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What is hemodialysis?How HD works
How hemodialysis works

During hemodialysis, your blood goes through a filter, called a dialyzer, outside your body. A dialyzer is sometimes called an “artificial kidney.

The three principles that make dialysis work

img diffusion

Particles in the areas of high concentration move towards the area of low concentration.

img osmosis 300x247

Fluid moves from areas of high water concentration to lower water concentration across a semi-permeable membrane until equilibrium is reached.

img ultrafiltration 300x247

Ultrafiltration is the removal of fluid volume from a patient.

Schatell D, Agar J. Help, I need dialysis! How to have a good future with kidney disease. Madison, WI: Medical Education Institute Inc. 2012. p. 34–38.
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There are two types of hemodialysis:

In-centre hemodialysis (ICHD)

Conventional ICHD is always an option and is a backup for other types of treatment. You have to go to your clinic or hospital at a scheduled time for ICHD treatment.

If you are on ICHD, arrive early for your treatment, wear comfortable clothes and bring something to pass the time. A physical assessment is performed, and your weight is measured before the treatment to assess how much water to remove during the HD treatment. Connecting to the hemodialysis machine requires your access site to be cleaned, needles inserted and/or catheter connected. After your prescribed treatment, you are disconnected from the machine and, once your blood pressure meets clinic standards, you can go home.

Older male patient on Artis Physio Plus with nurse 4

One of the advantages of this type of hemodialysis is that, you do not need to be trained for ICHD as clinical staff are present and will connect you to the machine and initiate treatment.

Advantages Inconvenients Post-treatment symptoms
  • No training required
  • Treatment managed by staff
  • No storage and management of supplies
  • Large time commitment
  • Travel to hospital 3 times/week
  • Treatment time and prep – more than 3-5 hours
  • Dependent of others
  • Feeling tired
  • Discomfort such as: nausea, leg cramps, during or after treatment

Home hemodialysis (HHD)

Female patient on AK 98 machine reading a book

Because HHD is done at home, the treatment schedules may vary from short daily or nocturnal HD (overnight HD). The decision on the treatment method will be made in partnership with your nephrology care team and will be based on your treatment needs and overall health assessment. It has been shown that the clinical benefits increase the more dialysis is done.1

1. Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs. conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA. 2007; 298:1291–1299.

See table below for short description.

Home hemodialysis options (HHD)

Short daily Nocturnal Conventional
  • Sessions run from 2,5-4 hours/day
  • 5-6 days a week
  • Done while you sleep for 8-10 hours
  • 3-6 days a week
  • Sessions of 3-4 hours
  • 3 times per week
Advantages Advantages Advantages
  • Frequent treatments
  • Liberal diet and fluid intake
  • Most flexible type of HHD
  • Carry out your daily activities like: work, school, other
  • Only need to take 3 afternoons or evenings in your weekly schedule
Inconvenient Inconvenient Inconvenient
  • Increased use of supplies
  • Need to take good care of your vascular access
  • Less frequently used option
Regardless of the type of home dialysis you and your healthcare team determine is best for your kidney disease and lifestyle, a nurse will always train you and your family on how the dialysis machine works and how to do dialysis at home.