What Is Dialysis?
Dialysis does not improve your kidney function but instead replaces the functions that your kidney used to perform. For this reason, a dialysis machine is sometimes also called an artificial kidney.
Dialysis treatments are vital for people with chronic kidney disease (CKD) who are near kidney failure or end-stage kidney disease. Dialysis can also help people who have had an acute kidney injury and may only need short-term treatment.
Dialysis will do everything your kidneys used to do, including:
- Manage your electrolytes.
- Help control your blood pressure.
- Remove extra fluid from your blood.
- Remove toxins from your body that your kidneys used to remove.
How Does Dialysis Work?
There are two basic forms of dialysis: hemodialysis and peritoneal dialysis, and both can accomplish the same goals.
During hemodialysis, you or a member of your care team will connect you to a dialysis machine, which will pull blood out of your body, clean the blood, and then return the cleaned blood to your body. The “cleaning" process replaces what your kidney used to do, and the machine does this by using an artificial membrane called a dialyzer. The machine is used for three to four hours at a time, three to four times per week, either at your home or in a dialysis clinic.
During peritoneal dialysis, instead of using an artificial membrane called a dialyzer, we use a membrane from your own body called the peritoneum, which is a sac located behind your abdominal muscles and in front of your intestines. This sac is filled with clean fluid, and then toxins from your body gradually flow into the clean fluid. A few hours later, the fluid that contains toxins is drained from the peritoneal sac, which removes the toxins from your body. The peritoneal sac is filled with clean fluid and the process repeats itself. This is done four or five times per day or can be done with a machine overnight while you sleep.
Where do I go for dialysis treatment?
You have dialysis treatment in a clinic or at your home. Your doctor and treatment team will discuss these options with you.
Which one you choose will depend largely on what works best with your schedule and makes you feel the best.
Hemodialysis in the clinic. Most people on dialysis go to a clinic three times a week for 4 hours. You will be in a large, open room with a number of other people.
Hemodialysis at home. There's a growing preference for doing hemodialysis at home. The sessions will be shorter but are performed more often than three times per week.
Peritoneal dialysis at home. This can either be done with four to five exchanges of fluid every day or by using a peritoneal dialysis machine every night, which drains old fluid and fills your peritoneum with clean fluid multiple times as you sleep.
Dialysis Risks and Benefits
Our first goal will be to provide medical therapy to help you avoid dialysis, or to have a kidney transplant instead of needing dialysis. However, if you reach stage 5 CKD and develop symptoms or electrolyte emergencies then you and your doctor will need to discuss the risks and benefits of starting dialysis.
Many people do well on dialysis. Those that do, often:
- Feel healthier
- Return to jobs, hobbies, and other passions
- Live longer lives
But dialysis isn't for everyone. Dialysis can cause physical strain on the body, and there's a lot of evidence that certain people won't benefit from dialysis or may suffer more severe complications.
Your doctor may caution against dialysis if you:
- Are over 80 years old.
- Have other serious conditions, such as advanced heart failure or cancer.
- Talk with your doctor about your goals for treatment and how you want to live your life.
Dialysis may not be the best way to meet your goals.
For those who don't want dialysis treatment, the UPMC Kidney Disease Center has world-renowned experts in conservative methods for treating CKD.
Conditions We Treat with Dialysis
The most common conditions we treat with dialysis are:
How to Prepare for Dialysis
Early in the course of CKD, we discuss the options of hemodialysis, peritoneal dialysis, kidney transplantation, and conservative care (no dialysis). We may even talk to you about these options during your first appointment. Many people don't want to talk about any form of dialysis, and we understand that the topic is not joyful, but we encourage everyone to make plans so that they can choose which option is best for them. The risk of delaying the decision too late is that, eventually, kidney toxins will make your thinking clouded and can interfere with making a decision.
Steps to help you prepare for end-stage kidney disease may include:
- Meeting with a nurse educator to discuss the types of dialysis and how each works.
- Meeting with a surgeon to talk about having dialysis access placed.
- Ongoing discussions with your kidney doctor about signs that dialysis could help you, and whether or not you would prefer conservative care with no dialysis.
- Visiting a dialysis clinic to get comfortable with the treatment options.
As your kidney function declines, you'll meet with your kidney doctor more often and learn more about dialysis. We want you to feel at ease and very satisfied with the plans you have made.
What To Expect During Dialysis Treatment
What to expect during dialysis depends on what type you choose. Most people receive in-clinic hemodialysis.
If you choose hemodialysis in a dialysis clinic, you will:
- Have a comfortable recliner to sit in during treatment.
- Be in a large open space, with a number of other people having dialysis.
- See dialysis nurses and technicians rotating the floor, helping you with your care.
- Meet with a health care provider once a week, and your kidney doctor once a month.
- Spend about three to four hours on the dialysis machine each time and come to dialysis three times per week. Most people use this time to watch a movie, read a book, or take a nap.
What to expect with at-home dialysis
During home dialysis, you have more privacy, but also need to:
- Learn how to use and maintain the dialyzer.
- Learn how to use the needle or dialysis catheter yourself.
- Go to your monthly follow-up appointments with your kidney doctor.
During dialysis, some people notice that they get cold. This can happen because your blood may cool slightly in the dialyzer.
You should not feel any other physical sensations during treatment.
Tell your nurse or doctor right away if you do feel any:
The recovery time varies from person to person and is based on the type of dialysis.
Hemodialysis can be thought of as a workout. It takes 48 to 72 hours of kidney function and squeezes it into just three or four hours.
If you're doing in-clinic hemodialysis, you may have a tired or “washed out" feeling after treatment. This will be most intense for about an hour or two after you're done. Some people may not feel fully energetic until the next day.
The best way to reduce this recovery time is to switch to home dialysis.
Because dialysis at home tends to take place more often, or over a longer period of time, it's a gentler process. Most people who do home dialysis don't have tired feeling after treatment. And even when they do feel tired, it's much less intense than in-clinic dialysis.
Peritoneal dialysis at home is even more gentle since the treatment is done every night over the course of eight to 10 hours, with additional exchanges that occur during the daytime if needed.
Contact the UPMC Kidney Disease Center about Dialysis Treatment
To learn more about dialysis treatments at the UPMC Kidney Disease Center: