Haemodialysis - Dialysis

This involves purifying the blood directly using a device with a filter system (artificial kidney) to supplement the function of your kidneys. To do this, an access to your blood vessels, or vascular approach, must be provided:

• either an arteriovenous fistula on one arm at least 3 weeks before the operation
• Or the insertion of a dialysis catheter in a neck vein if dialysis is started quickly or if your vessels do not allow an arteriovenous fistula to be made.

Hemodialysis treatment

Haemodialysis is an intermittent treatment (3 weekly sessions of a minimum of 4 hours per session as a general rule). The frequency and duration of the sessions are prescribed by your doctor, and the success of your treatment also depends on your compliance with all the prescribed sessions. In all cases, and always at the start of your treatment, it can be carried out in a centre and then, if your state of health and independence allow and after training, in a self-dialysis unit or at home. During your haemodialysis sessions, you will be able to benefit from ongoing nephrological monitoring, and you will be able to ask questions about your treatment and your state of health.

For more information on specific dialysis techniques and the equipment used, please consult the following sections:

• Dialysis techniques
• The equipment for your haemodialysis

Treatment carried out entirely by healthcare staff (nurse/care assistant)

• In-centre haemodialysis: the doctor is on site at all times.
• In a medical dialysis unit (UDM): the doctor is not present in the unit, but can be contacted and can intervene if necessary. He visits 3 times a week.

Treatment is partially or fully managed by the patient (who may be assisted by a nurse):

• In Auto Dialysis, the doctor is not present in the unit, but is contactable and likely to intervene if necessary, and makes visits once a week.
• At home: a consultation with the nephrologist is organised every 1-3 months.

Your treatment will always begin with a visit to the centre. Depending on your state of health and the tolerance of the sessions, you may be referred to the UDM on the basis of a medical decision.

If you wish to become more independent, the centre can offer you training in self-dialysis or home dialysis.

During visits or consultations with the nephrologist, you will be invited to inform him or her of your state of health and to ask any useful questions about your treatment.

Haemodialysis can present risks:

• Complications associated with your vascular access: these include the risk of bacterial or viral infection, thrombosis andhaemorrhage, which are common to fistula approaches and dialysis catheters. Protecting your venous capital is a concern that your nephrologist and all healthcare professionals share with you.
• The risk of haemorrhage: anti-coagulant treatment to prevent your blood clotting in the dialysis circuit exposes you to the risk of haemorrhage. You should report any bleeding tendency to your referring nephrologist and the fact that you are on dialysis to any intervention outside dialysis.
• Nausea, vomiting and dizziness may herald a drop in blood pressure. Following the rules of hygiene and diet limits the risk of hypotension.
• Temporary fatigue may occur in the few hours following a haemodialysis session. If these problems persist abnormally long after the session, you should report them to your nephrologist, who will see to it that the parameters of your treatment are modified.

Current haemodialysis monitoring conditions mean that session abnormalities can be quickly detected and treated, but do not hesitate to inform the staff of your signs as soon as possible.

Unforeseeable life-threatening complications have become rare.

Hemodialysis: How it works

Hemodialysis filters your blood using a machine called a dialyzer. Blood circulates outside the body, passes through a membrane that removes waste and excess water, and is then returned to your bloodstream.

To perform hemodialysis, a vascular access point is needed—a site where blood can be safely removed and returned.

Types of vascular access

Arteriovenous Fistula (AVF)
This is the preferred access for most patients. It is created under local anesthesia by a surgeon who connects an artery to a nearby vein, allowing the vein to enlarge and support reliable needle insertion for dialysis. Typically, the non-dominant arm is used.

• Maturation time: a few weeks to several months
• Daily care: avoid blood draws, blood pressure measurements, tight clothing, bracelets, or heavy objects on the access arm
• Possible complications: overdevelopment, clots, or dysfunction, which may require imaging or surgical intervention

Vascular Graft
Used only if an AVF is not possible. A small flexible tube (often made of PTFE/Goretex) is placed between an artery and a vein under general anesthesia. It can be used sooner than an AVF (2–3 weeks) but has a shorter lifespan.

Hemodialysis needle insertion

Two needles are inserted into the AVF: one to draw blood for filtration and one to return purified blood. An anesthetic cream can make the procedure nearly painless.