In hemodialysis, a machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately. Hemodialysis is one way to treat advanced kidney failure and can help you carry on an active life despite failing kidneys.
With hemodialysis, you'll need to:
- Follow a strict treatment schedule
- Take medications regularly
- Make changes in your diet
Hemodialysis is a serious responsibility, but you don't have to shoulder it alone. You'll work closely with your health care team, including a kidney specialist and other professionals with experience managing hemodialysis. You may be able to do hemodialysis at home.
Why it's done
Your doctor will help determine when you should start hemodialysis based on several factors, including your:
- Overall health
- Kidney function
- Signs and symptoms
- Quality of life
- Personal preferences
You might notice signs and symptoms of kidney failure (uremia), such as nausea, vomiting, swelling or fatigue. Your doctor uses your estimated glomerular filtration rate (eGFR) to measure your level of kidney function. Your eGFR is calculated using your blood creatinine test results, sex, age and other factors. A normal value varies with age. This measure of your kidney function can help to plan your treatment, including when to start hemodialysis.
Hemodialysis can help your body control blood pressure and maintain the proper balance of fluid and various minerals — such as potassium and sodium — in your body. Normally, hemodialysis begins well before your kidneys have shut down to the point of causing life-threatening complications.
Common causes of kidney failure include:
- High blood pressure (hypertension)
- Kidney inflammation (glomerulonephritis)
- Blood vessel inflammation (vasculitis)
- Kidney cysts (polycystic kidney disease)
However, your kidneys may shut down suddenly (acute kidney injury) after a severe illness, complicated surgery, heart attack or other serious problem. Certain medications also can cause kidney injury.
Some people with severe long-standing (chronic) kidney failure may opt for a different path, choosing maximal medical therapy, also called maximum conservative management, instead of dialysis. This therapy involves active management of complications of advanced chronic kidney disease, such as fluid overload, high blood pressure and anemia, with a focus on supportive management of symptoms that affect quality of life.
Others may be candidates for a preemptive kidney transplant, instead of starting on dialysis. Ask your health care team for more information about your options. This is an individualized decision because benefits of dialysis may vary, depending on your particular health issues.
Risks Of Hemodialysis
Most people who require hemodialysis have a variety of health problems. Hemodialysis prolongs life for many people, but life expectancy for people who need it is still less than that of the general population.
While hemodialysis treatment can be efficient at replacing some of the kidney's lost functions, you may experience some of the related conditions listed below, although not everyone experiences all of these issues. Your dialysis team can help you deal with them.
- Low blood pressure (hypotension). A drop in blood pressure is a common side effect of hemodialysis, particularly if you have diabetes. Low blood pressure may be accompanied by shortness of breath, abdominal cramps, muscle cramps, nausea or vomiting.
- Muscle cramps. Although the cause is not clear, muscle cramps during hemodialysis are common. Sometimes the cramps can be eased by adjusting the hemodialysis prescription. Adjusting fluid and sodium intake between hemodialysis treatments also may help prevent symptoms during treatments.
- Itching. Many people who undergo hemodialysis have itchy skin, which is often worse during or just after the procedure.
- Sleep problems. People receiving hemodialysis often have trouble sleeping, sometimes because of breaks in breathing during sleep (sleep apnea) or because of aching, uncomfortable or restless legs.
- Anemia. Not having enough red blood cells in your blood (anemia) is a common complication of kidney failure and hemodialysis. Failing kidneys reduce production of a hormone called erythropoietin (uh-rith-roe-POI-uh-tin), which stimulates formation of red blood cells. Diet restrictions, poor absorption of iron, frequent blood tests, or removal of iron and vitamins by hemodialysis also can contribute to anemia.
- Bone diseases. If your damaged kidneys are no longer able to process vitamin D, which helps you absorb calcium, your bones may weaken. In addition, overproduction of parathyroid hormone — a common complication of kidney failure — can release calcium from your bones.
- High blood pressure (hypertension). If you consume too much salt or drink too much fluid, your high blood pressure is likely to get worse and lead to heart problems or strokes.
- Fluid overload. Since fluid is removed from your body during hemodialysis, drinking more fluids than recommended between hemodialysis treatments may cause life-threatening complications, such as heart failure or fluid accumulation in your lungs (pulmonary edema).
- Inflammation of the membrane surrounding the heart (pericarditis). Insufficient hemodialysis can lead to inflammation of the membrane surrounding your heart, which can interfere with your heart's ability to pump blood to the rest of your body.
- High potassium levels (hyperkalemia). Potassium is a mineral that is normally removed from your body by your kidneys. If you consume more potassium than recommended, your potassium level may become too high. In severe cases, too much potassium can cause your heart to stop.
- Access site complications. Potentially dangerous complications ― such as infection, narrowing or ballooning of the blood vessel wall (aneurysm), or blockage ― can impact the quality of your hemodialysis. Follow your dialysis team's instructions on how to check for changes in your access site that may indicate a problem.
- Amyloidosis. Dialysis-related amyloidosis develops when proteins in blood are deposited on joints and tendons, causing pain, stiffness and fluid in the joints. The condition is more common in people who have undergone hemodialysis for more than five years.
- Depression. Changes in mood are common in people with kidney failure. If you experience depression or anxiety after starting hemodialysis, talk with your health care team about effective treatment options.