Comprehensive Hemodialysis, Kidney Failure & Renal Support Care

The Dialysis Service at AS Medical Complex provides specialized renal-support care for patients whose kidneys are no longer able to adequately remove waste products, maintain fluid balance, and regulate important minerals within the body.

Dialysis is a form of kidney replacement therapy used for selected patients with severe kidney dysfunction or kidney failure.

The kidneys normally perform several important functions, including:

• Removing waste products from the blood

• Removing excess fluid

• Maintaining sodium balance

• Maintaining potassium balance

• Helping regulate blood pressure

• Supporting red-blood-cell production

• Maintaining acid-base balance

• Supporting bone and mineral health

When kidney function becomes severely impaired, waste products and excess fluid can accumulate within the body and cause serious health problems.

Hemodialysis helps replace part of the kidneys’ filtering function by passing the patient’s blood through a specialized filter called a dialyzer and returning the cleaned blood to the body.

At AS Medical Complex, dialysis care should be coordinated with the Nephrology Department and individualized according to the patient’s kidney function, symptoms, laboratory findings, fluid status, cardiovascular condition, vascular access, medications, nutritional requirements, and overall health.

Our Dialysis Services

Depending on clinical need and available facilities, the Dialysis Service at AS Medical Complex may provide:

• Hemodialysis

• Maintenance hemodialysis

• Dialysis for kidney failure

• Dialysis for selected acute kidney injury patients

• Nephrology-supervised dialysis planning

• Dialysis-session monitoring

• Pre-dialysis assessment

• Blood-pressure monitoring

• Weight and fluid-status assessment

• Vascular-access assessment

• AV fistula monitoring

• AV graft monitoring

• Dialysis catheter assessment

• Dialysis access care

• Laboratory monitoring

• Electrolyte monitoring

• Potassium monitoring

• Hemoglobin monitoring

• Kidney-function assessment

• Fluid-balance management

• Dialysis diet counseling

• Renal nutrition coordination

• Medication review

• Anemia assessment

• Bone and mineral disorder assessment

• Dialysis-related infection prevention

• Hepatitis-related screening according to clinical protocols

• Post-dialysis assessment

• Long-term kidney-failure follow-up

• Referral for vascular-access creation

• Referral for AV fistula or graft procedures

• Peritoneal dialysis counseling and referral where appropriate

• Kidney-transplant evaluation referral where appropriate

• Multidisciplinary renal care

• Dialysis second opinions

The exact services provided depend on each patient’s clinical needs and the facilities available at AS Medical Complex.

What Is Dialysis?

Dialysis is a treatment used when the kidneys cannot adequately perform some of their essential filtering functions.

Dialysis can help:

• Remove waste products

• Remove excess fluid

• Control selected electrolyte abnormalities

• Support acid-base balance

• Reduce complications caused by severe kidney dysfunction

Dialysis can improve symptoms and help sustain life in kidney failure, but it does not cure kidney failure.

Some patients may require dialysis temporarily.

Others may require long-term dialysis unless they:

• Recover sufficient kidney function

• Receive a kidney transplant

• Choose another medically appropriate treatment pathway

Kidney Failure

Kidney failure represents severe loss of kidney function.

NIDDK describes kidney failure as a stage in which kidney function has fallen to a very low level and waste products and excess water may begin to accumulate in the body.

Kidney failure may develop because of:

• Long-standing diabetes

• High blood pressure

• Chronic glomerular disease

• Polycystic kidney disease

• Recurrent kidney injury

• Autoimmune disease

• Congenital kidney disease

• Other chronic kidney disorders

Not every patient with chronic kidney disease will require dialysis.

Chronic Kidney Disease & Dialysis

Chronic Kidney Disease – CKD means that kidney damage or impaired kidney function has persisted over time.

CKD can progress through different stages.

In earlier stages, treatment may focus on:

• Blood-pressure control

• Diabetes management

• Medication

• Nutrition

• Reduction of cardiovascular risk

• Treatment of the underlying kidney disease

As kidney function becomes severely impaired, patients may need to discuss kidney-replacement options such as:

• Hemodialysis

• Peritoneal dialysis

• Kidney transplantation

• Conservative kidney-failure management in selected circumstances

The decision should be made with a nephrologist.

Dialysis Is Not Based on One Laboratory Number Alone

Patients sometimes believe that dialysis begins automatically when creatinine reaches one particular number.

This is not an appropriate way to make the decision.

A nephrologist may consider:

• Kidney function

• Symptoms

• Potassium

• Acid-base abnormalities

• Fluid overload

• Blood pressure

• Nutrition

• Urine output

• Overall medical condition

• Response to medical treatment

The need for dialysis should therefore be based on the complete clinical picture, not a single creatinine value.

Symptoms of Advanced Kidney Disease

As kidney function worsens, patients may develop symptoms such as:

• Fatigue

• Weakness

• Poor appetite

• Nausea

• Vomiting

• Itching

• Swelling

• Reduced concentration

• Changes in urination

• Muscle cramps

• Shortness of breath

• Sleep problems

NIDDK identifies these among possible symptoms of advanced kidney disease.

Some people can have very advanced kidney disease with relatively few symptoms, which is why laboratory and specialist monitoring remain important.

Acute Kidney Injury & Dialysis

Dialysis is not only used for chronic kidney failure.

Some patients with Acute Kidney Injury – AKI may require temporary dialysis when kidney function suddenly deteriorates.

Possible causes of acute kidney injury include:

• Severe infection

• Sepsis

• Major dehydration

• Severe blood loss

• Low blood pressure

• Major surgery

• Certain medications or toxins

• Urinary obstruction

• Other critical illnesses

Dialysis may be required temporarily if complications cannot be adequately controlled through other treatment.

Some patients later recover sufficient kidney function and dialysis can be stopped.

Others may have incomplete recovery and require ongoing renal care.

When May Urgent Dialysis Be Considered?

Urgent dialysis may be considered in selected patients when severe kidney dysfunction leads to complications such as:

• Dangerous potassium elevation

• Severe fluid overload

• Pulmonary edema

• Severe acid-base disturbance

• Certain toxin-related conditions

• Severe symptoms related to accumulated waste products

• Other life-threatening complications

These situations require urgent specialist or emergency assessment.

Hemodialysis

What Is Hemodialysis?

Hemodialysis is a treatment in which blood is removed from the body through a vascular access, passed through a specialized filter, and then returned to the body.

The filter is called a dialyzer.

The dialysis machine helps control:

• Blood flow

• Dialysis fluid

• Fluid removal

• Treatment parameters

• Safety monitoring

NIDDK describes the dialyzer as a filter through which the patient’s blood passes so that wastes and extra fluid can be removed.

How Hemodialysis Works

During hemodialysis:

• Blood leaves the body through vascular access.

• Blood travels through dialysis tubing.

• It enters the dialyzer.

• Waste products move out of the blood.

• Excess fluid can be removed.

• The filtered blood returns to the patient.

The process repeats continuously during the dialysis session.

What Does Dialysis Remove?

Hemodialysis can help remove:

• Urea and other waste products

• Excess sodium

• Excess potassium

• Excess fluid

• Selected other substances

Dialysis does not reproduce every normal kidney function perfectly.

Patients often continue to require:

• Medication

• Dietary management

• Fluid control

• Blood-pressure treatment

• Anemia treatment

• Bone and mineral management

Dialysis Session Frequency

The dialysis schedule should be prescribed by the treating nephrologist.

In many conventional in-center hemodialysis programs, treatment is commonly performed several times per week.

NIDDK describes a common in-center schedule as approximately three treatments each week, with sessions often lasting several hours.

However, this should not be treated as a fixed schedule for every patient.

Frequency and duration depend on:

• Remaining kidney function

• Body size

• Laboratory results

• Fluid accumulation

• Dialysis adequacy

• Medical condition

• Treatment type

Patients should follow their individualized prescription.

Before a Dialysis Session

Before treatment, the dialysis team may assess:

• Weight

• Blood pressure

• Pulse

• Temperature where appropriate

• Symptoms

• Swelling

• Breathing

• Vascular access

• Recent hospital admissions

• Medication changes

• Recent illness

Patients should tell the dialysis team about any new symptoms before treatment begins.

Pre-Dialysis Weight

Patients are commonly weighed before dialysis.

This helps estimate how much fluid has accumulated since the previous session.

The difference between:

• Target or dry weight

• Current pre-dialysis weight

can help guide fluid-removal planning.

Too much fluid should not be removed too rapidly because this can contribute to:

• Low blood pressure

• Cramping

• Dizziness

• Nausea

• Other symptoms

Dry Weight

Dry weight generally refers to the patient’s approximate weight after excess fluid has been removed and the patient is not significantly fluid overloaded.

Dry weight can change over time because of:

• Weight loss

• Weight gain

• Illness

• Changes in nutrition

• Heart disease

• Other factors

It therefore needs periodic clinical reassessment.

During Hemodialysis

During treatment, the dialysis team may monitor:

• Blood pressure

• Heart rate

• Symptoms

• Vascular access

• Blood flow

• Dialysis-machine parameters

• Fluid removal

The patient should immediately report symptoms such as:

• Chest pain

• Severe dizziness

• Shortness of breath

• Severe cramps

• Nausea

• Palpitations

• Chills

• Feeling suddenly unwell

After Dialysis

After treatment, the patient may be reassessed for:

• Blood pressure

• Weight

• Symptoms

• Access-site bleeding

• General stability

Some people feel relatively well after dialysis.

Others may temporarily experience:

• Fatigue

• Weakness

• Dizziness

• Mild headache

• Muscle cramps

Symptoms should be discussed with the dialysis team, especially if they are severe or recurrent.

Vascular Access

Why Is Vascular Access Needed?

Hemodialysis requires a reliable way to repeatedly remove blood from the patient and return it after filtration.

This is called vascular access.

The National Kidney Foundation identifies three main forms of hemodialysis access:

• Arteriovenous fistula

• Arteriovenous graft

• Central venous catheter

The appropriate access depends on the patient’s blood vessels, medical circumstances, urgency, and long-term dialysis plan.

AV Fistula

What Is an Arteriovenous Fistula?

An AV fistula is created surgically by connecting an artery directly to a vein, usually in the arm.

Over time, the vein becomes stronger and larger so that it can support repeated dialysis needle placement.

An AV fistula generally requires time to mature before routine use.

For many patients requiring long-term hemodialysis, a well-functioning AV fistula can provide durable vascular access with relatively low infection risk compared with a dialysis catheter.

AV Graft

An AV graft connects an artery and vein using a synthetic or other graft material.

It may be considered when the patient’s own blood vessels are not suitable for creating an effective fistula.

A graft can provide long-term dialysis access but requires careful monitoring for:

• Infection

• Narrowing

• Clotting

• Other access problems

Dialysis Catheter

A dialysis catheter is a specialized tube placed into a large vein, commonly in the neck or chest region.

Catheters can provide immediate access to the bloodstream and may be used when:

• Dialysis must start urgently

• A fistula has not matured

• A graft is not yet available

• Another vascular access cannot be used

Catheters are particularly useful for urgent dialysis but have a higher bloodstream-infection risk than fistulas or grafts.

Temporary vs Long-Term Dialysis Access

The choice of access depends on:

• Urgency

• Expected duration of dialysis

• Quality of the blood vessels

• Previous access procedures

• Infection history

• Cardiovascular status

• Individual patient factors

Patients expected to require long-term hemodialysis may benefit from early vascular-access planning rather than repeatedly relying on temporary catheters.

Vascular Access Planning

Patients with advanced CKD may be referred for vascular-access planning before dialysis is urgently required.

This can provide time for:

• Vein assessment

• Surgical consultation

• AV fistula creation

• Fistula maturation

• Alternative planning if required

Early planning can reduce dependence on emergency catheter access.

Caring for an AV Fistula or Graft

Patients should be taught how to protect their dialysis access.

General precautions may include:

• Keeping the access area clean

• Checking it regularly

• Reporting redness or swelling

• Avoiding unnecessary pressure on the access

• Protecting the arm from injury

• Following the dialysis team’s specific instructions

The dialysis team may also teach patients to recognize the normal vibration or thrill over the access.

A change or disappearance of the usual thrill may indicate an access problem and should be reported promptly.

Avoid Pressure on the Access Arm

Depending on the patient’s access and medical instructions, it may be appropriate to avoid:

• Blood-pressure cuffs

• Routine blood draws

• Tight clothing

• Heavy prolonged pressure

over the fistula or graft arm.

Patients should tell other healthcare professionals that they have a dialysis access.

Access Infection

Signs of vascular-access infection may include:

• Redness

• Warmth

• Swelling

• Tenderness

• Drainage

• Pus

• Fever

• Chills

Dialysis-access infections can become serious and should not be ignored.

The National Kidney Foundation advises dialysis patients to seek medical attention for signs such as redness, skin breakdown, or pus at the access site.

Catheter Infection

A dialysis catheter can provide a pathway for bacteria or other organisms to enter the bloodstream.

Catheter-related bloodstream infection can lead to:

• Fever

• Chills

• Weakness

• Low blood pressure

• Sepsis

The National Kidney Foundation notes that central venous catheters carry a higher bloodstream-infection risk than fistulas or grafts.

Dialysis Infection Prevention

Patients receiving hemodialysis have increased infection risk because treatment repeatedly requires access to the bloodstream.

CDC infection-prevention guidance emphasizes careful infection-control practices in dialysis facilities.

Dialysis safety measures may include:

• Hand hygiene

• Appropriate use of gloves

• Cleaning vascular-access sites

• Proper catheter care

• Safe medication preparation

• Environmental cleaning

• Correct disinfection of dialysis equipment

• Appropriate separation of clean and contaminated activities

• Infection surveillance

Hand Hygiene

Hand hygiene is one of the most important infection-prevention measures.

Patients should also feel comfortable asking whether appropriate hand hygiene has been performed before access manipulation.

Infection prevention is a shared safety responsibility.

Bloodstream Infection

A bloodstream infection in a dialysis patient can progress rapidly.

Symptoms may include:

• Fever

• Shivering

• Feeling very cold

• Rapid heartbeat

• Low blood pressure

• Confusion

• Severe weakness

• Shortness of breath

These symptoms require urgent medical assessment.

Sepsis

Sepsis is a dangerous systemic response to infection.

Dialysis patients may be particularly vulnerable because of:

• Kidney failure

• Vascular access

• Chronic medical conditions

• Reduced immune defenses

Possible warning signs include:

• Fever or chills

• Confusion

• Severe illness

• Rapid heartbeat

• Shortness of breath

• Clammy skin

A dialysis patient with suspected serious infection should receive urgent medical care.

Dialysis & Hepatitis Prevention

Because hemodialysis involves repeated blood exposure, dialysis programs require strict infection-prevention procedures.

Patients may undergo appropriate screening according to dialysis protocols for infections such as:

• Hepatitis B

• Hepatitis C

• Other blood-borne infections

Vaccination against hepatitis B may also be considered according to the patient’s immune status, previous vaccination, and nephrology recommendations.

Blood Pressure During Dialysis

Blood pressure can change significantly during treatment.

Patients with kidney failure may have:

• High blood pressure before dialysis

• Low blood pressure during dialysis

• Complex blood-pressure patterns

Fluid removal, medications, heart disease, and other factors can influence blood pressure.

Low Blood Pressure During Dialysis

A sudden drop in blood pressure is one of the more common dialysis-related problems.

Symptoms may include:

• Dizziness

• Nausea

• Weakness

• Sweating

• Blurred vision

• Faintness

The National Kidney Foundation lists low blood pressure, dizziness, weakness, cramps, headache, and nausea among symptoms that can occur during or after hemodialysis.

Patients should immediately tell the dialysis team if these symptoms occur.

Muscle Cramps

Muscle cramps can occur during hemodialysis.

They may be influenced by:

• Fluid removal

• Blood-pressure changes

• Electrolyte shifts

• Other individual factors

Recurrent severe cramps should be discussed with the nephrology and dialysis team rather than managed independently.

Nausea During Dialysis

Some patients experience nausea during treatment.

Possible contributing factors include:

• Low blood pressure

• Rapid fluid removal

• Kidney-failure symptoms

• Other medical issues

The dialysis team may need to adjust or investigate the treatment if nausea is frequent or severe.

Headache During Dialysis

Headache may occasionally occur during or after treatment.

The clinical team may assess:

• Blood pressure

• Fluid removal

• Medication

• Other causes

A sudden severe headache accompanied by neurological symptoms requires urgent medical assessment.

Chest Pain During Dialysis

Chest pain during dialysis should always be reported immediately.

Possible causes can include:

• Cardiac disease

• Blood-pressure changes

• Fluid problems

• Other serious medical conditions

Dialysis patients have substantial cardiovascular risk, so chest pain should not be dismissed.

Shortness of Breath

Breathlessness in a dialysis patient may be related to:

• Fluid overload

• Heart failure

• Anemia

• Lung disease

• Infection

• Other conditions

Severe or sudden breathlessness requires urgent assessment.

Fluid Overload

When kidneys cannot remove enough fluid, it can accumulate within the body.

Symptoms may include:

• Leg swelling

• Rapid weight gain

• High blood pressure

• Breathlessness

• Difficulty lying flat

• Fluid in the lungs

Dialysis can remove excess fluid, but the amount that can safely be removed during one session is limited.

Fluid Intake Between Dialysis Sessions

Some hemodialysis patients need to limit fluids between treatments.

Fluid comes from:

• Water

• Tea

• Coffee

• Milk

• Juice

• Soft drinks

• Soup

• Ice

• Foods containing large amounts of water

The exact fluid allowance should be determined individually.

It depends on:

• Urine output

• Dialysis schedule

• Heart function

• Blood pressure

• Swelling

• Other clinical factors

Patients should not copy another dialysis patient’s fluid allowance.

Salt & Fluid Retention

High sodium intake can increase thirst and contribute to fluid retention.

Patients may therefore be advised to reduce foods high in salt or sodium.

This can make fluid control easier between dialysis sessions.

Dialysis Nutrition

Nutrition is a major part of kidney-failure treatment.

Hemodialysis patients may need individualized management of:

• Sodium

• Potassium

• Phosphorus

• Protein

• Fluids

• Calories

NIDDK emphasizes that dietary requirements during hemodialysis should be individualized according to laboratory results and dialysis treatment.

At AS Medical Complex, renal dietary care may be coordinated with the Dietitian Service.

Protein During Hemodialysis

Patients sometimes assume that all kidney patients must severely restrict protein.

This is not always correct.

Hemodialysis can increase protein needs in some patients.

The correct intake depends on:

• Nutritional status

• Dialysis type

• Other diseases

• Body size

Patients should receive individualized advice from their nephrologist and renal dietitian.

Potassium

Healthy kidneys help maintain potassium within a safe range.

When kidney function is severely impaired, potassium can accumulate in the blood.

Very high potassium can affect the heart rhythm and can become life-threatening.

Depending on laboratory results, patients may need to modify foods high in potassium.

The level of restriction should be individualized.

Symptoms of Severe Potassium Abnormality

Dangerously abnormal potassium may sometimes cause:

• Muscle weakness

• Palpitations

• Abnormal heartbeat

It may also cause few warning symptoms.

This is why regular laboratory monitoring is essential.

Phosphorus

High phosphorus levels are common in kidney failure because damaged kidneys cannot remove phosphorus efficiently.

Excess phosphorus can contribute to:

• Bone problems

• Mineral imbalance

• Itching

• Other complications

NIDDK notes that phosphorus may need dietary management in patients receiving dialysis.

Phosphate Binders

Some patients are prescribed medicines called phosphate binders.

These medicines reduce the amount of phosphorus absorbed from food.

They are generally taken with meals according to the nephrologist’s instructions.

Patients should not change or stop these medicines without medical advice.

Sodium

Excess sodium may contribute to:

• Thirst

• Fluid retention

• High blood pressure

• Swelling

Sodium can be present in large amounts in:

• Packaged foods

• Fast food

• Pickles

• Sauces

• Processed meats

• Salty snacks

• Restaurant meals

Dietitian counseling can help identify hidden sodium sources.

Dialysis & Diabetes

Diabetes is a major cause of chronic kidney disease.

Patients receiving dialysis who also have diabetes require coordinated management of:

• Blood glucose

• Insulin or diabetes medicines

• Nutrition

• Blood pressure

• Cardiovascular risk

• Foot health

Medication needs may change as kidney function changes.

Patients should not adjust diabetes medicines without medical advice.

Dialysis & High Blood Pressure

High blood pressure can both cause and worsen kidney disease.

Dialysis patients may require:

• Medication

• Sodium control

• Fluid management

• Dry-weight assessment

• Cardiovascular evaluation

Blood pressure should be interpreted across multiple readings rather than only one measurement.

Anemia in Kidney Failure

Anemia is common in advanced CKD and dialysis patients.

One reason is reduced production of erythropoietin – EPO, a hormone normally produced by the kidneys that stimulates red-blood-cell production.

Symptoms of anemia may include:

• Fatigue

• Weakness

• Breathlessness

• Reduced exercise tolerance

• Palpitations

Anemia Assessment

Evaluation may include:

• Complete Blood Count

• Hemoglobin

• Iron studies

• Other laboratory tests

Treatment may involve:

• Iron therapy

• Erythropoiesis-stimulating treatment

• Treatment of blood loss

• Correction of other causes

The treatment plan should be determined by the nephrology team.

Bone & Mineral Disorders

Kidney failure can disrupt normal regulation of:

• Calcium

• Phosphorus

• Vitamin D

• Parathyroid hormone

Over time, this can affect:

• Bones

• Blood vessels

• Other tissues

Patients may require laboratory monitoring and medication.

This is another reason dialysis care involves more than simply filtering the blood.

Medication Review

Kidney failure can change how medicines are:

• Cleared

• Metabolized

• Dosed

Patients should provide a complete medication list, including:

• Prescription medicines

• Over-the-counter medicines

• Pain medicines

• Vitamins

• Herbal products

• Supplements

Some medications require adjustment in severe kidney disease.

Pain Medicines & Kidney Disease

Patients with severe kidney disease should be cautious about taking over-the-counter pain medicines without professional advice.

Some medicines may worsen kidney function or create other complications.

Patients should ask their nephrologist or treating doctor which pain medicines are appropriate.

Herbal Medicines

Herbal remedies are often assumed to be safe because they are “natural.”

However, some products may:

• Affect potassium

• Affect blood pressure

• Interact with medication

• Contain unlisted substances

• Cause additional kidney injury

Dialysis patients should tell their medical team about all herbal products they use.

Missed Dialysis Sessions

Patients should not routinely miss dialysis sessions.

Missing treatments can allow:

• Fluid to accumulate

• Potassium to rise

• Waste products to increase

• Blood pressure to worsen

This can lead to serious illness.

If a patient cannot attend a scheduled treatment because of:

• Illness

• Travel

• Emergency

• Transportation problems

the dialysis team should be contacted as early as possible.

Shortening Dialysis Sessions

Leaving dialysis significantly earlier than prescribed may reduce treatment effectiveness.

Patients who repeatedly feel unable to complete sessions because of:

• Cramps

• Low blood pressure

• Nausea

• Anxiety

• Other symptoms

should discuss the problem with their dialysis team so treatment can be reviewed.

Dialysis Adequacy

The dialysis team may periodically assess whether the prescribed treatment is providing adequate removal of waste products.

This may involve laboratory-based measurements and review of:

• Treatment duration

• Blood flow

• Dialyzer performance

• Vascular access

• Symptoms

If treatment is inadequate, the dialysis prescription may require adjustment.

Urine Output During Dialysis

Some dialysis patients continue to produce urine.

Others produce very little or none.

Remaining urine output can influence:

• Fluid allowance

• Dialysis prescription

• Medication

• Nutrition

Patients should tell their nephrologist about significant changes in urine output.

Peritoneal Dialysis

What Is Peritoneal Dialysis?

Peritoneal dialysis is another form of dialysis.

Instead of circulating blood through an external dialyzer, it uses the lining of the abdomen—the peritoneum—as a natural filtering membrane.

A soft catheter is placed into the abdomen, and dialysis solution is exchanged through this catheter.

NIDDK describes peritoneal dialysis as kidney-failure treatment that uses the abdominal lining to filter wastes and extra fluid from the body.

Availability of a dedicated peritoneal dialysis program at AS Medical Complex should be confirmed before treatment planning.

Types of Peritoneal Dialysis

Depending on the program, peritoneal dialysis may be performed through:

• Manual exchanges during the day

• Automated exchanges using a machine, often at night

The appropriate method depends on:

• Patient suitability

• Lifestyle

• Home environment

• Kidney-failure needs

• Patient preference

• Available specialist services

Peritoneal Dialysis Catheter

Peritoneal dialysis requires a catheter placed through the abdominal wall.

The catheter requires careful hygiene because infection can lead to complications such as:

• Exit-site infection

• Peritonitis

Patients receiving peritoneal dialysis require specific training.

Peritonitis

Peritonitis is an infection of the abdominal lining and is an important complication of peritoneal dialysis.

Possible symptoms include:

• Abdominal pain

• Fever

• Cloudy dialysis fluid

• Nausea

• Feeling unwell

These symptoms require prompt medical assessment.

Hemodialysis vs Peritoneal Dialysis

Both treatments perform some of the functions of failed kidneys, but they work differently.

Hemodialysis

• Filters blood through an external dialyzer

• Requires vascular access

• Often performed in scheduled sessions

Peritoneal Dialysis

• Uses the abdominal lining as the filter

• Requires an abdominal catheter

• Usually involves regular exchanges

The best option depends on the individual patient.

Kidney Transplantation

Dialysis is one treatment for kidney failure.

Another option for suitable patients is kidney transplantation.

Not every patient is medically suitable for transplantation.

Evaluation may consider:

• Age

• Cardiovascular health

• Infection

• Cancer history

• Other diseases

• Ability to take long-term medications

• Donor availability

Patients interested in transplantation may be referred to an appropriate transplant center.

Dialysis While Awaiting Transplant

Some patients receive dialysis while undergoing transplant evaluation or waiting for transplantation.

Dialysis should continue according to medical instructions unless the transplant team advises otherwise.

Conservative Kidney-Failure Care

Dialysis is not always the treatment selected by every patient with kidney failure.

Some patients—particularly those with severe frailty or major medical illness—may choose conservative kidney-failure management after detailed discussion with their medical team.

NIDDK describes conservative management as treatment focused on symptom control and quality of life without dialysis or transplantation.

This should be a carefully informed decision involving the patient, family where appropriate, and treating nephrologist.

Dialysis & Cardiovascular Health

People with kidney disease have a high burden of cardiovascular disease.

Dialysis care may therefore involve assessment of:

• Blood pressure

• Heart failure

• Chest pain

• Rhythm abnormalities

• Fluid overload

NIDDK notes that cardiovascular disease is particularly important in people with kidney disease.

Patients may require Cardiology referral when appropriate.

Dialysis & Heart Failure

Heart failure and kidney failure frequently affect one another.

Patients may develop:

• Swelling

• Breathlessness

• Low blood pressure

• Fluid-management difficulty

Dialysis fluid removal must therefore be carefully individualized in patients with significant cardiac disease.

Dialysis & Vascular Surgery

The Vascular Surgery Department may become involved in:

• AV fistula creation

• AV graft creation

• Access revision

• Access narrowing

• Access thrombosis

• Other dialysis-access complications

Early communication between Nephrology and Vascular Surgery can support long-term access planning.

Dialysis & Nephrology

The Nephrology Department is central to dialysis management.

The nephrologist may oversee:

• Dialysis indication

• Dialysis prescription

• Laboratory monitoring

• Blood pressure

• Fluid management

• Anemia

• Bone and mineral disease

• Medication

• Vascular-access planning

• Nutrition

• Transplant referral

Dialysis-machine treatment should therefore be considered one component of comprehensive kidney-failure care.

Dialysis & Dietitian

Patients receiving dialysis can have complex nutritional requirements.

A renal dietitian may help individualize:

• Protein

• Potassium

• Phosphorus

• Sodium

• Fluid

• Calories

NIDDK recommends individualized meal planning for people receiving hemodialysis because food and fluid choices affect both symptoms and treatment.

Dialysis & Infectious Disease

Infectious Disease consultation may be appropriate for selected dialysis patients with:

• Bloodstream infection

• Complicated access infection

• Recurrent infection

• Resistant organisms

• Complex hepatitis-related issues

• Other serious infections

Dialysis & General Medicine

Dialysis patients frequently have additional conditions such as:

• Diabetes

• Hypertension

• Heart disease

• Anemia

• Infections

General Medicine may work alongside Nephrology to coordinate broader medical care.

Dialysis & Emergency Care

Dialysis patients can still experience medical emergencies unrelated to dialysis.

They may require urgent assessment for:

• Heart attack

• Stroke

• Severe infection

• Respiratory failure

• Major bleeding

• Other emergencies

Do not assume every symptom is simply a normal consequence of kidney failure.

Travel & Dialysis

Patients receiving maintenance dialysis can sometimes travel, but planning is essential.

Before travel, patients may need to arrange:

• Dialysis sessions at the destination

• Medical records

• Recent laboratory results

• Medication

• Vascular-access information

• Emergency contacts

Travel should be coordinated well in advance with the dialysis and nephrology teams.

What to Bring to a Dialysis Appointment

Patients should bring or provide:

• Relevant medical records

• Current medication list

• Recent laboratory results where available

• Dialysis records if transferring from another center

• Vascular-access information

• Allergy information

• Previous dialysis prescription where relevant

Patients transferring from another dialysis unit may require clinical review before treatment can be safely continued.

When Should You Contact the Dialysis Team?

Contact the dialysis team if you experience:

• Increasing swelling

• Significant weight gain between sessions

• Recurrent low blood pressure

• Severe cramps during dialysis

• Increasing breathlessness

• New access redness

• Access swelling

• Access pain

• Persistent access bleeding

• Changes in the usual fistula thrill

• Fever or chills

• Repeated vomiting

• Difficulty completing dialysis sessions

Early communication can help prevent complications.

When Is Emergency Care Required?

Seek urgent or emergency medical attention for:

• Severe shortness of breath

• Chest pain

• Loss of consciousness

• Severe weakness

• Dangerous heartbeat irregularity

• Severe confusion

• Seizures

• Heavy uncontrolled bleeding from dialysis access

• Severe infection symptoms

• Suspected sepsis

• Sudden neurological symptoms

• Severe fluid overload

• Rapid deterioration

• Other life-threatening symptoms

A patient who feels seriously unwell should not simply wait until the next scheduled dialysis session.

Bleeding From an AV Fistula or Graft

Minor bleeding after dialysis needle removal usually stops with appropriate pressure.

However, heavy or persistent bleeding from a fistula or graft can become an emergency.

Seek urgent care if:

• Bleeding does not stop

• Blood loss is significant

• The patient becomes dizzy

• The patient becomes weak

• The patient faints

The access should not be ignored because of its importance to long-term dialysis.

Access Clotting

A fistula or graft may occasionally become blocked.

Possible signs include:

• Loss of the usual vibration

• Significant reduction in access flow

• Difficulty performing dialysis

Prompt assessment can be important because some blocked accesses may require urgent treatment.

Long-Term Dialysis Care

Dialysis is usually part of a long-term care plan rather than an isolated procedure.

Ongoing care may include:

• Regular Nephrology review

• Laboratory monitoring

• Vascular-access monitoring

• Blood-pressure management

• Fluid management

• Nutrition

• Anemia treatment

• Bone and mineral management

• Infection prevention

• Cardiovascular assessment

• Transplant discussion where appropriate

At AS Medical Complex, our goal is to provide coordinated kidney-failure care that addresses both the dialysis treatment itself and the wider medical needs of each patient.