If your kidney disease becomes very severe and crosses a point where there’s not enough function to maintain the body, then you need either a transplant or dialysis.

You typically start dialysis when you have symptoms or your lab tests show toxic levels of waste in your blood. Symptoms of kidney failure include nausea, fatigue, swelling, and throwing up. 

When you should start dialysis depends on your age, energy level, overall health, lab test results and how willing you are to commit to a treatment plan. Although it can make you feel better and live longer, it involves a lot of your time.

Preparation for hemodialysis starts several weeks to months before your first procedure. To allow for easy access to your bloodstream, a surgeon will create a vascular access. The access provides a mechanism for a small amount of blood to be safely removed from your circulation and then returned to you in order for the hemodialysis process to work. The surgical access needs time to heal before you begin hemodialysis treatments.

During hemodialysis, two needles are inserted into your arm through the access site and taped in place to remain secure. Each needle is attached to a flexible plastic tube that connects to a dialyzer. Through one tube, the dialyzer filters your blood a few ounces at a time, allowing wastes and extra fluids to pass from your blood into a cleansing fluid called dialysate. The filtered blood returns to your body through the second tube.

When hemodialysis is completed, the needles are removed from your access site and a pressure dressing is applied to the site to prevent bleeding. Your weight may be recorded again. Then you're free to go about your usual activities until your next session.

Between hemodialysis treatments, you can help achieve the best possible results from your hemodialysis if you:

• Eat the right foods. Eating properly can improve your hemodialysis results and your overall health. While you're receiving hemodialysis, you'll need to carefully monitor your intake of fluids, protein, sodium, potassium and phosphorus. A dietitian can help you develop an individualized meal plan based on your weight, personal preferences, remaining kidney function and other medical conditions, such as diabetes or high blood pressure.
• Take your medications as prescribed. Carefully follow the instructions from your health care team.
• Allow your team to assist you by discussing your concerns. Your health care team can present options to you and help you deal with any concerns.