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Hemodialysis Explained

Hemodialysis

In hemodialysis, your blood flows through a special filter that removes wastes and extra fluids. The clean blood is then returned to your body. Removing the harmful wastes and extra salt and fluids helps control your blood pressure and keep the proper balance of chemicals like potassium and sodium in your body.

Hemodialysis Options

  • In Center-hemodialysis
  • Home hemodialysis (at home with the direction of a local dialysis center.)
  • Nocturnal dialysis (done in center and at home)
  • In-Center self-care dialysis

Hemodialysis Access Choices

  • Fistula – A type of vascular access that is created by connecting one of the arteries to one of the veins in the lower arm. A fistula is the most effective type of dialysis access.
  • Graft – A type of vascular access that uses a piece of synthetic tubing sewn between an artery and a vein if a fistula is not available.
  • Hemodialysis Catheter – Though typically not used for permanent access, a hemodialysis catheter may be used temporarily if kidney disease has progressed quickly and other access has not been obtained. In this case, a catheter is placed in a vein in the neck (jugular vein), chest (subclavian vein), or leg (femoral vein). Dialysis catheters are also used for patients needing dialysis while their permanent access develops.

In-Center Hemodialysis

Example of an In-Center Dialysis Clinic

Benefits of In-Center Hemodialysis:

  • Professional Monitoring:
    • Trained staff monitor your treatment, ensuring safety and quick response to any issues.
    • Dialysis staff manage the setup, operation, and maintenance of the dialysis machine.
  • Social Interaction:
    • Opportunities to meet and interact with other patients undergoing dialysis.
    • Provides a sense of community and support.
  • Regular Schedule:
    • Fixed treatment times (typically 3 sessions per week, 3–5 hours per session) help establish a routine. Consistency can help with planning other aspects of life.
  • No Equipment Responsibility:
    • Patients do not need to store, maintain, or troubleshoot dialysis equipment or supplies at home.
  • Reduced Home Burden:
    • No need to create a sterile environment or learn complex medical procedures.
    • Ideal for those who cannot or prefer not to manage their treatment independently.

Considerations for In-Center Hemodialysis:

  • Time Commitment:
    • Traveling to and from the dialysis center and spending hours there can be time-consuming.
    • Limits flexibility in daily scheduling.
  • Transportation Challenges:
    • Patients may need reliable transportation, which can be difficult for those in rural or underserved areas.
  • Physical Strain:
    • Some patients experience fatigue, low blood pressure, or cramping after treatment due to the rapid fluid and toxin removal.
  • Dietary and Fluid Restrictions:
    • Patients often need to follow strict dietary guidelines and limit fluid intake to avoid complications between treatments.
  • Risk of Infection:
    • Frequent use of vascular access (e.g., fistula, graft, or catheter) increases the risk of infection and other complications.
  • Less Freedom:
    • Fixed treatment times can limit flexibility in work, travel, or other activities.
  • Limited Kidney-Like Function:
    • Toxins and fluids are removed intermittently, leading to fluctuations in symptoms and energy levels compared to continuous methods like peritoneal dialysis.

      Suitability:

      In-center hemodialysis is well-suited for people who:

      • Require medical supervision due to other health conditions.
      • Are uncomfortable with or unable to manage home dialysis.
      • Prefer structured treatment schedules and professional oversight.

Home Hemodialysis

RSN Founder & President on Home Hemodialysis prior to her fourth kidney trnaplant

Benefits of Home Hemodialysis:

  • Increased Flexibility:
    • You can schedule treatments at your convenience, often during the times when you feel the best, allowing for greater flexibility in your daily life.
  • Improved Quality of Life:
    • Home dialysis allows you to have fewer restrictions on your activities and avoid long hours at a dialysis center, leading to a better overall quality of life.
  • Better Health Outcomes:
    • Studies suggest that home hemodialysis can lead to better health outcomes, including improved fluid and toxin removal, lower blood pressure, and fewer hospitalizations.
  • More Control:
    • Home dialysis offers a sense of control over the process, from the treatment schedule to the machine settings, empowering individuals to be actively involved in their care.
  • Reduced Travel and Waiting Time:
    • Avoiding travel to and from a dialysis center eliminates the need for transportation, long wait times, and the emotional toll of frequent visits to a clinic.

Considerations for Home Hemodialysis:

  • Training and Support:
    • You or a caregiver must undergo extensive training to learn how to properly operate the dialysis machine, manage supplies, and handle emergencies. This may require a commitment of several weeks.
  • Space Requirements:
    • You need a clean, dedicated space in your home to store supplies, set up the dialysis machine, and perform treatments. This may be a challenge for those with limited space.
  • Commitment and Responsibility:
    • Home hemodialysis requires a higher level of responsibility, as you are managing your treatment on a regular basis. This can be physically and emotionally demanding, particularly if you experience complications or health changes.
  • Caregiver Involvement:
    • You may need a caregiver to help with treatments, especially if you are not able to perform the process independently. This can be challenging for both the patient and the caregiver.
  • Emergency Preparedness:
    • You must have a plan for emergencies, including access to medical support if something goes wrong during treatment, as well as knowing how to handle unexpected issues with the dialysis equipment.

Suitability

Home hemodialysis is well-suited for people who:

  • Are willing and able to commit to regular treatments, learn to operate the equipment, and follow strict protocols.
  • Have a clean, suitable space for dialysis equipment and supplies available at home.
  • Are physically and emotionally ready for the responsibility that comes with home dialysis.

Notice, this video is NOT for training, the intent is to share the patient experience only!

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