Preparing for dialysis session

Overview

Dialysis is a treatment that does some of the work your kidneys would do when they are no longer healthy enough. It filters waste and extra fluid from your blood. Preparing for a dialysis session means getting your body and mind ready for this routine treatment so it goes smoothly and safely.

Yes, millions of people around the world receive dialysis. It is a common treatment for advanced kidney disease.

Dialysis is needed by people whose kidneys have stopped working well enough to keep them healthy. This can happen at any age, but it is more common in older adults and those with long-term conditions such as diabetes and high blood pressure.

Symptoms

Common symptoms

• Feeling very tired or weak
• Swelling in your ankles, feet, or hands (fluid build-up)
• Shortness of breath
• Nausea or vomiting
• Loss of appetite
• Itchy skin

Symptoms in children

• Poor growth or weight gain
• Feeling more tired than usual
• Swelling around the eyes or belly
• Frequent headaches
• Trouble concentrating at school

Symptoms in older adults

• Confusion or trouble thinking clearly
• Loss of balance or falls
• Loss of appetite leading to weight loss
• Swelling in the legs or belly
• Dry, itchy skin

Causes

Main causes

• Diabetes (high blood sugar damages kidneys over time)
• High blood pressure (damages the small blood vessels in the kidneys)
• Glomerulonephritis (inflammation of the kidney's filtering units)
• Polycystic kidney disease (a genetic condition causing cysts in the kidneys)
• Long-term use of certain medicines that can harm the kidneys

Risk factors

• Having diabetes or high blood pressure
• A family history of kidney disease
• Being over age 60
• Being of African, Hispanic, or Indigenous descent (higher rates of kidney disease)
• Obesity
• Smoking

When to see a doctor

See a doctor urgently if:

• If you miss a dialysis session and feel short of breath, have chest pain, or notice severe swelling
• If you have signs of infection at your dialysis access (redness, pus, fever)
• If you feel faint, confused, or have a very fast heart rate

Book a routine appointment if:

• Attend all scheduled dialysis sessions and follow-up appointments with your kidney specialist (nephrologist)
• See your doctor if you have any changes in your health, like new swelling or feeling more tired than usual

Diagnosis

Kidney disease is diagnosed through blood and urine tests that measure how well your kidneys are filtering waste. If your kidney function is very low, you may be referred to a kidney specialist who will talk with you about starting dialysis.

Tests that may be done

• Blood tests: check levels of creatinine and urea (waste products)
• Urine tests: look for protein or blood in the urine
• Estimated glomerular filtration rate (eGFR): a number that tells how well your kidneys are working
• Ultrasound of the kidneys: to see their size and shape

What to expect at your appointment

If your doctor decides you need dialysis, you will first have a minor surgery to create a 'dialysis access' – a site where blood can be safely taken out and returned. For haemodialysis, this is often a fistula (joining an artery and a vein in your arm). You will also learn how to prepare for each session, including checking your access site, eating a kidney-friendly diet, and taking your medicines as prescribed.

Treatment

Dialysis is the main treatment for advanced kidney failure. It replaces some of the work your kidneys can no longer do. Preparing for a dialysis session helps the treatment go smoothly and reduces the risk of problems.

Self-care at home

• Check your dialysis access site every day for signs of infection (redness, swelling, warmth) or a 'thrill' (a vibration feeling that means the access is working).
• Keep the access site clean and dry. Follow your healthcare team’s instructions for washing and protecting it.
• Take all prescribed medicines exactly as directed. These may include medicines to control blood pressure, balance minerals, or prevent anaemia.
• Follow a kidney-friendly diet. This usually means limiting salt, potassium, phosphorus, and fluids. Ask your dietitian for a plan that fits you.
• Weigh yourself every day and tell your dialysis team if you gain more than 2 kilograms (about 4–5 pounds) between sessions – this can mean too much fluid.
• Stay active as much as you can. Gentle exercise like walking can help you feel better.
• Get enough rest. Dialysis can be tiring, so listen to your body.

Medical treatments

Dialysis itself is a medical treatment that filters your blood. Your healthcare team will prescribe a specific schedule (usually three times a week) and adjust the dialysis session based on your blood tests and how you feel. They may also prescribe medicines to help control your blood pressure, treat anaemia (low red blood cells), and manage minerals like phosphorus and calcium. These are given at your dialysis centre or taken at home. Always follow your doctor’s instructions for any medicines.

When is surgery considered?

A minor surgery is needed to create your dialysis access before you start haemodialysis. This is called arteriovenous (AV) fistula creation or, in some cases, a graft or a catheter placement. This surgery is done by a vascular surgeon and is usually an outpatient procedure. You will need to care for the access site after surgery to keep it healthy.

Living with this condition

Living with dialysis means fitting your treatment into your weekly routine. Many people manage dialysis by planning ahead – for example, scheduling sessions at times that work best for you, arranging transportation, and preparing snacks or meals to bring. You can still work, travel, and enjoy hobbies, but you may need to plan dialysis stops or use a dialysis centre near your destination.

Lifestyle tips

• Build a support network of family, friends, and healthcare providers who understand your needs.
• Stay connected with your dialysis team – they can help with problems like low energy, itching, or trouble sleeping.
• Keep a log of your weight, blood pressure, and any symptoms to share with your doctor.
• Avoid smoking and limit alcohol, as these can harm your kidneys and overall health.

Diet and exercise

A kidney-friendly diet is very important. You will likely need to limit salt, potassium (found in bananas, potatoes, tomatoes), phosphorus (found in dairy, nuts, cola drinks), and fluids. A dietitian can give you a personalised plan. For exercise, try gentle activities like walking, stretching, or light resistance training – but always check with your doctor first if you have a catheter or fistula.

Mental health and emotional wellbeing

It is normal to feel sad, anxious, or frustrated about needing dialysis. Many people feel a sense of loss or worry about the future. These feelings are common, and you don’t have to face them alone. Talk to your doctor, a counsellor, or a support group. If you ever feel overwhelmed or have thoughts of harming yourself, please call a crisis helpline right away. You are not alone.

Prevention

Kidney disease can often be prevented or slowed down by managing conditions like diabetes and high blood pressure, eating a healthy diet, staying active, not smoking, and limiting alcohol. Once kidney failure has developed, dialysis is needed – but taking good care of yourself can help you stay as healthy as possible.

Vaccines

It is important to get recommended vaccines, such as the flu shot and pneumonia vaccine, because people on dialysis are at higher risk for infections. Talk to your doctor about which vaccines are right for you.

Screening programmes

If you have diabetes, high blood pressure, or a family history of kidney disease, your doctor may check your kidney function with blood and urine tests every year. Early detection can help slow the disease.

Complications

If left untreated

• Fluid build-up that causes swelling and shortness of breath
• High levels of potassium in the blood (can lead to dangerous heart rhythms)
• Anaemia (low red blood cells, causing severe tiredness)
• Bone disease because of imbalanced minerals
• Increased risk of infections
• Heart problems, including heart failure

Long-term outlook

With regular dialysis and good self-care, many people live full, active lives for years. The treatment helps you feel better and can prevent the most serious complications. Your outlook is brightest when you work closely with your healthcare team, follow your treatment plan, and take care of your overall health. There is also hope for a kidney transplant for many people, which can free you from dialysis.

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