the fistula. After two to three months, the fistula will be stronger than a normal artery or vein, and will be able to withstand having needles put in and taken out many times per week. Because the fistula needs time to heal and become strong, it is best to get an AV fistula two to three months before you need to start dialysis.
An AV graft is the next best vascular access option. Instead of connecting your artery directly to your vein, an AV graft uses a plastic tube to connect the artery and vein inside your body. Like an AV fistula, the AV graft is made by a doctor during a minor surgery. An AV graft is usually ready to be used in just two to three weeks. However, AV grafts are more likely to have problems with infections and blood clots. You must take good care of your AV graft to make it usable for as long as possible.
Other vascular access options
If you find out your kidneys are failing and you need to start dialysis right away, your doctor may recommend that you get a venous catheter. A venous catheter might be used if you have acute kidney failure or if there is not enough time to get an AV fistula or AV graft before you need to start dialysis. A venous catheter is a tube that is inserted into a vein in your neck, chest or leg and hangs outside your body from an opening in your skin. Catheters often have problems with infection, blood clots and scarring. Therefore, this type of vascular access should only be used for short periods of time.
If you cannot get an AV fistula or AV graft, your doctor might recommend that you get a tunneled catheter. This type of catheter is a tube that goes under your skin and connects to a large vein deeper inside your body. It can be used for longer periods of time than a normal venous catheter. A tunneled catheter is safer than a regular venous catheter, but still has problems with infections and blood clots more often than AV fistulas and AV grafts.
Caring for your vascular access
Because your vascular access allows you to get the treatment you need, you might call it your “lifeline.” It is important to take care of it to protect your health and to make sure your access is useful as long as possible.
Dialysis helps to remove water and waste from your blood. Because your kidneys are not functioning well, your body may hold onto extra water between dialysis sessions. Your target weight (sometimes called dry weight) is what you should weigh after you have finished each dialysis treatment. Your doctor will work with you to figure out your target weight.
Keeping track of your weight is a good way to know if your body is holding on to too much water. If you are on hemodialysis, you should weigh yourself every morning and contact your doctor if you weight is suddenly much higher or lower than normal. You can help prevent extra water weight by limiting how much sodium (salt) and fluid (water and other liquids) you take in between dialysis sessions. Doing this will also help prevent problems during and after your dialysis sessions.
Choosing a hemodialysis treatment plan
If you choose to have hemodialysis, you may do your treatments in a dialysis center or at home, during the day or at night. Learn more.
Things to consider when choosing a hemodialysis treatment plan
When you are deciding whether you want to do hemodialysis and what schedule is best for you, it is important to consider how the treatment will fit with your lifestyle. You know yourself and your daily routine. Taking your personality, strengths and weaknesses into account when choosing your treatment plan can help you be successful with the plan you choose.
Some types of hemodialysis treatment come with more limits on what and how much you can eat and drink. You know yourself and your habits better than anyone. Think about whether you will be able to manage a diet with strict limits on certain foods and drinks. If you know you like to “cheat” on your diet, a treatment plan that requires such limits might not be right for you. Work with your doctor and your dietitian to choose a treatment plan that fits best with your lifestyle and personality.
Some people like to or need to keep working or going to school while on dialysis. Some treatment schedules allow for more flexibility during work or school hours. Talk with your doctor and social worker about what treatment would work best for you and your daytime schedule.
If you travel often, you can still do hemodialysis, but you need to plan for it. If you choose in-center hemodialysis, you can do your treatment sessions at a dialysis center in the city you’re visiting. If you do any type of home hemodialysis, you can bring your dialysis machine with you on your trip. Remember that you will need a trained care partner to help you with each treatment. Talk to your doctor and your social worker about ways to have dialysis while traveling and what type of dialysis schedule would be best for you if you travel often.
Finances and insurance
Medicare, Medicaid and many private insurance plans cover most of the costs of dialysis. Most people on dialysis are able to get Medicare coverage, no matter their age. However, depending on the type of treatment you choose, you may have to wait a few months before insurance coverage begins. You may also need to pay deductibles or co-pays. Check with your insurance company to learn more about your coverage. Your social worker can also help answer questions.
Get to know your dialysis care team
Think of everyone who helps to care for you as part of a team. You are the team captain, and your dialysis care team members all play different supporting roles to help you achieve your health goals. Use the information here to learn what each team member does to help you through dialysis. Communication between team members is the key to success!
Your nephrologist is your kidney doctor. He or she can answer any questions you have about treatment options, medicines and how to care for your kidneys. You will meet with your nephrologist often to check on your kidney health and make any necessary changes to your care plan. If you have a kidney transplant, you will still see a nephrologist to make sure your new kidney stays healthy.
Nurse practitioner or physician assistant
You may have a nurse practitioner (NP), physician assistant (PA) or both on your care team. NPs and PAs have additional training in kidney care beyond what a nephrology nurse has. NPs and PAs work with closely with the nephrologist and the nephrology nurses. They may prescribe medicines, order tests and examine you.
The nephrology nurse is a registered nurse who is trained to take care of kidney patients. You will see nephrology nurses in your doctor’s office and in your dialysis center. If you choose to have in-center dialysis, you will see your nephrology nurses at every dialysis session. Your nurse will make sure that you are getting the right medicines every day and that you are getting your dialysis treatments correctly. If you choose to do your dialysis at home, a nephrology nurse will teach you how to do it. Even if you choose to do your dialysis at home, you may contact a nurse about any questions you have or help you need.
Your renal dietitian can help you meet your specific and unique nutrition needs. You may have already had to adjust your diet to control the amount of fluid, protein and certain vitamins and minerals in your blood. When you are on dialysis, your renal dietitian will help you understand what foods and drinks are healthy for you and which ones are not. He or she will also help you plan how much of each nutrient you should eat per day.
Nephrology social worker
Your social worker will support you in many ways as you go through dialysis. Social workers provide emotional support to you and your family, help you communicate your needs to the other members of your care team and help you find resources to improve your quality of life. If you need to stop working, for example, your social worker can help you apply for financial assistance programs. He or she can also help you get health insurance or keep it if you already have it.
The dialysis technicians are responsible for starting your dialysis treatment at each session, watching to make sure everything is going well during your treatment and ending your treatment when it is finished. They also make sure the dialysis machines are ready and working correctly for each patient. If you are on peritoneal dialysis or home hemodialysis, the dialysis technicians will make sure you have all of the supplies you need to do your dialysis treatments.
Vascular Access Team
If you are on hemodialysis, either at home or in-center, a vascular access team will perform the surgery to insert your vascular access that will connect you to the dialysis machine. Vascular access teams usually include a surgeon, a radiologist (a doctor who reads X-rays and other body scans), and a vascular access coordinator. The coordinator will work with you to review your medical history and make sure you get the right kind of vascular access for your treatment plans.