Hemodialysis is a form of kidney replacement therapy used when the kidneys are no longer able to adequately remove waste products and excess fluid from the blood.
During hemodialysis, blood is circulated through a specialized filter called a dialyzer. The dialyzer helps remove certain waste products and excess fluid before the filtered blood is returned to the body.
Hemodialysis does not cure the underlying cause of kidney failure. Instead, it performs some of the filtering functions normally carried out by healthy kidneys.
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized nephrology care for patients with advanced kidney disease and those requiring dialysis-related management.
Why Is Hemodialysis Needed?
Healthy kidneys continuously regulate the body's fluid and chemical balance.
When kidney function becomes severely impaired, waste products and excess fluid can accumulate.
Depending on the patient's condition, dialysis may be recommended to help manage problems such as:
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Accumulation of waste products
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Excess fluid
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High potassium
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Acid-base disturbances
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Certain symptoms associated with advanced kidney failure
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Complications that cannot be adequately controlled with medical treatment
Not every patient with a low eGFR immediately requires dialysis. The decision depends on symptoms, laboratory abnormalities, fluid status and the overall clinical condition.
How Does Hemodialysis Work?
Hemodialysis generally involves three main components:
1. Vascular Access
A reliable pathway is needed to allow blood to leave the body and return after filtration.
Common types include:
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Arteriovenous fistula (AV fistula)
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Arteriovenous graft
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Central venous catheter
For patients expected to require long-term hemodialysis, an AV fistula or suitable permanent access may be preferred when clinically appropriate.
2. Blood Circulation
Blood travels from the patient through the dialysis circuit toward the dialyzer.
3. Filtration Through the Dialyzer
Inside the dialyzer, blood passes alongside a special dialysis fluid separated by a semipermeable membrane.
Waste products and excess substances move across the membrane, while the cleaned blood is returned to the patient.
The dialysis machine controls and monitors several aspects of the treatment.
What Happens During a Hemodialysis Session?
A typical treatment involves several stages.
Before Treatment
The healthcare team may check:
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Blood pressure
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Pulse
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Weight
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Vascular access
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Symptoms
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Fluid status
The patient's weight can help estimate how much excess fluid may need to be removed.
During Treatment
Blood is circulated through the dialysis machine and dialyzer.
The dialysis team monitors the patient and machine throughout the session.
After Treatment
Blood pressure and weight may be checked again.
The dialysis team may also assess the vascular access and discuss any symptoms experienced during treatment.
Treatment duration and frequency vary according to the patient's individual needs.
How Often Is Hemodialysis Required?
For many people receiving maintenance hemodialysis, treatment is performed several times each week.
However, the exact schedule is individualized.
Factors influencing the dialysis prescription include:
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Remaining kidney function
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Body size
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Fluid accumulation
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Blood chemistry
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Nutritional status
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Medical conditions
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Type of vascular access
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Overall clinical condition
A nephrologist determines the appropriate dialysis prescription for each patient.
Hemodialysis for Acute Kidney Injury
Hemodialysis can sometimes be used temporarily in patients with acute kidney injury (AKI).
In certain situations, kidney function may recover sufficiently after the underlying cause is treated.
For example, severe infection, certain toxic exposures, major illness or other causes can produce temporary kidney dysfunction.
When kidney function recovers, dialysis may no longer be required.
Hemodialysis for Chronic Kidney Failure
In advanced chronic kidney disease, kidney function may decline permanently.
Some patients eventually require long-term kidney replacement therapy.
Long-term treatment options may include:
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Hemodialysis
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Peritoneal dialysis
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Kidney transplantation
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Conservative kidney management for selected patients
The most appropriate option depends on the patient's health, preferences, kidney function and medical circumstances.
What Is a Dialysis Access?
Vascular access is one of the most important parts of hemodialysis.
Arteriovenous Fistula
An AV fistula connects an artery and vein, usually in the arm.
It can provide durable access for repeated dialysis when it develops adequately.
Arteriovenous Graft
A synthetic or biological graft can connect an artery and vein when a fistula is not suitable or cannot be created successfully.
Central Venous Catheter
A catheter is inserted into a large vein.
Catheters may be used when dialysis needs to begin urgently or when permanent access is not available.
However, they can have a higher risk of infection and other complications compared with a well-functioning permanent access.
What Are the Benefits of Hemodialysis?
For patients who require kidney replacement therapy, hemodialysis can:
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Remove waste products from the blood
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Remove excess fluid
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Help manage certain electrolyte abnormalities
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Help control acid-base disturbances
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Reduce symptoms caused by severe kidney dysfunction
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Support patients whose kidneys can no longer adequately perform these functions
Hemodialysis can be life-sustaining for patients with kidney failure.
What Are the Possible Side Effects of Hemodialysis?
Some patients experience symptoms during or after treatment.
Possible effects include:
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Low blood pressure
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Muscle cramps
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Headache
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Nausea
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Dizziness
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Fatigue
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Itching
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Feeling weak after treatment
The likelihood and severity vary between patients.
If symptoms repeatedly occur during dialysis, the dialysis team should be informed so the treatment prescription can be reviewed.
Possible Hemodialysis Complications
Potential complications may include:
Vascular Access Infection
Infections can occur, particularly with certain types of catheters.
Access Blockage
A fistula or graft may develop narrowing or clotting that affects blood flow.
Low Blood Pressure
Removing fluid during dialysis can sometimes lower blood pressure.
Fluid and Electrolyte Changes
Dialysis changes the body's fluid and electrolyte balance. The treatment must therefore be carefully prescribed and monitored.
Anemia
People with advanced kidney disease commonly develop anemia. Dialysis patients may require treatment for anemia depending on their blood results.
What Is a Hemodialysis Diet?
Dietary requirements differ between patients.
Depending on laboratory results and remaining kidney function, a dialysis diet may involve individualized guidance regarding:
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Sodium
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Potassium
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Phosphorus
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Protein
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Fluids
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Calories
Patients should not follow a generic dialysis diet without professional advice.
The appropriate dietary plan depends on blood tests, dialysis frequency, urine output, nutritional status and other health conditions.
Why Is Fluid Restriction Sometimes Necessary?
When kidney function is severely reduced, the body may not be able to remove fluid efficiently between dialysis sessions.
Excess fluid can contribute to:
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Swelling
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High blood pressure
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Breathlessness
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Strain on the heart
Some patients therefore need a prescribed daily fluid limit.
The appropriate amount varies significantly between individuals.
What Is Dry Weight in Hemodialysis?
Dry weight is a clinical estimate of a patient's appropriate weight after excess fluid has been removed.
The dialysis team may use weight before and after treatment to guide fluid removal.
Dry weight is not necessarily a fixed lifelong number. It may change with nutrition, illness, changes in body composition and overall health.
What Should Patients Know About Their Dialysis Access?
Patients should take special care of their vascular access.
For an AV fistula or graft, patients may be advised to:
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Keep the area clean
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Check for signs of infection
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Avoid unnecessary pressure on the access arm
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Avoid blood-pressure measurements or blood draws from the access arm when advised by the care team
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Report unusual swelling, pain or bleeding promptly
A change in the usual vibration or “thrill” over a fistula may require urgent assessment.
Can Patients Live a Normal Life on Hemodialysis?
Many people receiving hemodialysis continue to work, study, travel and participate in family and social activities.
However, dialysis requires regular treatment and ongoing attention to:
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Medication
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Diet
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Fluid intake
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Vascular access
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Blood tests
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Appointments
The healthcare team can help patients adapt treatment around their lifestyle whenever medically possible.
Hemodialysis and Kidney Transplantation
For eligible patients with irreversible kidney failure, kidney transplantation may provide an alternative to long-term dialysis.
A transplant does not mean that dialysis is always immediately avoided or permanently unnecessary. Some patients may require dialysis before or after transplantation depending on their circumstances.
Transplant suitability is assessed individually.
Can Hemodialysis Be Stopped?
Hemodialysis should never be stopped or changed without discussion with the treating nephrologist.
For some patients with acute kidney injury, dialysis can eventually be discontinued if kidney function recovers sufficiently.
For patients with permanent kidney failure, stopping dialysis can result in dangerous accumulation of fluid and waste products.
Treatment decisions should be made through careful discussion between the patient, family and healthcare team.
When Should a Dialysis Patient Seek Urgent Medical Care?
Prompt medical assessment may be necessary for:
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Severe breathlessness
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Chest pain
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Fainting
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Severe weakness
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Confusion
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Persistent vomiting
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High fever or chills
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Redness, swelling or pus around dialysis access
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Heavy or uncontrolled bleeding from the access site
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Sudden loss of the normal fistula thrill
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Very rapid weight gain or severe swelling
Patients should follow the emergency instructions provided by their dialysis team.
How Can Patients Prepare for Hemodialysis?
Patients and families can make dialysis easier by understanding:
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Why dialysis has been recommended
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The planned treatment schedule
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The type of vascular access
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Medication instructions
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Fluid restrictions
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Dietary recommendations
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Signs of access infection
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Symptoms that require urgent medical attention
Understanding the treatment plan can help patients participate actively in their own care.
Hemodialysis Care at Prabhakar Bhurke Clinic
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides specialized nephrology care for patients with advanced kidney disease and dialysis-related concerns.
Care may include:
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Assessment of kidney-function decline
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Evaluation for kidney replacement therapy
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Dialysis-related medical management
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Monitoring of fluid and electrolyte problems
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Management of hypertension
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Diabetes-related kidney care
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Anemia and mineral-bone disorder management
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Vascular-access-related assessment
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Evaluation for kidney transplantation when appropriate
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Long-term chronic kidney disease follow-up
The dialysis plan is individualized according to kidney function, symptoms, laboratory findings, fluid status and other medical conditions.
Frequently Asked Questions About Hemodialysis
Is hemodialysis painful?
The dialysis procedure itself is not generally described as painful, although needle insertion for certain vascular accesses can cause temporary discomfort.
How long does a hemodialysis session take?
Treatment duration varies depending on the individual dialysis prescription. Many maintenance treatments last several hours.
Is dialysis required for everyone with kidney disease?
No. Dialysis is generally reserved for severe kidney dysfunction when the kidneys cannot adequately maintain the body's balance and medical treatment alone is insufficient.
Can kidney function improve after starting dialysis?
In acute kidney injury, kidney function may recover in some patients, allowing dialysis to be discontinued. In permanent kidney failure, dialysis generally replaces lost kidney function rather than restoring the kidneys.
Can a dialysis patient drink water?
Fluid intake is individualized. Some patients need a fluid restriction based on urine output, fluid accumulation and other medical factors.
Is hemodialysis a permanent treatment?
It can be long-term for patients with irreversible kidney failure, but some patients with acute kidney injury may require dialysis only temporarily.
Conclusion
Hemodialysis is an important kidney replacement therapy for people whose kidneys cannot adequately remove waste products and excess fluid.
The treatment uses a dialyzer and dialysis machine to perform some of the filtering functions normally provided by the kidneys. Successful dialysis involves more than the dialysis session itself—it also requires appropriate vascular-access care, medication management, dietary planning, fluid monitoring and regular nephrology follow-up.
For some patients, dialysis may be temporary, particularly when kidney function declines suddenly because of an acute illness. For others with irreversible kidney failure, long-term dialysis or kidney transplantation may be considered.
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized care for patients with advanced kidney disease and dialysis-related needs.
Medical Disclaimer
This article is intended for general educational purposes only and does not replace professional medical advice, diagnosis or treatment. Hemodialysis prescriptions, fluid limits, dietary recommendations, medications and treatment schedules must be determined by the treating nephrology team based on the patient's individual condition. Never change or skip dialysis sessions without medical guidance. Seek urgent medical attention for severe breathlessness, chest pain, confusion, uncontrolled bleeding, high fever or signs of vascular-access infection.
