Dialysis

Overview of the Condition

What is kidney failure?

• Kidney failure means the kidneys no longer work well enough to filter waste and extra fluid from the blood on their own
• Kidney failure is considered to be present when kidney function drops below about 15 percent of normal
• Waste products and fluid build up in the body, which can cause swelling, fatigue, and other health problems if untreated

Why is it important?

Dialysis and kidney transplant are the two main treatments that can keep a person alive once the kidneys have failed. Starting treatment at the right time, and following the treatment plan, helps people feel better, avoid complications, and live longer.

Who is commonly affected?

• People with long-standing diabetes, the most common cause of kidney failure
• People with high blood pressure, which can both cause and result from kidney damage
• People with glomerulonephritis, an inflammation of the kidney's filtering units
• People with polycystic kidney disease or other inherited kidney conditions
• People with recurrent kidney stones, infections, or long-term obstruction of the urinary tract

Causes / Why It Happens

Kidney failure develops when an underlying condition gradually damages the kidneys over time, or, less often, when a sudden illness or injury stops the kidneys from working. Common contributing conditions include:

• Diabetes: high blood sugar levels over many years can damage the small blood vessels in the kidneys
• High blood pressure: sustained high pressure damages the blood vessels that filter the kidneys
• Glomerulonephritis: inflammation of the kidney's filtering units, from various causes
• Polycystic kidney disease: an inherited condition in which fluid-filled cysts gradually replace healthy kidney tissue
• Recurrent infections, stones, or obstruction: repeated damage or long-term blockage of the urinary tract

As kidney disease progresses, the healthcare team monitors kidney function and helps the person plan for treatment well before dialysis becomes urgently necessary.

Signs and Symptoms

Common symptoms

• Swelling, usually in the legs, feet, or ankles
• Fatigue and weakness
• Nausea, vomiting, or poor appetite
• Not urinating as much as usual, or changes in urine output
• Difficulty concentrating or feeling mentally foggy
• Itching, muscle cramps, or trouble sleeping

Symptoms often develop gradually as kidney function declines, though some people have very few symptoms until kidney failure is advanced. In sudden, severe cases, symptoms such as shortness of breath, chest pain, or confusion can develop quickly and need urgent medical attention.

Diagnosing kidney failure and planning for dialysis

Kidney failure is diagnosed using blood tests (such as creatinine and estimated glomerular filtration rate), urine tests, and sometimes imaging. Once kidney function falls to a low level, the healthcare team discusses treatment options, including hemodialysis, peritoneal dialysis, kidney transplant, or conservative management.

Procedure Overview

What is dialysis, and why is it done?

• Dialysis is a treatment that filters waste products and extra fluid from the blood when the kidneys can no longer do this well enough on their own
• There are two main types: hemodialysis, which filters the blood using a machine, and peritoneal dialysis, which uses the lining of the abdomen (the peritoneum) as a natural filter
• Dialysis does not cure kidney failure; it replaces some, but not all, of the work healthy kidneys normally do

Why is it done?

Dialysis is done to:

• Remove waste products and toxins that build up in the blood when the kidneys fail
• Remove extra fluid and help control blood pressure
• Help keep important minerals, such as potassium and sodium, at safe levels
• Relieve symptoms of kidney failure and improve quality of life

Before the Procedure

Preparing for hemodialysis: vascular access

• Before starting hemodialysis, minor surgery is needed to create a vascular access, the site where needles are placed to connect to the dialysis machine
• AV fistula: a surgeon connects an artery to a vein, usually in the arm; this is the preferred long-term access because it has the lowest risk of infection and clotting, but it can take several weeks to months to mature before it is ready to use
• AV graft: a synthetic tube connects an artery and vein when the veins are not suitable for a fistula; it can be used sooner but carries a higher risk of infection and clotting
• Central venous catheter: a temporary tube placed in a large vein in the neck, chest, or groin, used when dialysis is needed urgently or while a fistula or graft is healing

Working with a nephrologist and vascular surgeon well ahead of time helps ensure the access is ready when dialysis is needed.

Preparing for peritoneal dialysis: catheter placement

• A soft, flexible catheter is placed into the abdomen during a minor surgical procedure, usually a few weeks before dialysis begins, to allow the site to heal
• The healthcare team teaches the person and, if needed, a family member or carer, how to perform exchanges safely at home

Procedure Overview

During hemodialysis

• Two needles are placed into the vascular access; one carries blood to the dialysis machine and the other returns filtered blood to the body
• Blood passes through a filter called a dialyzer, sometimes called an artificial kidney, which removes waste products and extra fluid
• A typical in-center session lasts three to four hours and is usually needed three times a week, though home hemodialysis schedules can vary

During peritoneal dialysis

• A dialysis solution (dialysate) is drained into the abdomen through the catheter and left in place for a set period, allowing it to absorb waste and extra fluid across the peritoneal membrane
• The used solution is then drained out into a bag and replaced with fresh solution; this cycle is called an exchange
• Continuous ambulatory peritoneal dialysis (CAPD) involves three to five manual exchanges during the day, each taking about 30 to 40 minutes
• Automated peritoneal dialysis (APD) uses a machine to perform exchanges overnight while sleeping, usually over eight to twelve hours

After the procedure

• Some people feel tired after a hemodialysis session, and mild side effects such as low blood pressure, nausea, cramps, or headache can occur, particularly if fluid or dietary guidelines are not followed
• The vascular access or catheter site is checked regularly for signs of infection, swelling, or reduced blood flow

Time required

• In-center hemodialysis: about three to four hours per session, typically three times a week
• Home hemodialysis: sessions and schedules vary, but may occur three to seven days a week
• CAPD: about 30 to 40 minutes per exchange, three to five times daily
• APD: roughly eight to twelve hours overnight, typically every night

Procedure types

• In-center hemodialysis: performed at a dialysis facility by trained staff, with regular medical oversight
• Home hemodialysis: performed at home after training, offering more flexibility over scheduling
• Continuous ambulatory peritoneal dialysis (CAPD): manual exchanges performed several times during the day
• Automated peritoneal dialysis (APD): exchanges performed by a machine overnight

Risks, Benefits and Hospital Stay

Risks and Complications

Dialysis is generally safe, and most side effects can be prevented or managed by following the prescribed diet, fluid limits, and treatment schedule:

• Low blood pressure: can cause dizziness, nausea, or cramps during or after hemodialysis
• Access-related problems: infection, clotting, or narrowing of an AV fistula, graft, or catheter
• Peritonitis: an infection of the abdominal lining, a key risk specific to peritoneal dialysis, usually caused by bacteria entering during an exchange
• Muscle cramps and itching: common, and often related to fluid shifts or mineral imbalances
• Fatigue: many people feel tired, particularly after a hemodialysis session

Benefits and Expected Outcome

• Removes waste products and extra fluid that the kidneys can no longer clear
• Helps control blood pressure and keep minerals such as potassium at safe levels
• Relieves many symptoms of kidney failure and can improve day-to-day wellbeing
• Allows people to continue their lives, including work and travel, with planning and support

Duration of Care

• Dialysis is typically an ongoing, long-term treatment rather than a single procedure, continued until a kidney transplant is possible or according to the person's treatment plan
• Vascular access or catheter placement surgery is usually a day procedure, with most people going home the same day

Recovery, Lifestyle and Follow-up

Recovery and Aftercare after access surgery

• The arm with a new fistula or graft can usually be used normally the same day, but heavy lifting should be avoided as advised
• Propping the arm on a pillow and keeping the elbow straight can help reduce swelling in the first few days
• Keep the dressing dry for the first 24 to 48 hours, as instructed by the surgical team

Living with dialysis

• Most people can continue working, travelling, and taking part in usual activities, with some planning around the treatment schedule
• A dialysis social worker or care team can help arrange treatment at another facility when travelling
• Adjusting emotionally to a new routine is common; support from the dialysis team, family, and other patients can help

Lifestyle

• Diet and fluids: a kidney dietitian helps create an eating plan that manages sodium, potassium, phosphorus, and fluid intake, tailored to the person's lab results and dialysis type
• Caring for the access: avoid blood draws, blood pressure checks, or tight clothing on the arm with a fistula or graft, and check daily for a normal pulsing sensation (thrill)
• Physical activity: regular, moderate activity as advised can help improve strength, heart health, and treatment outcomes

When to Contact a Doctor

• Fever, chills, or other signs of infection at the access or catheter site
• Redness, swelling, warmth, or pus around the access site
• Loss of the normal pulsing sensation (thrill) in a fistula or graft
• Cloudy fluid or abdominal pain during peritoneal dialysis, which may signal peritonitis
• Severe dizziness, chest pain, or shortness of breath during or after a session

Follow-up

• Regular blood tests monitor how well dialysis is working and guide adjustments to the treatment plan
• Vascular access is checked at every hemodialysis session, with periodic ultrasound or other tests to confirm good blood flow
• The dialysis team, including the nephrologist, nurses, dietitian, and social worker, provides ongoing support and adjusts care as needs change

References

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11. Dialysis - Types, effectiveness, side effects. National Kidney Foundation. Available from: https://www.kidney.org/kidney-topics/dialysis Accessed on 9 July 2026.

12. Taking care of your vascular access for hemodialysis. MedlinePlus Medical Encyclopedia. Available from: https://medlineplus.gov/ency/patientinstructions/000591.htm Accessed on 9 July 2026.

13. Vascular Access for Hemodialysis. UCSF Department of Surgery. Available from: https://surgery.ucsf.edu/procedure/vascular-access-hemodialysis Accessed on 9 July 2026.

14. What Is a Dialysis Fistula? Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/procedures/dialysis-fistula Accessed on 9 July 2026.

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