What is hemodialysis?

The blood circulates outside the body of the patient - it goes through a machine that has special filters. The blood comes out of the patient through a catheter (a flexible tube) that is inserted into the vein. The filters do what the kidney's do; they filter out the waste products from the blood. The filtered blood then returns to the patient via another catheter. The patient is, in effect, connected to a kind of artificial kidney.

Patients need to be prepared for hemodialysis. A blood vessel, usually in the arm, needs to be enlarged. Surgery is required for this. The enlarged vein makes the insertion of the catheters possible. US researchers have developed a new way of growing blood vessels using patients' own skin cells to seed the growth of tissue and have tested it in dialysis patients with end stage kidney disease.

Hemodialysis usually lasts about 3 to 4 hours each week. The duration of each session depends on how well the patient's kidneys work, and how much fluid weight the patient has gained between treatments.

In the UK hemodialysis is either done in a special dialysis center in a hospital, or at home. When it is carried out at home it is important that the patient, and/or his/her caregiver knows what to do. A study revealed that kidney disease patients who are educated about dialysis are more likely to undergo a standard but under-utilized dialysis-related procedure than less knowledgeable patients The following people may have hemodialysis done at home:

• People who can and want to learn how to do it at home.
• People who are willing to carry on doing it at home.
• People whose condition has been stable while on dialysis.
• People who do not suffer from other diseases which would make home hemodialysis unsafe.
• People who have suitable blood vessels for the insertion of the catheters.
• People who have a caregiver, and that caregiver is willing to help with hemodialysis. People whose homes can be adapted for hemodialysis equipment.

In the UK, the National Institutes of Health and Clinical Excellence (NICE) recommends that every patient deemed suitable for home dialysis should have both home dialysis and hospital offered.