Hemodialysis treatment is a form of kidney replacement therapy that helps remove waste products and excess fluid from the blood when the kidneys can no longer perform these functions adequately.

Healthy kidneys continuously filter the blood, maintain fluid balance and help regulate electrolytes and acid-base balance. When kidney function becomes severely impaired, these processes may become inadequate.

Hemodialysis uses a dialysis machine and a special filter called a dialyzer to perform some of the filtering functions normally carried out by the kidneys.

However, dialysis is not simply started because a person has one abnormal blood-test result. A nephrologist considers kidney function, symptoms, fluid status, potassium, acid-base balance, urine output and the underlying medical condition before recommending treatment.

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized evaluation and management for patients with kidney failure and dialysis-related concerns.

When Is Hemodialysis Recommended?

Hemodialysis may be considered when kidney function is severely reduced and complications cannot be adequately controlled with medical treatment.

Potential indications can include:

• Severe or persistent fluid overload

• Dangerous potassium abnormalities

• Significant metabolic acidosis

• Symptoms caused by accumulation of waste products

• Certain toxin or medication-related poisonings

• Severe complications of kidney failure

• Some cases of acute kidney injury

• Advanced kidney failure requiring long-term kidney replacement therapy

There is no single creatinine value that automatically means dialysis is required.

The decision is based on the patient's complete clinical condition.

Hemodialysis for Acute Kidney Injury

Hemodialysis may sometimes be required temporarily in people who develop acute kidney injury (AKI).

AKI can occur because of:

• Severe dehydration

• Serious infection

• Low blood pressure

• Certain medicines

• Urinary obstruction

• Major surgery or critical illness

• Severe kidney inflammation

When the underlying cause is reversible, kidney function may recover sufficiently for dialysis to be stopped.

Therefore, requiring dialysis during AKI does not necessarily mean that a person will need lifelong dialysis.

Hemodialysis for Chronic Kidney Disease

In advanced chronic kidney disease (CKD), kidney function may progressively decline over time.

When the kidneys can no longer adequately maintain the body's fluid, electrolyte and waste balance, kidney replacement therapy may become necessary.

Depending on the patient's condition and preferences, options may include:

• Hemodialysis

• Peritoneal dialysis

• Kidney transplantation

• Conservative kidney management in selected patients

Early nephrology care can help patients understand these options and prepare appropriately if kidney replacement therapy becomes necessary.

What Happens During a Hemodialysis Session?

During conventional hemodialysis, blood is circulated outside the body through a dialysis circuit.

The basic process involves:

1. Blood Access

Blood is withdrawn through a vascular access.

Common access types include:

• Arteriovenous fistula

• Arteriovenous graft

• Central venous catheter

An AV fistula is often preferred for long-term hemodialysis when it is suitable for the patient.

2. Blood Enters the Dialyzer

The blood travels through the dialyzer, which contains a semipermeable membrane.

3. Waste and Excess Fluid Are Removed

Waste substances and excess water move across the membrane into the dialysis fluid through processes including diffusion and ultrafiltration.

4. Filtered Blood Returns to the Body

The cleaned blood is returned through the vascular access.

The treatment prescription is individualized according to the patient's kidney function, body size, fluid status, laboratory results and other clinical factors.

How Long Does Hemodialysis Take?

The duration and frequency of dialysis vary from person to person.

Many patients receiving maintenance hemodialysis undergo treatment several times per week, with individual sessions commonly lasting several hours.

The exact schedule depends on:

• Residual kidney function

• Body size

• Fluid accumulation

• Laboratory results

• Dialysis adequacy

• Medical condition

• Prescribed treatment plan

Patients should follow the schedule recommended by their nephrology team.

What Is Dialysis Access?

Dialysis access provides a reliable route for blood to leave and return to the body during hemodialysis.

Arteriovenous Fistula

An AV fistula is surgically created by connecting an artery to a vein.

It may require time to mature before it can be used.

Arteriovenous Graft

A graft uses a synthetic or biological material to connect an artery and vein when a fistula is not suitable.

Central Venous Catheter

A catheter can provide dialysis access, particularly when dialysis needs to begin urgently.

For long-term dialysis, fistulas or grafts are generally preferred when clinically appropriate because catheters have higher risks of infection and other complications.

What Are the Benefits of Hemodialysis?

Hemodialysis can perform several important functions when the kidneys are severely impaired.

It can help:

• Remove waste products

• Remove excess fluid

• Control certain electrolyte abnormalities

• Correct some acid-base disturbances

• Reduce symptoms caused by kidney failure

• Support patients whose kidneys cannot adequately maintain internal balance

Dialysis can be life-sustaining when kidney failure becomes severe.

However, it does not restore all functions of healthy kidneys and does not by itself cure the underlying cause of chronic kidney disease.

What Are Common Side Effects of Hemodialysis?

Some patients may experience symptoms during or after treatment.

Possible effects include:

• Low blood pressure

• Muscle cramps

• Fatigue

• Headache

• Nausea

• Dizziness

• Itching

• Temporary weakness

These symptoms can have different causes, including changes in fluid volume or blood pressure.

The dialysis team can adjust treatment when appropriate.

What Are the Possible Complications?

Hemodialysis and vascular access can have complications.

These may include:

• Access infection

• Access blockage

• Bleeding

• Blood clots

• Low blood pressure

• Dialysis disequilibrium in certain situations

• Cardiovascular complications

• Anemia and other complications associated with advanced kidney disease

Regular medical monitoring helps identify and manage complications.

Hemodialysis and Fluid Management

When kidneys cannot remove enough water, fluid can accumulate in the body.

This may cause:

• Swelling

• Increased blood pressure

• Breathlessness

• Weight gain between dialysis sessions

The dialysis team determines how much excess fluid should be removed during treatment.

Patients are often advised to monitor their fluid intake and daily weight according to their individualized dialysis plan.

What Is Dry Weight in Hemodialysis?

Dry weight is an estimated target weight after dialysis at which the patient is considered to have an appropriate amount of fluid in the body.

It is not simply a fixed number.

The dialysis team may reassess the target based on:

• Blood pressure

• Swelling

• Breathing

• Weight changes

• Fluid accumulation

• Other clinical findings

Accurate fluid assessment helps reduce the risk of removing too much or too little fluid during dialysis.

Hemodialysis Diet

People receiving hemodialysis may need an individualized nutritional plan.

Depending on laboratory results and residual kidney function, the diet may involve adjustments to:

• Sodium

• Potassium

• Phosphorus

• Fluid

• Protein

Protein requirements in dialysis patients can differ from those of people with earlier stages of CKD.

A renal dietitian or nephrologist can provide dietary recommendations suited to the patient's condition.

Hemodialysis and CKD Creatinine Levels

People searching for CKD creatinine levels often wonder whether a particular creatinine value means dialysis is necessary.

Creatinine is useful for assessing kidney function, but dialysis decisions should not be based on creatinine alone.

Doctors may also consider:

• eGFR

• Potassium

• Bicarbonate

• Blood urea

• Fluid status

• Urine output

• Symptoms of uremia

• Blood pressure

• Nutritional status

• Overall clinical condition

A person with a high creatinine level may not need immediate dialysis, while another patient may require dialysis because of serious complications despite having a different creatinine level.

Can Hemodialysis Be Temporary?

Yes.

Hemodialysis can be temporary in selected patients with acute kidney injury.

If the kidneys recover adequately after treatment of the underlying condition, dialysis may eventually be discontinued.

In contrast, patients with irreversible advanced kidney failure may need long-term dialysis unless they undergo kidney transplantation or choose another appropriate management approach.

Can Kidney Function Improve After Starting Dialysis?

Starting dialysis does not necessarily mean that kidney recovery is impossible.

In AKI, kidney function may improve after the underlying cause is treated.

In established end-stage kidney disease caused by irreversible kidney damage, dialysis generally replaces some kidney functions rather than restoring the damaged kidneys.

The prognosis depends on the cause, duration and severity of kidney dysfunction.

Hemodialysis vs Peritoneal Dialysis

Both are forms of kidney replacement therapy, but they work differently.

Hemodialysis

• Uses a dialysis machine and dialyzer

• Requires vascular access

• Blood is filtered outside the body

• Usually performed at a dialysis center, although home treatment may be possible for selected patients

Peritoneal Dialysis

• Uses the lining of the abdomen as a filtering membrane

• Requires a peritoneal dialysis catheter

• Dialysis fluid is introduced into and drained from the abdominal cavity

• Can be performed at home by suitable patients after appropriate training

The best option depends on medical suitability, lifestyle, home circumstances and patient preference.

Preparing for Long-Term Hemodialysis

When progressive CKD makes dialysis likely, early planning is valuable.

Preparation may include:

• Discussing dialysis modalities

• Planning vascular access

• Protecting veins that may be needed for fistula creation

• Reviewing medications

• Managing anemia and mineral abnormalities

• Optimizing blood pressure

• Reviewing nutrition

• Discussing kidney transplantation

• Planning treatment logistics

Early preparation can help avoid emergency dialysis initiation when circumstances allow.

What Happens If Dialysis Is Missed?

Missing scheduled hemodialysis can allow fluid, potassium and waste products to accumulate.

Depending on the patient's residual kidney function and medical condition, this can become dangerous.

Patients should contact their dialysis team promptly if they cannot attend a scheduled session rather than independently changing their treatment schedule.

Can Hemodialysis Cure Kidney Failure?

Hemodialysis does not cure permanent kidney failure.

It replaces some of the kidneys' filtration functions and can help maintain the body's internal balance.

For selected patients, kidney transplantation may provide an alternative form of long-term kidney replacement.

The underlying cause of kidney failure should also be managed whenever possible.

When Should a Dialysis Patient Seek Urgent Medical Care?

Urgent medical attention may be necessary for:

• Severe breathlessness

• Chest pain

• Fainting

• Confusion

• Severe weakness

• Very high or rapidly changing blood pressure

• Fever or chills, especially with a dialysis catheter

• Bleeding from dialysis access that does not stop

• Sudden severe swelling

• Very little or no urine when this represents a significant change

Patients should follow their dialysis center's emergency instructions.

Hemodialysis Treatment at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized nephrology care for patients requiring evaluation and management of kidney failure.

Depending on the patient's condition, care may involve:

• Assessment of kidney-function decline

• Review of creatinine and eGFR trends

• Evaluation of dialysis indications

• Management of acute kidney injury

• Chronic kidney disease management

• Dialysis-related medical care

• Fluid and electrolyte management

• Vascular-access considerations

• Assessment for kidney transplantation

• Long-term kidney replacement therapy planning

Treatment recommendations are based on the patient's diagnosis, laboratory results, symptoms and overall health.

Frequently Asked Questions

What is hemodialysis treatment?

Hemodialysis is a kidney replacement therapy in which blood passes through a dialyzer to remove waste products and excess fluid when kidney function is severely impaired.

How many times a week is hemodialysis done?

Many people receiving maintenance hemodialysis undergo treatment several times each week, but the exact schedule is individualized according to medical needs and the prescribed dialysis plan.

Is hemodialysis painful?

The dialysis process itself is not generally described as painful, although needle insertion for vascular access can cause discomfort. Some patients may experience cramps, low blood pressure or fatigue during treatment.

Does high creatinine always require hemodialysis?

No. CKD creatinine levels alone do not determine the need for dialysis. Symptoms, eGFR, electrolyte abnormalities, fluid overload, acid-base disturbances and other complications are also considered.

Can someone stop hemodialysis?

Patients should never stop or skip dialysis without medical guidance. In some cases of acute kidney injury, dialysis can eventually be discontinued when kidney function recovers.

Is hemodialysis better than peritoneal dialysis?

Neither is universally better. The appropriate modality depends on medical suitability, lifestyle, home circumstances, access considerations and patient preference.

Conclusion

Hemodialysis treatment is an established form of kidney replacement therapy for people whose kidneys cannot adequately remove waste and excess fluid.

It can be used temporarily in selected cases of acute kidney injury or as ongoing treatment for advanced kidney failure. The need for dialysis is determined by the patient's overall condition rather than a single creatinine result.

Understanding kidney function early, monitoring CKD creatinine levels, managing underlying diseases and discussing treatment options with a nephrologist can help patients make informed decisions about kidney care.

For individualized evaluation and specialist nephrology care, consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic.

Medical Disclaimer

This article is intended for general educational and informational purposes only and should not be considered medical advice, diagnosis or treatment. Hemodialysis is a specialized medical treatment, and the decision to start, modify or stop dialysis must be made by a qualified nephrologist based on the patient's clinical condition, laboratory results and other relevant factors. CKD creatinine levels alone cannot determine whether dialysis is necessary. Do not alter dialysis schedules, fluid intake, medicines or dietary restrictions without professional medical guidance. Seek urgent medical attention for severe breathlessness, chest pain, confusion, fainting, severe weakness, uncontrolled bleeding from dialysis access, fever or chills associated with a dialysis catheter, or rapidly worsening symptoms.