The decision to begin dialysis for kidney failure can feel overwhelming. Dialysis is a life-sustaining process that filters waste products and excess fluid from the blood, taking over the work of the failing kidneys. It is normal to feel a mix of shock, worry, and relief when starting treatment. Understanding the process of starting treatment can help replace anxiety with confidence. This guide breaks down the practical and personal adjustments you can expect during this health journey.
Preparing the Body: Vascular Access and Catheter Placement
Before filtration begins, a specialized entry point into the bloodstream, known as vascular access, must be created to handle the high blood flow rates required for effective treatment. This preparatory step is usually completed well in advance of the first session to allow for proper healing. There are three primary types of access, each with a different timeline for use.
The preferred method is the arteriovenous (AV) fistula, where a surgeon connects an artery directly to a nearby vein, usually in the arm. This connection causes the vein to enlarge and thicken (maturation), which can take six to eight weeks before the site is ready for hemodialysis needles. A second option is an AV graft, which uses a synthetic tube to connect an artery and vein, and it can typically be used in two to four weeks.
For those needing immediate treatment, a central venous catheter is often placed in a large vein in the neck or chest. This soft plastic tube can be used right away but is considered a temporary solution due to a higher risk of infection and blood clots compared to a fistula or graft. Proper care of the site is mandatory to ensure its function. Patients must avoid sleeping on the access arm, carrying heavy objects, or wearing tight clothing that could restrict blood flow near the site.
Your First Dialysis Sessions
The first few dialysis sessions allow your body and care team to determine the optimal treatment settings. Hemodialysis usually involves visiting a clinic three times a week, with each session lasting approximately three to four hours. During the session, blood is drawn out through one needle, cleaned in an artificial kidney called a dialyzer, and then returned to the body through a second needle.
The physical experience of the first treatment involves new sensations as the body adjusts to rapid fluid and waste removal. Feeling cold is common because a portion of your blood circulates outside the body through the machine before being returned. Patients should wear warm clothing or ask for a blanket to manage this.
The most frequent side effects are related to a sudden drop in blood pressure (hypotension). This can cause lightheadedness, nausea, or dizziness if fluid is removed too quickly. Muscle cramps, particularly in the legs, may also occur due to shifts in fluid and electrolyte balance. Your care team will closely monitor your blood pressure and adjust the fluid removal rate to minimize these symptoms.
Alarms from the dialysis machine are a regular occurrence and do not typically signal severe danger. These sounds indicate that a monitored parameter, such as blood flow pressure, has gone outside its preset range, prompting a nurse to check the machine. Side effects like cramping or low blood pressure are often managed and reduced in subsequent sessions as the care team learns how your body responds.
Managing Diet, Fluids, and Medications
Starting dialysis requires strict management of consumption, making a partnership with a renal dietitian extremely helpful. Since the kidneys no longer regulate fluid and waste effectively, careful control of fluid intake is necessary to prevent excessive weight gain between treatments. Limiting fluid intake is important because removing too much fluid during dialysis can trigger unpleasant side effects like severe cramping and low blood pressure.
Dietary restrictions primarily focus on three minerals: potassium, phosphorus, and sodium. Potassium levels can rise between sessions, risking heart function, so foods like bananas, oranges, and potatoes are limited. Phosphorus builds up, potentially leading to weak bones and itchy skin, and is found in high amounts in dairy, nuts, and dark colas. Patients often take phosphate binder medications with meals to prevent phosphorus absorption.
Sodium intake is restricted because it increases thirst, complicating fluid restriction and contributing to high blood pressure. Paradoxically, dialysis patients often need to increase their protein intake, particularly from high-quality sources like lean meats and eggs, because the dialysis process removes some protein. Balancing these complex dietary needs requires meticulous planning and consistent communication with the healthcare team.
Adherence to a new medication regimen is fundamental to managing health while on dialysis. Many patients require injections of Erythropoietin-Stimulating Agents (ESAs) to treat anemia, a common complication of kidney failure. Maintaining proper blood pressure is also important; while blood pressure medications are necessary, they may need adjustment or may be held on treatment days to avoid a drop in pressure during the session.
Adjusting to a New Routine: Social and Emotional Impact
The physical demands and time commitment of dialysis treatments create significant shifts in a person’s weekly schedule and overall quality of life. The three-times-per-week commitment fundamentally alters personal and professional routines, requiring re-integration of work, family, and social activities around the treatment schedule. This logistical burden can lead to feelings of isolation and frustration.
Chronic fatigue is a pervasive non-physical symptom, and patients often feel extremely tired, especially after a treatment session. This persistent tiredness makes it challenging to maintain energy levels for daily responsibilities and social engagement. Sleep disturbances, including insomnia and sleep apnea, are also prevalent among those undergoing dialysis, further compounding the fatigue.
The emotional response to starting dialysis is complex, often involving feelings of denial, anger, sadness, and worry. A significant number of dialysis patients experience depression and anxiety, which are natural responses to a life-changing chronic illness and the uncertainty it brings. It is important to recognize these feelings as normal.
Seeking support is a necessary part of adjusting to the new routine. Connecting with a social worker, counselor, or support group can provide valuable coping strategies and a safe space to process the emotional toll. Sharing experiences with other patients helps alleviate feelings of isolation and provides practical advice for navigating the new lifestyle.