Hemodialysis for chronic kidney disease

Hemodialysis involves transporting the blood through tubes outside the body into a machine and then cleaning the blood there using a dialysis fluid. This treatment typically takes place in a dialysis center, usually three times per week for about four to five hours each time.

Sometimes hemodialysis is combined with a technique called hemofiltration, which uses pressure to remove water and waste products from the blood.

If testing has shown that your kidneys are very weak and will probably fail completely soon, preparations for hemodialysis should be started. A vascular access point must be created to reach the bloodstream. Because superficial veins are not suitable for this purpose, minor surgery is needed. During that procedure, the surgeon connects (if possible) one vein and one artery in one of your forearms. This “short-circuit” of the blood's circulation (called an arteriovenous (AV) fistula) allows a larger blood vessel to form, into which the dialysis tubes can be inserted.

It is best to plan the procedure several months before starting dialysis. This is because several examinations need to be done first, and the AV fistula needs several weeks to develop so that it can be used over the long term.

If it’s not possible to create an AV fistula, hemodialysis can also be done using a “neck line.” This is where a catheter is inserted into a large vein in your neck that is close to the heart. That kind of vascular access has a higher risk of complications such as infection, though.

Hemodialysis is typically carried out in a dialysis center. The medical staff at the center make sure that everything runs smoothly. This gives most people a feeling of safety and is an advantage for those who would prefer not to have the dialysis done at home. Some people also think that not needing to have hemodialysis every day is an advantage.

If you are traveling away from your usual center, you can get dialysis at a different center as a guest. Traveling to more distant countries is also possible: You will usually just need to make arrangements for dialysis at your travel destination in advance. German public health insurers cover the costs at the level of the costs for dialysis treatment in Germany.

Hemodialysis is also possible at home (home hemodialysis). Health insurers will cover those costs as well. Like peritoneal dialysis, home hemodialysis allows for more independence and flexibility. You aren’t limited by the opening hours of the dialysis center, and it saves you the travel time to get there. But home hemodialysis isn’t possible without having training at a dialysis center and the support of one family member who has also been trained. There also needs to be enough space at home for the dialysis machine and the necessary equipment. It is not clear whether there are differences in life expectancy between people who have in-center hemodialysis and those who have home hemodialysis. There is a lack of suitable research in this area.

Some people feel like they are “dependent” on the dialysis machine. The long treatment times and the time it takes to get there and back can also be a burden and make it more difficult to see friends and family regularly. The scheduled dialysis appointments at the center are usually on weekdays and during the day – which can be a problem for people who would still like to work. So most larger centers offer evening hours as well. This disadvantage doesn't apply to home dialysis.

There are also certain recommendations for eating and drinking for hemodialysis. But they are somewhat stricter than the ones for peritoneal dialysis.

The AV fistula can be bothersome: Some people feel constantly reminded of their condition and their dependency on dialysis. Sometimes, that's enough of a reason to opt for the other dialysis method, peritoneal dialysis, instead. This type of access passageway is also the cause of the typical complications of hemodialysis: The new blood vessel may become inflamed, for example, or be blocked by a blood clot.

But these complications are rare. Hemodialysis usually doesn’t lead to any complications. In rare cases, some symptoms may arise while you are connected to the dialysis machine, such as a drop in blood pressure or muscle cramps (especially in the legs). Blood coagulation needs to be suppressed using medication during dialysis. That kind of medication can increase the risk of bleeding.

If your individual situation or personal needs change, you may no longer be satisfied with the type of dialysis you chose. It is possible to switch to peritoneal dialysis (or back to hemodialysis) if you are having too much difficulty managing it.

Some people make a general decision not to have dialysis or a kidney transplant (or they decide that later on). Possible reasons might include old age or other health problems that they have. Making this decision means letting your life come to an end. It is often difficult for friends and family to accept a decision like that – so it's important to discuss it with them. During this end-of-life period, palliative treatment can help to relieve pain and other symptoms in order to maintain as much quality of life as possible. That may involve things like being allowed to eat and drink a greater variety of things, or whatever you feel like.