End stage renal disease (ESRD) refers to kidney failure in which the kidneys have lost most of their ability to perform essential functions such as removing waste and excess fluid and maintaining electrolyte and acid-base balance.

Kidney failure is generally associated with kidney function below approximately 15% of normal. A person with kidney failure may develop accumulation of waste products, excess fluid and electrolyte abnormalities.

When the kidneys can no longer adequately perform these functions, hemodialysis may be used as a form of kidney replacement therapy.

Hemodialysis removes waste products and excess fluid from the blood using a dialysis machine and a specialized filter called a dialyzer. It replaces only part of normal kidney function and is not a cure for kidney failure.

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

How Does ESRD Develop?

End stage kidney disease usually develops after substantial and often prolonged kidney damage.

Some common underlying causes include:

• Diabetes-related kidney disease

• Long-standing high blood pressure

• Glomerular diseases

• Polycystic kidney disease

• Recurrent kidney injury

• Chronic urinary obstruction

• Certain inherited kidney disorders

• Autoimmune kidney diseases

• Other chronic kidney conditions

Not everyone with chronic kidney disease progresses to kidney failure.

The rate of progression varies according to the underlying disease, kidney-function trend, albuminuria, blood-pressure control, diabetes and other health factors.

What Happens When the Kidneys Can No Longer Keep Up?

Healthy kidneys continuously perform several functions.

They help:

• Remove metabolic waste

• Control body-fluid volume

• Regulate electrolytes

• Maintain acid-base balance

• Contribute to blood-pressure regulation

• Support red-blood-cell production

• Maintain bone and mineral health

When kidney function becomes severely impaired, these processes can become disturbed.

Patients may develop:

• Swelling

• Reduced urine output

• Fatigue

• Nausea

• Poor appetite

• Itching

• Muscle cramps

• Breathlessness

• Difficulty concentrating

• Electrolyte abnormalities

• Anemia

• Bone and mineral problems

The symptoms and severity differ considerably between patients.

Why Is Hemodialysis Used in ESRD?

Hemodialysis provides an external method of filtering the blood when the kidneys cannot do enough of the work.

During treatment:

1. Blood is taken from the body through a dialysis access.

2. It travels through tubing to the dialysis machine.

3. The blood passes through the dialyzer.

4. Waste products and excess fluid are removed.

5. The cleaned blood returns to the body.

Hemodialysis can remove waste and excess fluid and help maintain appropriate levels of important minerals.

However, dialysis does not reproduce every function of healthy kidneys.

This is why ESRD management also involves medicines, nutrition planning, fluid management, monitoring and treatment of complications.

How Often Is Hemodialysis Usually Done?

For many people receiving in-center hemodialysis, treatment is commonly scheduled around three times per week, with each session lasting several hours.

However, the exact dialysis prescription is individualized.

Factors affecting the prescription can include:

• Remaining kidney function

• Body size

• Fluid accumulation

• Laboratory results

• Dialysis adequacy

• Medical conditions

• Type of dialysis program

• Whether dialysis is performed at home or in a center

NIDDK and National Kidney Foundation information describes conventional in-center schedules as commonly three treatments per week, while home hemodialysis can provide greater flexibility.

Patients should follow the schedule prescribed by their nephrologist rather than changing dialysis frequency independently.

What Is Dialysis Access?

Hemodialysis requires reliable access to the bloodstream.

The main access types are:

Arteriovenous Fistula

A fistula connects an artery and vein, usually in the arm.

When suitable, it is generally preferred because it can provide durable access with fewer complications than a catheter.

Arteriovenous Graft

A graft uses a synthetic tube to connect an artery and vein.

It may be considered when a patient's blood vessels are not suitable for a fistula.

Dialysis Catheter

A catheter is placed into a large vein and can allow dialysis to begin quickly.

Catheters may be used when urgent dialysis is necessary or while waiting for another access to become usable. However, they can have higher infection and clotting risks than a fistula.

Why Should Dialysis Access Be Protected?

Dialysis access is essential for receiving hemodialysis.

Patients should report problems such as:

• Redness

• Warmth

• Swelling

• Pain

• Drainage

• Bleeding

• Fever

• A change or disappearance of the usual fistula vibration or “thrill”

For a fistula or graft, patients are generally advised to avoid unnecessary blood pressure measurements or blood draws from the access arm.

Early recognition of access problems can help prevent serious complications.

What Is the Role of Diet in ESRD on Hemodialysis?

Diet becomes an important part of kidney-failure management.

However, there is no single dialysis diet suitable for every patient.

Dietary recommendations may need to account for:

• Potassium

• Phosphorus

• Sodium

• Fluid intake

• Protein requirements

• Calorie needs

• Diabetes

• Cardiovascular health

• Remaining kidney function

People receiving hemodialysis often need to monitor sodium, potassium, phosphorus and fluid intake, while protein requirements may differ from those of people with earlier CKD.

A renal dietitian can help create a plan based on laboratory results and nutritional needs.

Why Is Fluid Control Important During Hemodialysis?

As kidney function declines, the ability to remove water between dialysis sessions becomes limited.

Excess fluid may cause:

• Swelling

• Rapid weight gain

• High blood pressure

• Breathlessness

• Fluid in the lungs

• Increased strain on the heart

Dialysis can remove excess fluid, but the amount removed during an individual session needs to be carefully planned.

Patients should follow the fluid target recommended by their dialysis team rather than deliberately drinking excessive amounts of water.

What Is Dry Weight in Hemodialysis?

The dialysis team may establish a target weight commonly referred to as dry weight.

It represents an estimated post-dialysis weight at which the patient is considered to have an appropriate amount of fluid in the body.

The target may be adjusted over time based on:

• Blood pressure

• Swelling

• Breathlessness

• Weight trends

• Blood pressure during dialysis

• Symptoms during or after treatment

• Overall clinical assessment

Dry weight is individualized and should not be treated as a fixed number for every dialysis patient.

What Problems Can Occur During Hemodialysis?

Some patients may experience complications during or after treatment.

These can include:

• Low blood pressure

• Muscle cramps

• Headache

• Fatigue

• Nausea

• Access-related problems

• Infection

• Bleeding

• Clotting of the vascular access

• Excessive or inadequate fluid removal

The dialysis team monitors the patient and may modify the treatment prescription when clinically necessary. NIDDK notes that dialysis settings can be adjusted for issues such as mineral abnormalities, low blood pressure or muscle cramps.

What Happens If Dialysis Access Becomes Infected?

Access infection requires prompt medical attention.

Warning signs can include:

• Redness around the access

• Warmth

• Swelling

• Pain

• Pus or drainage

• Fever

• Chills

• Feeling suddenly unwell

Treatment may involve antibiotics and, depending on the type and severity of the access problem, additional procedures or access management.

Patients should not wait for the next routine dialysis appointment if they develop concerning access symptoms.

How Is Dialysis Adequacy Monitored?

Hemodialysis needs to provide an appropriate amount of treatment for the individual patient.

The dialysis team may monitor:

• Blood urea levels

• Dialysis adequacy measurements

• Fluid status

• Potassium

• Bicarbonate

• Hemoglobin

• Calcium and phosphorus

• Blood pressure

• Weight

• Symptoms

• Access performance

The exact monitoring schedule and targets depend on the dialysis program and patient's clinical condition.

Medicines Commonly Used in ESRD

Dialysis does not eliminate the need for other medical treatment.

Depending on the patient's problems, medicines may be prescribed for:

• Blood-pressure control

• Anemia

• Mineral and bone disorders

• Diabetes

• Cardiovascular disease

• Itching

• Infection

• Other kidney-failure complications

Medication doses may need to be changed because severely reduced kidney function alters how many medicines are processed and eliminated.

Patients should tell their nephrologist about prescription medicines, over-the-counter products, painkillers, supplements and herbal preparations.

Can a Person With ESRD Still Produce Urine?

Yes.

Some people receiving dialysis continue to produce urine, particularly when they have residual kidney function.

However, urine output may gradually decrease as kidney function declines.

The amount of urine a dialysis patient produces should not be used by itself to determine whether dialysis is working or whether dialysis can be stopped.

Can Hemodialysis Be Temporary?

Sometimes.

Hemodialysis is not exclusively used for permanent kidney failure.

People with acute kidney injury may require dialysis temporarily if their kidneys are unable to maintain fluid, electrolyte or acid-base balance safely. Some recover enough kidney function to discontinue dialysis.

In established ESRD, however, long-term kidney replacement therapy is generally required unless the patient receives a functioning kidney transplant or follows an appropriate alternative treatment plan.

Is Kidney Transplantation an Option After Starting Hemodialysis?

Yes.

For appropriately selected patients, kidney transplantation can provide functioning kidney tissue and is another major kidney replacement option.

Some patients may undergo transplant evaluation before dialysis, while others are assessed after dialysis has already begun.

Transplant suitability depends on factors such as:

• Overall health

• Cardiovascular condition

• Age and functional status

• Underlying kidney disease

• Infection status

• Cancer history

• Surgical considerations

• Ability to safely receive long-term immunosuppressive medicines

NIDDK identifies hemodialysis, peritoneal dialysis and kidney transplantation as kidney-failure treatment options, alongside conservative management for selected patients.

Is Peritoneal Dialysis an Alternative to Hemodialysis?

Yes.

Peritoneal dialysis (PD) is another form of kidney replacement therapy.

Instead of circulating blood through an external dialyzer, PD uses the lining of the abdomen as a filtering membrane.

It can often be performed at home.

Whether hemodialysis or peritoneal dialysis is more suitable depends on the patient's medical condition, lifestyle, home circumstances, preferences and ability to perform the treatment.

The choice should be discussed with a nephrology team before dialysis is initiated whenever possible.

What Is Conservative Kidney Management?

Not every person with kidney failure chooses dialysis or transplantation.

Conservative kidney management focuses on symptom control, quality of life, management of complications and supportive care without dialysis or transplant. It may be considered for selected patients after discussion with the healthcare team and family.

This is different from simply receiving no treatment.

The care plan can include management of:

• Breathlessness

• Nausea

• Itching

• Pain

• Anemia

• Fluid symptoms

• Blood pressure

• Emotional and supportive needs

The appropriate approach depends on the patient's health status, goals and preferences.

How Can Patients Stay Healthier While on Hemodialysis?

Long-term dialysis care involves more than attending dialysis sessions.

Helpful habits may include:

Attend Every Prescribed Treatment

Skipping or shortening dialysis without medical advice can allow fluid and waste products to accumulate.

Follow the Individualized Diet

Dietary restrictions should be based on laboratory results and professional advice.

Follow the Fluid Plan

Do not increase fluid intake simply because you feel thirsty if your dialysis team has prescribed a fluid limit.

Protect the Dialysis Access

Check the access regularly and report changes promptly.

Take Medicines Correctly

Some medicines are essential for controlling anemia, blood pressure, mineral abnormalities and other complications.

Stay Physically Active When Appropriate

Activity can support strength, mobility and overall health when approved by the medical team.

Attend Regular Reviews

Dialysis prescriptions may need adjustment as health conditions and residual kidney function change.

When Should an ESRD Patient Seek Urgent Medical Attention?

A person receiving hemodialysis should seek urgent medical care for symptoms such as:

• Severe breathlessness

• Chest pain

• Fainting

• Severe confusion

• Very low blood pressure with serious symptoms

• Persistent vomiting

• Severe weakness

• Major bleeding from dialysis access

• Fever with suspected access infection

• Sudden loss of fistula thrill

• Severe swelling with breathing difficulty

Some of these symptoms can indicate fluid overload, cardiovascular problems, infection or dialysis-access complications.

Why Early Dialysis Planning Matters

When advanced CKD is progressing toward kidney failure, early planning gives patients time to understand their treatment choices.

Preparation may include:

• Learning about hemodialysis

• Considering peritoneal dialysis

• Discussing home dialysis options

• Planning vascular access

• Evaluating transplant eligibility

• Reviewing medications

• Meeting a renal dietitian

• Planning for transportation and practical support

NIDDK recommends early education and preparation for kidney replacement therapy in people approaching kidney failure. Early preparation can help avoid unplanned emergency dialysis starts and allow more time for access planning.

Long-Term Outlook for People With ESRD on Hemodialysis

ESRD is a serious chronic condition, but dialysis can provide life-sustaining kidney replacement therapy.

Long-term outcomes vary substantially between individuals.

Factors that influence health outcomes include:

• Age

• Cause of kidney failure

• Cardiovascular disease

• Diabetes

• Nutrition

• Dialysis adequacy

• Infection

• Vascular access health

• Remaining kidney function

• Other medical conditions

• Eligibility for transplantation

Hemodialysis can help remove waste and excess fluid and may help patients feel better and live longer, but it does not restore all functions of healthy kidneys.

Hemodialysis and Kidney Care at Prabhakar Bhurke Clinic

At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides individualized nephrology care for patients with advanced CKD and kidney failure.

Depending on the patient's needs, care may include:

• Assessment of advanced kidney disease

• Review of kidney-function trends

• Dialysis planning

• Hemodialysis-related medical management

• Fluid and electrolyte management

• Blood-pressure control

• Anemia and mineral-bone disorder management

• Dialysis medication review

• Vascular-access assessment and coordination

• Evaluation for kidney transplantation

• Management of dialysis-related complications

• Long-term kidney-failure care

Treatment decisions are individualized according to kidney function, medical history, dialysis status and overall health.

Frequently Asked Questions

What does end stage renal disease on hemodialysis mean?

It means a person has kidney failure and is receiving hemodialysis as kidney replacement therapy. Kidney failure is generally associated with kidney function below about 15% of normal, although dialysis decisions are based on the overall clinical situation rather than one number alone.

Is hemodialysis a cure for end stage renal disease?

No. Hemodialysis replaces part of kidney function by removing waste and excess fluid, but it does not cure permanent kidney failure.

How many times a week is hemodialysis needed?

Many people receiving conventional in-center hemodialysis have treatments about three times per week, but the exact schedule and duration are individualized.

Can someone with ESRD stop dialysis?

A person with established kidney failure generally needs ongoing kidney replacement therapy unless kidney function recovers, a functioning transplant is received, or an individualized conservative-management approach is chosen. Dialysis should never be stopped without medical supervision.

Can a person with ESRD get a kidney transplant?

Some patients with kidney failure are suitable for transplantation. Eligibility requires a comprehensive medical evaluation.

What is the best dialysis access?

When medically suitable, an arteriovenous fistula is generally preferred because it can be more durable and have fewer complications than a catheter. However, access selection is individualized.

Can ESRD patients drink normal amounts of water?

Not necessarily. Many dialysis patients need an individualized fluid limit because the kidneys cannot adequately remove excess fluid. The appropriate amount depends on urine output, dialysis prescription, heart health and other factors.

Can ESRD patients still urinate?

Yes. Some dialysis patients continue to produce urine because they retain residual kidney function. Urine production can decrease over time.

What are the alternatives to hemodialysis?

Kidney-failure treatment options include peritoneal dialysis, kidney transplantation and, for selected patients, comprehensive conservative management.

Conclusion

End stage renal disease on hemodialysis means that kidney function has become severely impaired and hemodialysis is being used to replace part of the kidneys' filtration work.

Successful long-term dialysis care involves much more than the dialysis session itself. Vascular-access protection, fluid management, individualized nutrition, medication review, laboratory monitoring and management of complications are all important parts of treatment.

For suitable patients, kidney transplantation may provide another kidney-replacement option. Peritoneal dialysis and conservative kidney management may also be considered depending on individual circumstances and treatment goals.

If you or a family member has kidney failure and is receiving or preparing to start hemodialysis, specialist nephrology care can help with dialysis planning, complication management and long-term treatment decisions.

For individualized kidney-failure and dialysis 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 a substitute for professional medical advice, diagnosis or treatment. End stage renal disease requires individualized nephrology care, and dialysis schedules, fluid restrictions, dietary requirements, medicines and vascular-access decisions vary between patients. Do not change, shorten or skip dialysis sessions, alter fluid intake, stop medicines or change your diet without guidance from your treating healthcare team. Seek urgent medical attention for severe breathlessness, chest pain, fainting, severe confusion, major bleeding, fever with suspected dialysis-access infection, sudden loss of fistula thrill, or rapidly worsening symptoms. Consult Dr. Sandip Prabhakar Bhurke or another qualified nephrologist for personalized treatment and dialysis management.