In-centre haemodialysis

During haemodialysis, the dialysis machine removes a small amount of your blood from your body through a needle inserted into a fistula (a large vein created by joining an artery and a vein to increase blood flow) or a catheter (a tube placed into a large vein). The dialyser then cleans your blood, removing waste, toxins, and excess fluid. Finally, your clean blood is returned to your body.

Clinic-based HD treatments take place at a hospital or dialysis clinic under the supervision of a clinical care team. This is called in-centre haemodialysis (in-centre HD). If you are receiving HD treatments in-centre you will typically schedule them 3 times per week, and each session will last somewhere between 4 and 5 hours.

Before each in-centre HD treatment, a member of your care team will give you a short physical examination and weigh you to determine how much water will need to be removed from your body. Your treatment access site will be cleaned, the needles needed for treatment will be inserted, and the tubing that connects your access site to the haemodialysis machine will be set up. Your HD treatment will then begin, and you will be looked after by a nurse. When your treatment is done and you’ve been disconnected from the machine, your blood pressure will be measured, your weight taken, and you can leave the centre.

It is a good idea to arrive early for your in-centre HD appointments to allow ample time for your healthcare team’s preparation. It is best to wear comfortable clothing and bring a book or other form of entertainment to keep yourself occupied while you’re being treated. During and after your haemodialysis treatments, you may feel tired or experience uncomfortable leg cramps or nausea. Therefore, it is common to want to go home and rest. If you experience unusual symptoms during or after your treatment, you should talk to your clinical team about your symptoms.

In terms of how the therapy feels, you may feel some mild pain during the needle insertion if you have a fistula, and as mentioned before, you may feel tired or experience uncomfortable leg cramps or nausea after therapy. The therapy itself should not be painful.

It is crucial that you attend all of your in-centre treatment sessions, so discussing your lifestyle needs with your healthcare team in order to find a suitable treatment timeslot is the best way to ensure that it’s easy for you to stay on your treatment plan. You should be aware that it is not always possible to have in-centre treatments at the exact time you would prefer – so flexibility is key. You should also talk to your clinician regularly about your treatment options, in case the option you first choose doesn’t work for your lifestyle.

• Daytime in-centre HD

This is the most common form of in-centre dialysis and can work well with your lifestyle if you work nights, are retired, or have free time on most weekdays. You will have to commit to 3 treatment appointments per week, typically 4 to 5 hours for the treatment and another 1 hour for commencing and finishing dialysis. A nurse or clinician will administer your treatments for you, so you won’t have to do them yourself.

• Nocturnal in-centre HD

For some patients, nocturnal HD may be a therapy option. If it will be difficult for you to fulfil your professional or personal responsibilities while receiving daytime HD, nocturnal HD may be the right therapy for you. Nocturnal HD is haemodialysis performed while you sleep at the hospital or clinic. Because it is a longer, slower form of dialysis, it filters your blood in a way that more closely resembles what a natural kidney would do. Because nocturnal HD is done while you sleep, it may fit more easily with a busy daytime schedule. Keep in mind that nocturnal HD is not available to many patients; your clinical team will tell you if it’s an option for you.

If you opt for nocturnal HD, or it is recommended by your clinician, be sure to choose a hospital or clinic that offers it.

There are three different types of HD access: fistula, graft and haemodialysis catheter. Each has its own benefits and drawbacks, and you should discuss these with your care team in order to determine which will be the safest and most effective access option for you. Typically, a fistula is considered the standard of care in most dialysis centres.

Fistula

• A fistula is often the best choice for HD because it uses your own blood vessels, allowing for good blood flow during therapy, and has the lowest chance of infection
• Your surgeon will connect one of your arteries to a vein under the skin of your upper or lower arm
• This surgery should be done ideally 2-3 months in advance of your dialysis start date
• During dialysis, unfiltered blood will flow from your blood vessels through one needle, connected to your fistula, and your clean blood will flow back into your body through a second needle, also connected to your fistula

Graft

• To create a graft, your surgeon will use a piece of medical tubing to connect one of your arteries to one of your veins. This graft will be placed under the skin either on your arm or your leg.  
• During dialysis, unfiltered blood will flow from your blood vessels through one needle, connected to your graft, and your clean blood will flow back into your body through a second needle, also connected to your graft

Catheter

• Catheters are usually temporary and are only used while you’re waiting to receive a fistula or a graft. 
• A catheter will be placed inside a vein, either in your neck or your chest. The other end of the tube will exit your skin and be attached to the haemodialysis machine tubing. 
• Catheters are not recommended for long-term use because they can put you at higher risk of blood clotting and infection and provide less efficient dialysis due to lower blood flow rates

Depending on the strength of your veins and your overall health, your clinician will be able to decide what type of access option is best suited to you. If your clinician decides that you need a fistula or graft, they will need to schedule the surgery in advance of your dialysis start date.

No matter which kind of access type you choose, you’ll have to protect your access site from excess pressure, germs and infection. Remember to clean your hands before touching your access site and consistently check it for signs of swelling and irritation. If you suspect these issues, contact your nurse immediately. This is true for all dialysis treatment options.

There may be other benefits to receiving in-centre haemodialysis (In-Centre HD). For example, it might be favourable for you to receive treatment outside your home, both because it gives you the opportunity to get out of the house, it may be less invasive for your family and because you may have more ability to keep your treatment life separate from your home life.

While in-centre haemodialysis (In-Centre HD) has certain benefits, it also has special considerations. You should consider the following before speaking with your clinician about whether in-centre haemodialysis (In-Centre HD) is right for you: 

• Depending on how far you live from your dialysis clinic, you may need to build transportation time into your treatment schedule
• Needles must be inserted during each treatment, which may be uncomfortable for you if you are afraid of needles
• During and after your haemodialysis (HD) treatments, you may feel tired or nauseated.
• Some people find they need a little time to recover after a haemodialysis session. You will need to discuss with the dialysis staff and treating doctor whether it is safe for you to drive home after a treatment.
• It may be difficult to plan your daily schedule around your in-centre treatment sessions