nephrologist is a doctor who specializes in kidney diseases. Critical care medicine doctors (intensivists) also prescribe dialysis. These doctors specialize in caring for acute, life-threatening illnesses or injuries. 

Dialysis teams also include specialized nurses and certified hemodialysis technologists. Some patients may be trained to perform their own hemodialysis at home with the support of a trained partner and a home care dialysis team.

How is dialysis performed?

Dialysis procedures vary depending on the type of dialysis. 

How hemodialysis is performed

The frequency and length of hemodialysis sessions vary depending on your condition. Hemodialysis often takes three to five hours, three times a week. Some people may have hemodialysis for a shorter period every day. 

Weeks to months before starting hemodialysis, your surgeon will create a vascular access. This is a minor surgical procedure. A vascular access is the place where your dialysis team will insert the dialysis needles. Dialysis needles allow blood to flow out to the hemodialyzer machine and return back to your body after filtering. 

The best long-term vascular access is an arteriovenous (AV) fistula. Your surgeon makes an AV fistula by connecting an artery to a vein, usually in the forearm. Sometimes, a piece of synthetic material called a graft is needed to construct the connection between the artery and vein.

Another type of vascular access is a tube (catheter) inserted into a large neck vein, called a vasc-cath or perma-cath. This type of access is often temporary. The dialysis team uses it only until an AV fistula or other permanent access is ready.   

Your hemodialysis will be performed in a hospital or outpatient dialysis center. The procedure generally includes these steps:

  1. The dialysis team checks your vital signs and weight.
  2. The dialysis team cleans your vascular access site and may apply an anesthetic cream or spray to numb your skin. 
  3. The dialysis team inserts one or two needles through the skin into your vascular access point. The needles are attached to tubes that carry your blood to the dialyzer machine and back to your body.
  4. You can relax, read, watch TV, text, use your laptop, or nap during the treatment.
  5. Your dialysis team will check your vital signs throughout the procedure. 
  6. Your dialysis team removes the needles, applies a dressing, and rechecks your weight. 

How peritoneal dialysis is performed

A surgeon will perform a surgery to insert a small soft tube (catheter) into the abdomen before your first peritoneal dialysis treatment. The tube has a port outside your body located near the belly button. The catheter stays in your abdomen between dialysis sessions. Peritoneal dialysis can begin as soon as the catheter is in place. You may begin with a partial schedule of sessions until the site is fully healed.

Continuous ambulatory peritoneal dialysis (CAPD) generally involves these steps:

  1. You wear a surgical mask and wash your hands, catheter site, and other equipment as directed to prevent infection. You should perform the procedure in a clean, dry place.
  2. You connect your catheter to a tube and bag containing dialysis fluid.
  3. You fill your abdomen with the dialysis fluid. The fluid flows into your abdomen by gravity.
  4. You disconnect the tube and allow the fluid to stay (dwell) in your abdomen for a certain period of time, generally four to six hours. Your doctor will tell you what dwell time period is appropriate for you. You can perform certain activities with the solution in your abdomen.
  5. You connect a tube to your abdominal catheter and allow the fluid to drain out by gravity. The fluid now contains wastes and extra water that your body doesn’t need.
  6. You repeat this procedure, usually several times a day. Your doctor will tell you how many times a day to do this.

Continuous cycling-assisted peritoneal dialysis (CCPD) generally involves these steps:

  1. You wear a surgical mask and wash your hands, catheter site, and other equipment as directed to prevent infection. You should perform the procedure in a clean, dry place.
  2. At bedtime, you connect your catheter to a tube attached to your automated cycler machine. 
  3. As you sleep, the automated cycler fills your abdomen with dialysis fluid and allows it to dwell. It then drains the fluid at the right time. The automated cycler will generally perform this about three to five times a night for a total of 10 to 12 hours. Your doctor will tell you how many cycles you need each night and the best dwell time for you. 
  4. In the morning, your automated cycler fills your abdomen with dialysis fluid, but you disconnect your catheter from the machine before draining the fluid. 
  5. You allow this cycle of fluid to dwell in your abdomen for a prescribed amount of time during the day. Your doctor will tell you how long your daytime dwelling should last. After the dwell time, you reconnect your catheter to the machine to drain the used fluid.
  6. You repeat this procedure every night.