PURPOSE
(When is the procedure required?)

S.no   1. Your doctor will help determine when you should start hemodialysis, based on several factors — your overall health, kidney function, signs and symptoms, quality of life, and personal preferences. 2. You might notice signs and symptoms of kidney failure (uremia), such as nausea, vomiting, swelling or fatigue. Your doctor uses your estimated glomerular filtration rate (eGFR) to measure your level of kidney function. Your eGFR is calculated using your blood creatinine test results, sex, age and other factors. A normal value varies with age. This measure of your kidney function can help to plan your treatment, including when to start hemodialysis. 3. Hemodialysis can help your body control blood pressure and maintain the proper balance of fluid and various minerals — such as potassium and sodium — in your body. Normally, hemodialysis begins well before your kidneys have shut down to the point of causing life-threatening complications.

Common causes of kidney failure include: S.no   1. Diabetes 2. High blood pressure (hypertension) 3. Kidney inflammation (glomerulonephritis) 4. Hemodialysis can help your body control blood pressure and maintain the proper balance of fluid and various minerals — such as potassium and sodium — in your body. Normally, hemodialysis begins well before your kidneys have shut down to the point of causing life-threatening complications. 5. Blood vessel inflammation (vasculitis) 6. Kidney cysts (polycystic kidney disease) 7. However, your kidneys may shut down suddenly (acute kidney injury) after a severe illness, complicated surgery, heart attack or other serious problem. Certain medications can also cause kidney injury. 8. Some people with severe long-standing (chronic) kidney failure may opt for a different path, choosing maximal medical therapy, also called maximum conservative management, instead of dialysis. This therapy involves active management of complications of advanced chronic kidney disease, such as fluid overload, high blood pressure, and anemia, with a focus on supportive management of symptoms that affect quality of life. Ask your health care team for more information about your options. This is an individualized decision because benefits of dialysis may vary, depending on your particular health issues.

EXPECTATION
(How is it done? What to expect before, during, and after the procedure?)

S.no   1. The procedure During treatments, you sit or recline in a chair while your blood flows through the dialyzer — a filter that acts as an artificial kidney to clean your blood. You can use the time to watch TV or a movie, read, nap, or perhaps talk to your "neighbors" at the center. If you receive hemodialysis at night, you can sleep during the procedure. 2. Preparation. Your weight, blood pressure, pulse and temperature are checked. The skin covering your access site — the point where blood leaves and then re-enters your body during treatment — is cleansed. 3. Starting. During hemodialysis, two needles are inserted into your arm through the access and taped in place to remain secure. Each needle is attached to a flexible plastic tube that connects to a dialyzer. Through one tube, the dialyzer filters your blood a few ounces at a time, allowing wastes and extra fluids to pass from your blood into a cleansing fluid called dialysate. The filtered blood returns to your body through the second tube. 4. Symptoms. You may experience nausea and abdominal cramps as excess fluid is pulled from your body — especially if you have hemodialysis only three times a week rather than more often. If you're uncomfortable during the procedure, ask your care team about minimizing side effects by such measures as adjusting the speed of your hemodialysis, your medication or your hemodialysis fluids. 5. Monitoring. Because blood pressure and heart rate can fluctuate as excess fluid is drawn from your body, your blood pressure and heart rate will be checked several times during each treatment. 6. Finishing. When hemodialysis is completed, the needles are removed from your access and a pressure dressing is applied to the site to prevent bleeding. Your weight may be recorded again. Then you're free to go about your usual activities until your next session.

You can receive hemodialysis in a dialysis center, at home or in a hospital. Frequency of treatment varies, depending on your situation: S.no   1. In-center hemodialysis. Many people get hemodialysis three times a week in sessions of three to five hours each. 2. Daily hemodialysis. This involves more-frequent, but shorter sessions — usually performed at home six or seven days a week for about two to three hours each time. 3. Simpler hemodialysis machines have made home hemodialysis less cumbersome, so with special training and someone to help you, you may be able to do hemodialysis at home. You may even be able to do the procedure at night while you sleep. 4. There are dialysis centers located throughout the United States and in some other countries, so you can travel to many areas and still receive your hemodialysis on schedule. Your dialysis team can help you make appointments at other locations, or you can contact the dialysis center at your destination directly. Plan ahead to make sure space is available and proper arrangements can be made.

PREPARATION
( How to prepare for the procedure? What arrangements to be done? )

S.no   1. Preparation for hemodialysis starts several weeks to months before your first procedure. To allow for easy access to your bloodstream, a surgeon will create a vascular access. The access provides a mechanism for a small amount of blood to be safely removed from your circulation and then returned to you in order for the hemodialysis process to work. The surgical access needs time to heal before you begin hemodialysis treatments.

There are three types of accesses: S.no   1. Arteriovenous (AV) fistula. A surgically created AV fistula is a connection between an artery and a vein, usually in the arm you use less often. This is the preferred type of access because of effectiveness and safety. 2. AV graft. If your blood vessels are too small to form an AV fistula, the surgeon may instead create a path between an artery and a vein using a flexible, synthetic tube called a graft. 3. Central venous catheter. If you need emergency hemodialysis, a plastic tube (catheter) may be inserted into a large vein in your neck or near your groin. The catheter is temporary. 4. It's extremely important to take care of your access to reduce the possibility of infection and other complications. Follow your health care team's instructions about caring for your access.

RESULT
(What is the impact of the procedure on the health and day to day life.)

S.no   1. If you had sudden (acute) kidney injury, you may need hemodialysis only for a short time until your kidneys recover. If you had reduced kidney function before a sudden injury to your kidneys, the chances of full recovery back to independence from hemodialysis are lessened. 2. If hemodialysis is started in an emergency, and later it's determined you may need dialysis for the rest of your life, your dialysis team can explain other types of dialysis so that you learn which options can help you reach your goals.

Although in-center, three-times-a-week hemodialysis is more common, some studies suggest that home dialysis is linked to: S.no   1. Better quality of life 2. Increased well-being 3. Reduced symptoms and less cramping, headaches and shortness of breath 4. Improved appetite, sleeping patterns, energy level and ability to concentrate