So You Need Dialysis. Here’s How to Prep.
Your doctor says you’re a candidate for dialysis. But what exactly does that mean? Get the 411 on what happens during this life-saving treatment.by Alice Lesch Kelly Health Writer
When your kidneys can no longer filter wastes and fluids from your blood on their own, they need help getting the job done. That’s dialysis: A treatment that can save your life but will also change your daily routine significantly. Dialysis involves a pretty big weekly time commitment, and it requires you to make some changes to your lifestyle in order to get the most from your treatment.
The best way to prepare is to learn as much as you can about the procedure in advance. “That way, you can understand what your options are and how to best take care of yourself,” says Stephen Pastan, M.D., professor of medicine at the Emory Transplant Center and a National Kidney Foundation board member. Start with these insights to help you get ready for your first day of dialysis.
There are two types of dialysis available: hemodialysis and peritoneal dialysis. Although, there may be some early benefits to peritoneal dialysis, long term they are both equal in risks and benefits. Hemodialysis can be performed in-center or at home, while peritoneal dialysis is performed at home. For hemodialysis, needles are required to access the dialysis access site, whereas in peritoneal dialysis, a catheter is placed in the abdomen which can be used to perform dialysis without any needles.
Before Your First Treatment
Several weeks or months before you begin dialysis treatment, your doctor will perform a small, out-patient operation to create a connection point for the dialysis machine to attach to a vein in your arm or wrist. Known as an arteriovenous fistula, this insertion point must be fully healed in order to get the best connection with the machine, which is why your doc will do it well in advance of treatment. A graft (inserting a plastic tube under your skin to connect your vein with the machine artery) and a catheter (inserting a tube directly into your neck) are less common methods of creating an attachment point.
While you’re waiting for your surgery to heal, read up on your treatment. Many nephrologists (that’s fancy for kidney doctor) and dialysis centers or clinics offer educational programs that provide detailed information about what will happen over the course of treatment. These classes can be in-person or online, and they are great resources if you’re nervous about your first dialysis session. If you’re taking the class online, be sure to write down any questions you may have and bring them to your appointment.
What Happens at the Clinic
At that first appointment, things should run fairly seamlessly—your clinic likely performs hundreds of these treatments every week. You’ll be asked to come into a room where the someone on your care team will weigh you and take vitals such as blood pressure, temperature and heart rate. Then you’ll be escorted to a comfortable chair or bed, where you’ll be connected with a dialysis machine via the port in your arm. For the next three to four hours, the machine will remove your blood, filter fluids and wastes from it, then return it to your body. Most people visit their dialysis center for three treatments a week.
The process can be tiring, and sometimes makes you nauseous. It can also be downright boring, and since you can’t move around during it, it’s a smart idea to bring books, your phone, headphones, and some downloaded podcasts to help pass the time. Your blood pressure will be monitored throughout treatment, and again at the end (you may feel a little lightheaded and need to sit for a few minutes afterward until you feel better).
Doing Dialysis at Home
While many people receive dialysis at a local center, some people can have dialysis at home. “If you are getting treatment at home, you still require multiple hours of dialysis each week, but there is far greater flexibility in the schedule since you determine the timing that works best,” says Francesca Tentori, M.D., medical director of outcomes research and patient empowerment at DaVita and an adjunct instructor in medicine at Vanderbilt University.
One type of home dialysis is known as peritoneal dialysis. It uses the lining of your abdomen (known as your peritoneum) to serve as a filter, and a solution known as dialysate to clean and absorb toxins from your blood. People like peritoneal dialysis because it is convenient, although it can make you feel bloated and needs to be performed daily. Also, before you begin peritoneal dialysis you must have a catheter surgically implanted in your belly, allowing several weeks for it to heal, says Michael Spigler, vice president of patient services and kidney disease education at the American Kidney Fund.
Another method of home dialysis uses a small machine that can work at night while you sleep. It requires a fair amount of training, and you or a fully trained family member or friend must insert needles into your body as part of the treatment.
What to Know About Diet
Dialysis filters excess fluids and wastes from your blood. Your goal is to make it as easy as possible for the machine to do its thing, so limiting your intake of certain minerals like sodium, potassium, and phosphorus will give you a head start. Eating foods high in these minerals between treatments can lead to side-effects such as bloating, swelling, nausea, and heart palpitations, while avoiding these foods can help you feel better.
You’ll also need to limit your liquids, since your body has no ways to get rid of them except through dialysis. Drinking too many fluids can stress your kidneys and lead to bloating, blood pressure changes, and swelling between treatments. Most people on dialysis have a fluid restriction of 1 liter per day, according to Kristen F. Gradney, R.D., a renal dietician and spokesperson for the Academy of Nutrition and Dietetics.
Dialysis providers usually have a staff dietitian who can create a personalized eating and drinking plan for you. That’s especially helpful if you have other conditions, such as diabetes or celiac disease, that have their own dietary restrictions as well.
Expect to Feel Emotional
Beginning dialysis can bring up intense feelings. After an adulthood of independence, you’re no longer self-sufficient. “Dialysis is a life-changing event,” Spigler says. “You’re suddenly dependent on a machine and on other people to keep you alive, and there’s going to be emotional baggage that comes with that.”
Most dialysis care providers have a social worker on staff; it’s smart to take advantage of this resource—they’ve helped a lot of other people transition to dialysis and can offer ideas on how to not let it bring you down. “Depression and anxiety are a normal part of this process, so don’t hide them,” Spigler says. “Be honest with your social worker and yourself about what you’re feeling. If you’re not, you won’t get the care you need.”
Emotional support can also come from other dialysis patients. The National Kidney Foundation’s NKF Peers Program matches dialysis patients with peer mentors by phone. Joining a support group at your local hospital can also help by connecting you with other dialysis patients so you don’t feel isolated.
Figure Out Your Finances
Navigating health insurance coverage for dialysis can be complex. “Everyone’s insurance is different in terms of how they pay for dialysis,” Pastan says. All dialysis providers have social workers who can work with you to understand and optimize your coverage.
If you’re struggling to pay for your care, your social worker may be able to point you to organizations that provide financial assistance. One such resource is the American Kidney Fund, which offers financial grant programs for kidney patients who can’t afford to pay for their treatment.
If you didn’t work out before, start now. And if you’ve been active all your life, this is no time to stop! Even if fatigue, physical limitations, or time restrictions putting a damper on your activity, making fitness a priority will serve you well in the long run. “Try not to become sedentary,” says Spigler. “Not exercising will only compound other physical and emotional issues.” Tap into an active lifestyle through daily walks, bike rides, and group classes at your local gym. (Check with your doctor first.) Regular exercise can boost your energy, build muscle strength, improve your mood, help you sleep well, and keep your blood pressure under control. In other words, something everyone should do—dialysis or not!
Kidney Disease and Treatment: National Kidney Foundation. (n.d.) “Kidney Disease: The Basics.” kidney.org/news/newsroom/factsheets/KidneyDiseaseBasics
Kidney Failure and Dialysis: National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.) “Hemodialysis.” niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis
Kidney Failure and Dialysis: National Kidney Foundation. (n.d.) “Dialysis.” kidney.org/atoz/content/dialysisinfo
Home Dialysis: American Kidney Fund. (n.d.) “Peritoneal Dialysis.” kidneyfund.org/kidney-disease/kidney-failure/treatment-of-kidney-failure/peritoneal-dialysis-pd.html
Home Dialysis: National Kidney Foundation. (n.d.) “Home Hemodialysis.” kidney.org/atoz/content/homehemo
Kidney Disease and Insurance: American Kidney Fund. (n.d.) “Kidney Patient Financial Assistance.” kidneyfund.org/financial-assistance/information-for-patients/