Understanding Dialysis

---

---

When is Dialysis Needed?

---

Healthy kidneys filter waste and extra fluid from your blood. When kidneys stop working well—often in advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD)—these wastes build up in your body.

Dialysis may be needed if you experience:

• Very low kidney function (usually less than 10–15%).
• Symptoms such as nausea, loss of appetite, swelling, shortness of breath, or confusion, excessive hiccups, muscle cramps, and spasm.
• High potassium, acid, or fluid levels that cannot be controlled with medicine.

Short-term vs. Long-term Dialysis
Some patients only need dialysis for a short time. This usually happens when kidney function is lost suddenly—for example, after a severe infection, certain medications, or other medical conditions. As the kidneys heal and their cells regenerate, function may return, and dialysis can often be stopped.

Other patients need dialysis for the long term. This is more common when kidney function declines slowly over time due to chronic kidney disease. In these cases, the remaining kidney function is no longer enough to support the body’s daily needs, and dialysis becomes a permanent treatment unless a kidney transplant is possible.

Your doctor will monitor your lab results, symptoms, and overall health to decide the best time to begin dialysis

---

How Does Dialysis Work?

---

Dialysis is a treatment that takes over some of the kidney’s work by removing waste, salt, and extra water from the body. It also helps keep your blood pressure and certain minerals (like potassium and calcium) in balance.

When kidney function drops too low, these jobs are no longer done effectively. Dialysis steps in to take over part of this work. It removes waste, excess water, and helps keep your blood chemistry in balance.

Your doctor may recommend dialysis when your kidneys cannot do these jobs anymore, or when the remaining function is not enough to keep your body in balance.

Your kidneys are vital organs with several important roles:

• Remove waste products from the blood.
• Remove extra water to keep the right balance of fluids in your body.
• Help control blood pressure by managing salt, water, and hormones.
• Produce hormones that help your body make hemoglobin, the part of red blood cells that carries oxygen and nutrients to your organs.

Healthy Kidneys vs. Dialysis

Function	Healthy Kidneys	Dialysis
Remove waste products	Yes	Yes
Remove extra water	Yes	Yes
Regulate blood pressure	Yes	Helps, but not as well
Produce hormones for red blood cells (hemoglobin)	Yes	No (patients may need medicines or injections)

There are two main ways dialysis can do this:

• By using a machine that filters your blood (hemodialysis).
• By using the lining of your abdomen as a natural filter (peritoneal dialysis).

---

Different Types of Dialysis

---

Hemodialysis (HD)

Hemodialysis uses a special machine to clean your blood. To do this, your doctor needs to create an access to your blood—either through a soft tube called a catheter or a connection made in your arm called a fistula (or sometimes a graft). The dialysis machine takes a small amount of blood out at a time, passes it through a filter to remove waste and extra water, and then safely returns the clean blood back to your body.

• In-center hemodialysis: You come to a dialysis center, usually 3 times a week. A machine cleans your blood while you relax in a chair. Nurses and technicians monitor you during the treatment.
• Home hemodialysis: Some patients may do dialysis at home. With special training and equipment, you can dialyze more often or at times that fit your schedule. This can give you more flexibility and independence.

Peritoneal Dialysis (PD)

This treatment uses the lining of your belly (the peritoneum) as a natural filter. A soft tube (catheter) is placed in your abdomen, and a special fluid is used to absorb waste and extra fluid. You can do this at home, either during the day or overnight while you sleep.

Your doctor and care team will discuss which option may be best for you, based on your lifestyle, health, and personal preferences.

---

Ongoing Care for Patients on Dialysis

---

Dialysis is more than just a machine treatment — it involves regular medical care and support from a full health care team.

• Doctor visits: Your kidney doctor (nephrologist) and treating providers see you regularly while you are receiving dialysis. During these visits, they:
  • Monitor your overall health and check for any new symptoms.
  • Manage blood pressure, which is very important for protecting your heart and remaining kidney function.
  • Adjust the dialysis treatment by changing machine settings, treatment time, or fluid removal goals to make sure you are getting safe and effective dialysis.
  • Review and adjust your medications such as blood pressure medicines, bone and mineral supplements, anemia treatments, or other prescriptions to match your changing needs.
  • Discuss transplant evaluation or other long-term plans if appropriate.
• Lab tests: Each month, blood is drawn to check important minerals such as potassium, calcium, and phosphorus, as well as other markers that show how well dialysis is working. Your doctor reviews these results with you and adjusts your care plan as needed.
• Diet support: Every dialysis unit has a certified dietitian who works closely with you. A kidney-friendly diet is very important because your kidneys and dialysis cannot remove everything from your body on their own.
  • You may need to limit salt, potassium, and phosphorus to protect your heart, bones, and overall health.
  • Protein is especially important for patients on dialysis to help keep muscles strong and support healing.
  • Your dietitian will also guide you on how much fluid you can drink each day, since too much water between dialysis sessions can cause swelling and strain your heart.
  • They will meet with you regularly to review your lab results, answer questions, and suggest food choices that fit your lifestyle and culture.
• Social support: A social worker is also part of your dialysis team. They can help with emotional support, planning, insurance questions, and connecting you to community resources.

This ongoing care ensures that you receive not only the dialysis treatment itself, but also the medical, nutritional, and emotional support needed to live as well as possible with kidney disease.

---