Hemodialysis (HD) is a medical procedure that removes waste, excess fluids, and toxins from the blood when the kidneys are no longer able to do so adequately—usually in end-stage renal disease (ESRD) or chronic kidney disease (CKD) stage 5.

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🩺 Hemodialysis (HD): Complete Guide

1. What is Hemodialysis?



2. Purpose of Hemodialysis

  • Removes uremic toxins (urea, creatinine)

  • Balances electrolytes (potassium, sodium, calcium, etc.)

  • Maintains fluid balance

  • Regulates acid–base balance

  • Reduces symptoms of kidney failure (nausea, fatigue, swelling)

3. When is Hemodialysis Needed?

Indications include:

  • GFR <15 mL/min/1.73m² (CKD stage 5)

  • Symptoms of uremia (confusion, nausea, breathlessness)

  • Severe electrolyte imbalances (e.g., hyperkalemia)

  • Volume overload not responsive to diuretics

  • Metabolic acidosis

  • Acute kidney injury (AKI) in some cases

4. How Hemodialysis Works

The Basic Principle:

Blood is passed through a dialyzer (artificial kidney), which filters waste and excess fluid through a semi-permeable membrane and then returns clean blood to the body.

Steps:

  1. Blood is drawn through a vascular access (e.g., AV fistula).

  2. Blood flows into the dialyzer.

  3. Waste and fluids pass into the dialysate solution.

  4. Cleaned blood returns to the body.

5. Components of the Hemodialysis System

Component Function
Dialyzer Filters blood; contains thousands of tiny fibers for diffusion
Dialysate Special fluid that helps remove waste and balances electrolytes
Blood pump Moves blood from patient through dialyzer and back
Monitoring system Checks pressure, flow rates, clotting, and safety

6. Types of Vascular Access

Type Description Pros Cons
AV Fistula Surgical connection of an artery and vein Long-lasting, low infection risk Takes weeks to mature
AV Graft Synthetic tube between artery and vein Faster to use Higher infection/clotting risk
Central Venous Catheter (CVC) Tube placed in a large vein (neck, chest) Immediate use High risk of infection, temporary

7. Hemodialysis Schedule

  • Frequency: Typically 3 times per week

  • Duration: About 3 to 5 hours per session

  • Can be done in-center or at home (home HD)

8. Home Hemodialysis

  • Requires training

  • Can be done daily or at night (nocturnal dialysis)

  • Offers more flexibility and better quality of life

  • Not suitable for all patients

9. Dietary and Fluid Restrictions

Nutrient/Fluid Restriction
Protein Moderate intake for non-HD; increased in HD
Sodium Low sodium diet to prevent fluid retention
Potassium Avoid high-potassium foods (bananas, oranges, potatoes)
Phosphorus Restricted (dairy, nuts, dark sodas)
Fluids Limited (usually ~1 liter/day depending on urine output)

10. Complications of Hemodialysis

During Treatment:

  • Hypotension (low blood pressure)

  • Cramps

  • Nausea/vomiting

  • Headache

  • Dialysis disequilibrium syndrome (rare, from rapid urea removal)

Long-Term:

  • Infection at access site

  • Access clotting or failure

  • Anemia

  • Bone disease (renal osteodystrophy)

  • Cardiovascular disease

  • Amyloidosis (β2-microglobulin buildup)

11. Medications Commonly Used in Dialysis Patients

  • Erythropoietin (EPO): Treats anemia

  • Iron supplements

  • Phosphate binders: Prevent high phosphorus levels

  • Vitamin D analogs: Help bone health

  • Antihypertensives

  • Anticoagulants (e.g., heparin): Used during dialysis

12. Hemodialysis vs Other Renal Replacement Therapies

Therapy Description Pros Cons
Hemodialysis Blood filtered by machine Effective, widely available Time-consuming, strict schedule
Peritoneal Dialysis Uses the peritoneum to filter blood Can be done at home, flexible Risk of peritonitis
Kidney Transplant Surgical replacement with donor kidney Best long-term outcome Requires donor, immunosuppressants

13. Psychological and Social Impact

  • Anxiety, depression are common

  • Time-consuming schedule can impact work and social life

  • Support groups, counseling, and education are vital

  • Dialysis patients often benefit from renal rehabilitation programs

14. Life Expectancy on Hemodialysis

  • Varies widely (5–10 years average), depending on:

    • Age

    • Other health conditions

    • Dialysis quality

    • Comorbidities (like diabetes, heart disease)

  • Some live 20+ years on dialysis with good care

15. Tips for Patients on Hemodialysis

  • Follow diet and fluid guidelines

  • Keep access site clean

  • Don’t skip sessions

  • Monitor weight and blood pressure

  • Report symptoms (fatigue, dizziness, shortness of breath)

  • Stay active if possible

16. Summary


Feature		 Description
What is it?             Blood filtration process to replace kidney function
Who needs it? Patients with ESRD (CKD stage 5)
How often? 3 times/week (standard), daily in some cases
Where? Dialysis center or home
Benefits Removes toxins, balances electrolytes, relieves symptoms
Risks Infections, hypotension, access failure

Would you like a PDF handout, visual chart, or a patient-friendly version of this? I can also explain how to prepare for a dialysis session if you want practical tips.


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