Infusion therapy and kidney disease

Is infusion therapy the same as dialysis and IV hydration?

No, infusion therapy is not the same thing as dialysis.  Infusion therapy is when you get medicine, fluids or nutrients delivered directly into your bloodstream through a needle or catheter, while dialysis is a procedure that filters waste and extra fluid from your blood when your kidneys can't. Infusion therapy does not clean your blood or replace kidney function the way dialysis does. Some people with kidney disease may need both dialysis and infusion therapy depending on their treatment plan.

IV hydration is a type of infusion therapy that gives fluids through an IV. It may be used in some medical situations to treat dehydration or replace fluids. Wellness drips or IV Vitamin therapy are forms of IV hydration and are sometimes advertised for providing energy, vitamins or general wellness to help target specific health goals. It's important to note that these are not the same as kidney-care infusions and if you have kidney disease, extra fluids, vitamins or minerals may not be safe for you. Always talk to your doctor before starting any new medicines or treatments.  
 

Why might someone with kidney disease need infusion therapy?

Your doctor may recommend infusion therapy for:

• Anemia, a condition where your blood does not have enough healthy red blood cells to carry oxygen throughout your body 
• Low iron when iron pills are not enough or are not a good option
• Autoimmune or inflammatory diseases that affect the kidneys, such as lupus nephritis and vasculitis
• Certain rare kidney diseases, such as atypical hemolytic uremic syndrome, also called aHUS
• Kidney-related conditions or complications like IgA nephropathy or gout
• Certain medicines  after a kidney transplant, such as immunosuppressants or anti-rejection medicines to help protect your new kidney
• Specific medical situation where you may need fluids or nutrients
• Infections or other complications

The type of infusion you need will depend on your diagnosis, lab results, symptoms and overall treatment plan.

Benefits of infusion therapy may include:

• Helping medicine work faster because it goes directly into your bloodstream
• Giving a higher or more controlled amount of medicine when needed
• Providing medicines, fluids or nutrients that cannot be taken by mouth
• Allowing your care team to monitor you during treatment
• Supporting long-term treatment plans for some conditions

What types of infusion therapy are used in kidney disease care?

Different types of infusion therapy may be used in kidney disease care, depending on the cause of your kidney disease and what your doctor is trying to treat.

These may include:

• Iron infusions: Iron infusions may be used to treat low iron or anemia related to kidney disease. Anemia happens when your body does not have enough healthy red blood cells to carry oxygen well.
• Immunosuppressive infusions: Immunosuppressive medicines lower the immune system's (your body's defense system) activity. After a kidney transplant, some people may receive an infusion medicine to help prevent rejection  and protect their new kidney.
• IV antibiotics: IV antibiotics may be used to treat serious infections or infections that cannot be treated with pills. Some people may need IV antibiotics after a transplant, during a hospital stay or when an infection needs close monitoring.
• Some medicines target specific parts of the immune system. These may be used for autoimmune or inflammatory diseases that affect the kidneys, such as lupus nephritis or vasculitis.  Rare kidney diseases may also need specialized infusion medicines.
• IV fluids or nutrients: IV fluids or nutrients may be used in specific medical situations, such as dehydration and trouble eating or drinking. If you have kidney disease, extra fluids may not be safe for you, so these treatments should be managed by your care team.
   

Where can I get infusion therapy?

You may receive infusion therapy in a hospital, outpatient infusion center, doctor's office, stand-alone infusion center or sometimes at home.

Where you get your infusion may depend on:

• The medicine you need
• Your insurance coverage
• Your health needs
• Your risk for side effects
• How closely you need to be monitored during treatment

Some people with kidney failure or a higher risk of complications may need infusions in a clinic to allow health care professionals to watch them more closely.

Your infusion schedule will depend on the medicine you are getting, your condition and how your body responds to treatment. Some infusions are given one time while others may happen weekly, monthly, every few months or on another schedule. Your care team should explain what medicine you are getting, why you need it and what to expect.

Infusion care team

Your infusion care team may include: 

• Infusion Nurses
• Nephrologist (kidney doctor)
• Pharmacists
• Medical assistants 
• Other trained health care professionals and support staff, including patient navigators or coordinators, social workers  

Depending on your treatment, your kidney doctor or another specialist may order the infusion, while the infusion center team gives the medicine and monitors you during the appointment.

What to bring to an infusion appointment?

Your infusion center will tell you if there is anything specific you need to bring. In general, it may help to bring:

• Photo ID
• Insurance card
• A list of your medicines and supplements
• A list of allergies
• Any forms your infusion center asked you to bring
• Water or a snack, if allowed
• Items to keep you busy: Phone, laptop or tablet (andchargers), headphones, book or an activity, such as knitting or crochet.
• A support person or ride home, if recommended by your care team
• Items to keep you comfortable: A blanket and  comfortable, loose-fitting clothes that allow your care team to easily reach your arms. 
  • Consider dressing in layers or bringing a blanket because some people feel cold during an infusion.
    If your appointment may take several hours, ask ahead of time whether you can eat, drink or take breaks during treatment.

What happens before an infusion treatment?

Before an infusion, your care team may review your health history and current medicines. They may also ask about allergies or past reactions to medicines. They may check your blood pressure, temperature and other vital signs. Before your infusion begins, your care team may give you medicines called premedications or medicines you take before your infusion that help reduce the risk of side effects.

Your care team may tell you:

• How long the infusion may take
• Whether you can eat or drink before the appointment
• Whether you should take your usual medicines
• Whether you need someone to drive you home
• What side effects to watch for

What should I tell my infusion care team?

Tell your care team anything that could affect your treatment. Even small details may matter. Before your infusion, tell your care team if you have a preference for which arm or area they use to place your IV.

Before your infusion, tell your care team if you:

• Have had a past reaction to an infusion
• Have allergies
• Are pregnant, planning pregnancy or breastfeeding
• Have an infection, fever or recent illness
• Recently had a vaccine or plan to get one
• Are on dialysis
• Have heart failure, high blood pressure, swelling or shortness of breath
• Have changes in urination
• Take blood thinners
• Take immune-suppressing medicines
• Started any new medicines, vitamins or supplements

If you are not sure whether something matters, it is still a good idea to mention it.
 

What happens during an infusion treatment?

During an infusion treatment, a nurse or trained health care professional places an IV, usually in a vein in your arm or hand. The medicine, fluid or nutrients then goes through the IV into your bloodstream. The infusion may take a few minutes or several hours, depending on the treatment. The nurse will also check for infusion reactions.

It is very important to let them know right away if you start to feel any of the following symptoms:

• Out of breath or having difficulty breathing
• Tightness in your chest
• Dizzy or lightheaded
• Feel hot or flushed
• A headache or muscle aches
• Pain or stinging around the IV area  

How is the IV placed?

A nurse or trained health care professional places a small IV in a vein, usually in your arm or hand. You may feel a quick pinch or sting when the IV is placed. It is normal to feel nervous or scared before getting an IV placed. Your care team will usually follow these steps: 

1. A nurse or trained health care professional will place a band around your upper arm.
2. They will clean the area where the IV will be placed.
3. They use a needle to place the IV into a vein. You may feel mild discomfort, such as a quick pinch or sting, when the IV is placed.
4. After the IV is placed, the needle is removed, and a small, flexible tube stays in your vein.

Some people who need repeated infusions may need a longer-term IV line. This may make it easier to receive treatment over time. Your care team will explain what type of IV access you need and how to care for it.

Some people are asked to stay for a short time after the infusion. This allows the care team to watch for side effects or reactions. 

What are the possible risks and side effects?

The side effects you may have depend on the medicine or treatment you receive. Some side effects happen during the infusion, while other reactions can happen hours to days from when the infusion was done. Some side effects are common and may go away on their own. 

Tell your healthcare team if your side effects do not go away or if they get worse. 

Some things to look out for include:

• Pain, bruising, or swelling where the IV was placed
• Headache
• Nausea
• Tiredness

Call your healthcare team if you have:

• Dizziness
• Fever or chills
• Rash or itching
• Redness, warmth, swelling, drainage, or pain at the IV site

Call 911 or get emergency help right away if you have:

• Trouble breathing
• Swelling of the face, lips, tongue, or throat
• Severe dizziness or fainting
• Signs of fluid overload, such as trouble breathing, sudden swelling (in your feet, ankles, legs, or belly), chest tightness or feel like your heart is beating faster than usual.

Safety considerations for people with kidney disease

People with kidney disease may need extra care with infusion therapy. Some IV medicines or fluids may also affect kidney function or electrolyte levels. Electrolytes are minerals in your blood, such as sodium and potassium, that help your body work properly.

Tell your care team if you have:

• Swelling in your legs, feet, hands or face
• Shortness of breath
• Low urine output
• Heart failure
• High blood pressure
• Dialysis treatments
• Recent changes in your kidney function or lab results

Talk to your doctor before getting any IV fluids, IV hydration or vitamin drips outside your treatment plan.

Will insurance cover infusion therapy?

Insurance coverage depends on your health plan, diagnosis, medicine and where the infusion happens. Some insurance plans may require prior authorization before treatment.

Some drug manufacturers offer patient assistance programs for people who qualify. Ask your doctor's office, infusion center or insurance plan whether there are programs that may help with costs.

Learn more about insurance for kidney health

Learn more about patient assistance programs
 

Questions to ask your doctor or infusion care team

It is okay to ask questions before starting infusion therapy. You deserve to understand what treatment you are getting and why.

You may want to ask:

• Why do I need infusion therapy?
• What medicine or treatment am I getting?
• How does this treatment help my kidney disease or related condition?
• How often will I need infusions?
• What side effects should I watch for?
• Will I need premedication before my infusion?
• Can I eat, drink and take my usual medicines before the infusion?
• Will this treatment affect my dialysis schedule, transplant medicines or other kidney care?

You can also bring a family member, friend or caregiver to help you take notes, if your infusion center allows it.