Complete Dialysis Guide: Types, Process, Side Effects & Care

Dialysis cleans the blood when the kidneys stop working. It removes waste, extra water, and salt. There are two types: hemodialysis uses a machine, and peritoneal dialysis uses the lining of the belly. Dialysis does not fix the kidneys, but it helps people stay healthy and active.

When a doctor first talks about dialysis, many families have questions and want to learn more. This dialysis guide walks you through it step by step, from choosing a dialysis treatment to managing side effects, food and fluid limits, and daily routines.

Dialysis at a Glance

What Is Dialysis?

Healthy kidneys continuously filter the blood and expel waste in urine. When they fail, waste products such as urea, creatinine and acids remain in the bloodstream. Doctors refer to this accumulation as uremia. It can lead to nausea, poor appetite, itching, swelling, breathlessness, and confusion. These are common, and your care team knows how to manage them.

The good news is that starting dialysis often eases these signals, and most people notice a difference once treatment settles into a routine.

Doctors categorize dialysis as renal replacement therapy because it takes over part of the kidneys' workload. Doctors measure kidney function through a blood test known as eGFR (estimated glomerular filtration rate). A healthy adult typically scores 90 or above. Below 15 mL/min/1.73 m², kidney function is at about one-tenth of normal, a stage where the kidneys need extra support, known as end-stage kidney disease (ESKD).

There are two very different scenarios.

In acute kidney injury (AKI), the kidneys may need time to recover after an infection, surgery, dehydration, or a toxic drug. Dialysis can support the body during that healing period, and many people recover enough to stop treatment.

In chronic kidney disease, damage accumulates slowly over years and does not reverse, so dialysis becomes a long-term necessity.

Who Needs Dialysis Treatment?

Diabetes and high blood pressure account for most kidney failure in adults. Years of elevated blood sugar damage the tiny kidney filters, so good diabetes control is one of the strongest protections. Other causes include glomerulonephritis, polycystic kidney disease, kidney stones, and prolonged use of certain medicines.

A Global Burden of Disease analysis counted 697.5 million cases of chronic kidney disease worldwide in 2017. In South Asia, a systematic review of population studies put CKD prevalence in Pakistan as high as 23.3%. Early CKD seldom produces symptoms, so recognizing the early signs of diabetes and monitoring blood pressure regularly is important.

No single lab value determines when to start dialysis treatment. A nephrologist evaluates eGFR together with symptoms such as:

• Fluid overload causing swelling or shortness of breath

• High potassium (hyperkalemia), which can affect the heart's rhythm

• Persistent nausea, vomiting, or weight loss from uremia

• Feeling foggy, itchy skin, or low energy

• Blood that has become too acidic

How Dialysis Works

All dialysis methods depend on a thin, semipermeable membrane that acts as a filter. Waste and water pass through it; blood cells and most proteins do not. Blood is on one side, and dialysate, a sterile cleansing fluid, is on the other.

Two simple processes accomplish the cleaning.

In diffusion, waste travels from the blood (where its concentration is higher) into the dialysate, which holds little of that waste.

In ultrafiltration, pressure in hemodialysis (or sugar in the peritoneal fluid) pulls excess water out of the blood. Some machines also use convection, a method called hemodiafiltration, to remove slightly larger molecules.

Understanding how dialysis works clarifies the daily rules: each session can only remove a limited amount of fluid and potassium, so what happens between sessions matters.

Types of Dialysis

Long-term dialysis comes in two principal forms.

Hemodialysis

In hemodialysis, blood exits the body through an access point, usually in the arm, and passes through a dialyzer. Staff often call this filter an artificial kidney. The cleaned blood then returns directly to the body. Most patients visit a center three times a week, for 3 to 4 hours per session. Some learn to perform it at home instead. Home schedules vary: a few short sessions spread across the week, or long, slow runs overnight during sleep.

Peritoneal Dialysis

In peritoneal dialysis, the peritoneum (the abdomen's natural inner lining) serves as the filtering membrane. A soft catheter carries dialysate into the abdomen, where it stays for a few hours (the dwell) before being drained. This fill-and-drain cycle is known as an exchange.

• In continuous ambulatory peritoneal dialysis (CAPD), the patient performs 3 to 5 manual exchanges a day, each taking about 30 to 40 minutes.

• In automated peritoneal dialysis (APD), a machine called a cycler performs the exchanges overnight over about 8 to 12 hours.

Hemodialysis vs Peritoneal Dialysis

Each option has benefits and challenges. Use this dialysis guide to prepare for that conversation with the kidney team, since heart health, past surgery, and home setup all influence the choice.

What Happens During a Hemodialysis Session

The first session can feel stressful, but the routine soon becomes familiar. A typical in-center visit follows these steps:

1. Check-in. Team members note weight, blood pressure, pulse, and temperature. Comparing today's weight with the target dry weight shows how much fluid must come off.

2. Connection. Two needles go into the fistula or graft, or the catheter is connected. One line carries blood to the machine, and the other brings it back.

3. Filtering. For about 3 to 4 hours, blood flows through the dialyzer while sensors watch pressure, air bubbles, and flow.

4. Monitoring. Nurses check blood pressure throughout the session. Patients can rest, read, pray, watch something, or sleep.

5. Finish. Needles come out, pressure is held on the sites until bleeding stops, and weight and blood pressure are checked again.

Before the first session

• Wear a loose, short-sleeved shirt or kurta so the arm is easy to reach

• Carry a written list of all medicines and recent lab reports

• Arrange a ride home in case you feel tired or lightheaded afterward

Is it painful? The needles cause a brief pinch, but the filtering itself does not hurt.

Common Dialysis Side Effects and What Helps

Most side effects arise from shifting a large amount of fluid and minerals within a few hours. The encouraging news is that many improve once the correct dry weight and settings are established.

Itching, known as uremic pruritus, affects roughly half of hemodialysis patients, while sharp drops in blood pressure (intradialytic hypotension) are less common.

Some people feel tired after sessions, and a short rest usually helps. The large DOPPS study linked longer recovery times to removing more fluid per session, so cutting salt and keeping fluid gains small often helps.

Warning Signs: When to Call the Dialysis Team

Contact the dialysis team promptly if you notice any of these:

• A fever, chills, or shivering during or after a session

• Redness, warmth, swelling, or discharge around the access or catheter

• A daily buzz check keeps your fistula healthy. If the buzz ever feels fainter or different than usual, or if bleeding continues after the needles come out, let your team know, as they can check things quickly and help it stay strong.

• Cloudy peritoneal fluid or new belly pain

• A quick rise in weight, swollen legs, or puffiness under the eyes

• Weak muscles, numbness, or an uneven heartbeat, which may point to high potassium

Chest pain, serious trouble breathing, fainting, or sudden confusion needs medical help quickly, so call emergency services.

Never skip or shorten a session without the team's advice. Potassium and fluid levels can change quickly between sessions, so keeping to your schedule helps protect your heart rhythm.

Eating and Drinking on Dialysis

 

Food choices work hand in hand with the machine, as the NIDDK hemodialysis nutrition guide explains. A renal dietitian sets exact limits based on lab results.

Fluid. Every drink counts toward the daily allowance, including chai, soup, thin daal, lassi, and ice. Cutting salt is the easiest way to feel less thirsty.

Sodium. Watch achar, papad, nimko, instant noodles, packet masalas, and restaurant food. Avoid salt substitutes too, since many are made with potassium.

Potassium. The right amount helps keep the heartbeat steady. Bananas, dates (khajoor), dried fruit, oranges, potatoes, tomatoes, and coconut water are high. Boiling chopped vegetables in plenty of water and discarding it lowers potassium.

Phosphorus. Keeping phosphorus within range helps protect your bones and ease itching. Milk, yogurt, paneer, colas, and processed foods are major sources, so several cups of doodh patti a day add up fast. Phosphate binders prescribed by the doctor should be swallowed with meals.

Protein. Needs go up once dialysis starts, because some protein is lost during treatment. Eggs, chicken, and fish are good choices in portions the dietitian approves.

Star fruit (kamrakh). Leaving star fruit off your plate is the safest choice. It contains a compound that healthy kidneys remove easily, but for people with kidney problems it has been linked to hiccups, confusion, and seizures.

Patients with diabetes should know their normal blood sugar range, since dialysis can change how insulin and other diabetes medicines behave.

Medicines and Long-Term Health

Anemia. Failing kidneys make less erythropoietin, the hormone behind red blood cell production, so many patients need erythropoietin injections and iron.

Bones. When phosphorus stays high, and calcium and vitamin D fall out of balance, bones weaken. Phosphate binders, active vitamin D, and regular parathyroid hormone (PTH) checks help protect them.

Heart. Looking after your heart is an important part of dialysis care. Steady blood pressure, small fluid gains, good sugar control, and not smoking all lower the risk.

Medication safety. Many drug doses need changing on dialysis. Avoid over-the-counter painkillers such as ibuprofen and diclofenac unless the nephrologist approves, and bring every medicine and supplement to each review.

Protecting Against Hepatitis and Infection?

Needles and shared machines make infection control vital. In Pakistan, a meta-analysis of 19 studies found hepatitis C in about 32% of hemodialysis patients. Ask how the center screens for hepatitis B and C, and get the hepatitis B vaccine, ideally before dialysis starts.

Life During Dialysis Treatment

Dialysis changes the week, not the whole life. Many patients keep working around early or evening sessions, and travel is possible with guest sessions or portable PD supplies.

Staying active. A meta-analysis of 24 trials found that exercise during sessions improved dialysis efficiency, fitness, and quality of life. Light pedaling and walking on off days are good starts, with the nephrologist's approval.

Mind and family. Many people feel low, anxious, or worried about money at some point, and talking about it helps. Share these feelings with your team, and make sure caregivers get breaks too.

Fasting. Long fasts followed by heavy iftar meals can swing potassium and fluid levels sharply, so Ramadan plans should be agreed with the nephrologist in advance.

Costs in Pakistan. Some large centers treat patients free, including SIUT, which reports more than 1,600 dialysis sessions a day. Families should still budget for transport, lab tests, medicines, and anemia injections.

Can Dialysis Ever Stop?

It depends on why the kidneys failed. After a sudden injury from dehydration, infection, or a drug reaction, kidneys can recover within weeks, and dialysis stops once they cope again. Chronic kidney failure is permanent, so treatment continues unless a transplant works. Some frail or elderly patients choose conservative kidney management, which focuses on comfort rather than dialysis.

The primary route to permanently leaving dialysis is a kidney transplant, whether from a deceased or living donor. Ask about it early, since assessment takes time.

Stopping dialysis is always a medical decision.

Herbal Support Alongside Dialysis

Many families in Pakistan turn to desi totkay once dialysis begins. Herbs cannot replace dialysis or restore failed kidneys. Some remedies can be harmful when the kidneys cannot clear them properly.

Where Herbal Care Can Fit

Dr Ibrahim Herbalist's Tibb (Unani) approach works alongside dialysis, not against it. It focuses on strength, appetite, digestion, and sleep, always within the patient's lab results and the nephrologist's limits.

Options from Dr Ibrahim Herbalist, each used alongside prescribed treatment:

• X7 herbal dialysis support ...... for weakness and low energy during dialysis

• Dialysis Management Course ...... a structured plan pairing the X5, X6 and QN formulations with routine and lifestyle guidance

• Video consultation with Dr Ibrahim Herbalist ...... a review of reports and medicines before anything new is added

Using Herbal Support Safely

These simple steps keep everyone informed and help catch any reaction early.

1. Share recent lab reports and the full medicine list before starting anything.

2. Get the nephrologist's approval, especially for anything taken by mouth.

3. Start one product at a time, so any reaction is easy to trace.

4. Recheck potassium and phosphorus at the next monthly blood test.

5. Stop and tell the dialysis team about any new symptom, such as weakness, palpitations, or itching.

Note: Products mentioned here are formulated by Dr Ibrahim Herbalist.

Frequently Asked Questions

What is dialysis in simple words?

It is a filter that does part of the kidneys' job. It removes waste and extra water from the blood when the kidneys have failed.

How long can someone live on dialysis?

It varies from person to person. Age, heart health, diabetes, and sticking to the treatment plan all matter, and many people live for years on dialysis.

Can the kidneys start working again after dialysis?

After a sudden kidney injury, they sometimes recover, and dialysis can stop. In chronic kidney failure, they do not, so dialysis continues unless a transplant is done.

Can dialysis patients drink milk tea?

Usually in small amounts, because milk adds phosphorus and every cup counts as fluid. A renal dietitian can set a safe daily limit.

Is dialysis free in Pakistan?

Some centers, such as SIUT, provide it free of charge. Private hospitals charge per session, so confirm current costs directly.

Final Word

Dialysis is demanding, but it keeps people with failed kidneys alive and active. The main message of this dialysis guide is simple: know your treatment, take care of your access, follow your food and fluid limits, and tell your team about problems early.

---

Medical Disclaimer: The content on this page is shared for general awareness only and should not be used in place of guidance from a licensed healthcare professional.

Last Medically Reviewed: September 2026