Even if you’ve lived with kidney disease for a long time, hearing that your kidneys have stopped working can feel frightening and overwhelming. Knowing what to expect, though, can empower you and help you plan for the necessary lifestyle adjustments.

If you’ve been working closely with your doctor, you may already be aware that hemodialysis is one of the most common treatments for kidney failure. People can live for many years on hemodialysis, and the more you know about it, the more proactive you can be in your healthcare decisions.

What is hemodialysis?

Hemodialysis is a process that uses a machine with a special filter, called a dialyzer, to do the work that your kidneys can no longer do, namely clean your blood of wastes and excess fluids. 

The process involves the following steps:

• Two needles are placed in your arm. Each one attached to a soft, plastic tube that is connected to the dialysis machine.
• The machine pumps your blood—in small amounts—through one of the tubes into the machine, and the dialyzer filters out impurities.
• The clean blood is then pumped back into your body through the second tube. 

Where does hemodialysis take place?

Hemodialysis can be performed either:

• at a dialysis center, or
• at home.

If you choose to have your hemodialysis done at a center, expect to have three sessions per week. A hemodialysis session averages about three to four hours, but it can sometimes take longer. Your sessions will be prescheduled, and all hands-on tasks involved in the process are done by a nurse or dialysis technician.

If you choose to do your dialysis at home, you and a caregiver of your choice (partner, family member, friend, or other) will be trained to perform all the necessary tasks. These tasks will be decided according to the method that you and your healthcare provider determine is best for your treatment and lifestyle. 

Methods of home dialysis

Home hemodialysis can be performed in three different ways: 

• Conventional sessions: Like in-center sessions, conventional home sessions are done three times a week for an average of three to four hours per session. Training for conventional sessions can take a few weeks to a few months.
• Short daily sessions: Daily sessions are done with a specially-designed machine. The more frequent sessions only last about two hours each. Many patients find that shorter sessions reduce common post-dialysis symptoms, like headache, cramping, nausea, and fatigue. Training for short sessions takes a few weeks.
• Nocturnal sessions: These six- to eight-hour sessions can be done every other night or six nights per week, depending on what your doctor prescribes. Treatments take place while you sleep. Training for nocturnal sessions occurs over several weeks. 

Patients have reported some additional benefits, in regards to both short daily sessions and nocturnal treatments, which include:

• needing less medication to control blood pressure, phosphorus levels, and anemia; 
• improved neuropathy and restless leg syndrome;
• feeling better overall during and after treatments;
• sleeping better and having more energy;
• fewer and shorter hospital stays; and
• longer and better quality of life.

Who pays for home hemodialysis?

Medicare covers part of the treatment and training costs if:

• you’re 65 or older or disabled; and/or
• you have kidney failure and you, your spouse, or your parent qualify for Social Security (SS).

There are other sources that can help defray home dialysis costs. Your social worker at the dialysis center can provide information about coverage for treatments and supplies.

Home hemodialysis isn’t for everyone, and not all dialysis centers provide training and follow-up care for home-based treatments. Speak with your healthcare provider and do your research to find the best treatment solution for you.

*National Kidney Foundation. (2020, Apr. 16). Home Hemodialysis.