💉 Haemodialysis: A Patient’s Guide
Understanding the process, access types, what to expect, and how to live well on dialysis.
📑 Contents
🩸 What is haemodialysis?
Haemodialysis is a treatment that removes waste products, excess fluid, and toxins from your blood when your kidneys can no longer do so. Blood is pumped through a dialyser (artificial kidney) where it flows past a special membrane bathed in dialysis fluid (dialysate). Waste and excess fluid pass from the blood into the dialysate, and the cleaned blood is returned to your body.
🔗 Vascular access – your lifeline
Good blood flow is essential. Access must be created weeks or months before starting dialysis. Three main types:
Surgical connection of an artery to a vein, usually in the arm. Gold standard – longest lasting, fewest infections, best blood flow. Takes 2‑4 months to mature.
Artificial tube connecting artery and vein. Used if veins are too small. Matures faster (2‑3 weeks), but higher infection/clot risk than fistula.
Temporary plastic tube inserted into a large neck/chest vein. Used for urgent starts or while waiting for fistula. Highest infection risk, not preferred long‑term.
🔄 What happens during haemodialysis?
- You sit or lie in a comfortable chair.
- Two needles are placed into your access (or one if using a catheter).
- Blood flows through tubing to the dialyser, then back to you.
- Blood is anticoagulated (usually with heparin) to prevent clotting in the circuit.
- You can read, sleep, watch TV, or use a tablet during treatment – but avoid moving the access arm.
- Vital signs (blood pressure, heart rate) are checked regularly.
Schematic of a haemodialysis circuit (blood pump, dialyser, venous bubble trap).
⏰ Typical schedule
- Usually 3 sessions per week, each lasting 3‑5 hours.
- Sessions are commonly Monday‑Wednesday‑Friday or Tuesday‑Thursday‑Saturday.
- In‑centre dialysis vs home haemodialysis (more flexible, often better quality of life).
- Longer or more frequent sessions may be prescribed for fluid overload or high potassium.
⚠️ Possible side effects & how to manage
Eat a small snack before, avoid large fluid gains.
Stretching, reducing fluid removal, or adjusting dialysate sodium.
Often due to rapid fluid or electrolyte shifts – inform nurse.
Good phosphate control and dialyser type can help.
Normal to feel tired; rest and adjust diet gradually.
Redness, swelling, pain, fever – seek immediate attention.
🥗 Diet & fluid management
- Fluids: Usually limited to 1‑1.5 L/day (including soups, ice cream). Gains between sessions should be <2‑3 kg.
- Potassium: Limit high‑K foods (bananas, oranges, potatoes, tomatoes, beans).
- Phosphorus: Avoid dairy, nuts, cola, processed meats. Take phosphate binders (calcium acetate, sevelamer) with every meal.
- Sodium: Reduce salt – no added salt, avoid processed foods.
- Protein: Dialysis removes amino acids. Eat high‑quality protein (egg whites, chicken, fish) – about 1.2 g per kg body weight daily.
💊 Common medications for haemodialysis patients
- Phosphate binders – take with meals to control phosphorus.
- Active vitamin D (calcitriol, paricalcitol) – for bone health.
- Erythropoiesis‑stimulating agents (ESAs) – injected during dialysis to treat anaemia.
- Iron supplements – intravenous or oral.
- Blood pressure medications – often held before dialysis to avoid low BP.
- Vitamin B12 and folic acid – replaced due to dialysis losses.
❤️ Living well on haemodialysis
Many people work, travel, and enjoy hobbies while on dialysis. Tips:
- Arrange dialysis at other centres if travelling – plan ahead.
- Stay active – light exercise (walking, swimming) improves energy and cardiovascular health.
- Mental health support – depression is common; counselling and support groups help.
- Transplant evaluation – even while on dialysis, you can be listed for a kidney transplant.