Haemodialysis: what patients should know

Understanding haemodialysis

Healthy kidneys constantly filter waste products and extra fluid out of the blood and pass them out as urine, while also helping control blood pressure, salt and mineral balance. When kidney function fails to the point where the body can no longer safely manage on its own, haemodialysis takes over part of that job: blood is drawn from the body, passed through an artificial filter (a dialyser, sometimes called an "artificial kidney") that removes waste and excess fluid, and returned to the body — usually over three sessions a week, each lasting several hours.

Dialysis is not a cure and not a short course of treatment — it is an ongoing, recurring form of life support for the kidneys, usually continuing indefinitely unless a kidney transplant becomes possible. Because of that, living with dialysis well is as much about the routines between sessions — fluid, diet, medicines, protecting your vascular access — as it is about the sessions themselves.

Vascular access and what a session involves

Every haemodialysis session needs a reliable way to move a large volume of blood out to the filter and back — this is called vascular access, and protecting it is one of the most important parts of living with dialysis.

• ●Arteriovenous (AV) fistula — a surgical join between an artery and vein, usually in the arm, that strengthens the vein over some weeks so it can be used repeatedly; generally the preferred long-term access
• ●AV graft — a synthetic tube joining an artery and vein, used when a person's own veins are not suitable for a fistula
• ●Central venous catheter — a tube placed into a large vein, usually in the neck or chest, often used when dialysis is needed urgently or while a fistula matures

During a session, two needles (or catheter ports) connect the access to the dialysis machine — blood flows out through one, through the filter, and back through the other. Most people feel the needle placement but not the filtering itself; some notice tiredness, light-headedness or cramping as fluid is removed, which the care team monitors and adjusts for throughout.

Why kidneys reach the point of needing dialysis

Dialysis becomes necessary when kidney function has declined so far that waste products and fluid can no longer be safely managed without support — usually the end stage of a process that has built up over years.

• ●Diabetes — the leading cause of kidney failure worldwide, from long-term damage to the kidneys' filtering units
• ●High blood pressure — very common in Nigeria and often undiagnosed, it damages the small blood vessels within the kidneys over time
• ●Glomerulonephritis — inflammation of the kidneys' filtering units from various causes
• ●Recurrent kidney infections or long-standing obstruction — such as from stones or an enlarged prostate
• ●Polycystic kidney disease — an inherited condition causing fluid-filled cysts that gradually replace healthy kidney tissue
• ●Sudden severe kidney injury that does not recover, from a major illness, severe dehydration or certain medicines

Who is more likely to need dialysis

• ●Diabetes, particularly if blood glucose has been poorly controlled over years
• ●High blood pressure, especially if long-standing or poorly controlled
• ●A family history of kidney disease
• ●Existing heart disease — the heart and kidneys affect each other closely
• ●Regular use of certain pain medicines over long periods
• ●Older age
• ●Anaemia and other markers picked up incidentally on blood tests

What can happen without consistent dialysis and follow-up

Missing sessions or letting fluid and mineral levels drift is not a minor lapse — kidney failure without adequate dialysis has serious, sometimes rapid, consequences.

Fluid overload. Without the kidneys' or dialysis's help to remove excess fluid, it can build up in the lungs, causing severe breathlessness, and around the heart.

Dangerous potassium levels. The kidneys normally keep blood potassium within a safe range; when this fails, potassium can rise to levels that disturb the heart's rhythm, occasionally dangerously.

Heart strain. Long-term kidney failure and fluid overload place extra strain on the heart, contributing to high blood pressure and, over time, heart failure.

Access problems. A poorly protected fistula, graft or catheter can clot, narrow or become infected, threatening the reliable access dialysis depends on.

Ongoing monitoring alongside dialysis

Cardiocare's dialysis care draws on regular, coordinated review rather than a single test:

• 01
  Kidney and electrolyte blood tests. Regular blood tests track how well waste and minerals, including potassium, are being controlled between sessions.
• 02
  Dialysis prescription and dry-weight assessment. Session length, frequency and fluid-removal targets are reviewed and adjusted as your needs change.
• 03
  Vascular access examination. Your fistula, graft or catheter is checked regularly for signs of narrowing, infection or reduced flow.
• 04
  Heart and anaemia monitoring. Because kidney failure affects the heart and commonly causes anaemia, both are tracked and treated as part of the same care plan.

Medicines and other treatments alongside dialysis

Dialysis itself removes waste and fluid, but several other treatments usually run alongside it to manage the wider effects of kidney failure; your clinician will discuss the right choice and dose for you:

• ●Phosphate binders — taken with meals, reduce absorption of phosphate, which failing kidneys can no longer clear
• ●Erythropoiesis-stimulating agents — replace a hormone the kidneys normally produce to make red blood cells, treating the anaemia common in kidney failure
• ●Iron supplements — support red blood cell production alongside the above
• ●Blood pressure medicines — control blood pressure, which is closely linked to fluid balance in kidney failure
• ●Vitamin D and calcium-related medicines — support bone health, which is commonly affected by long-term kidney failure

For selected patients, a kidney transplant can eventually replace the need for dialysis altogether — see our guides to transplant evaluation and beginning the transplant journey.

Living with dialysis: your daily and weekly routine

Dialysis becomes part of the rhythm of life rather than a single event, and consistency between sessions matters as much as the sessions themselves:

• ✓Do not miss or shorten sessions without contacting the unit first — missed sessions let waste and fluid build up quickly
• ✓Protect your fistula or graft arm — avoid blood pressure checks, injections or heavy lifting on that side, and check daily for warmth, swelling or the usual buzzing feeling
• ✓Follow your individual fluid, salt and potassium guidance closely between sessions — small daily choices add up over a week
• ✓Take phosphate binders and other prescribed medicines consistently, and with meals if advised
• ✓Keep catheter sites clean and dry, and report any redness, discharge or fever promptly
• ✓Plan work, travel and family commitments around your dialysis schedule — most units can help arrange care if you travel
• ✓Bring any new symptoms, tiredness or medicine concerns to your care team rather than adjusting things yourself

Preparing for your appointment

What to bring

• ✓A list of all medicines you take, including herbal and over-the-counter preparations
• ✓Recent blood test results or a dialysis diary if you keep one
• ✓Your HMO card or payment details
• ✓A valid means of identification

What we will ask

How sessions have been going, any symptoms between sessions, changes in weight or swelling, appetite, and how you are managing fluid and dietary guidance.

Questions worth asking us

• ●Is my dialysis prescription still right for me?
• ●How is my access, and is there anything I should change to protect it?
• ●Could I be considered for kidney transplant evaluation?
• ●What symptoms should bring me back before my next scheduled visit?