What you can expect

You can receive hemodialysis in a dialysis center, at home or in a hospital. The frequency of treatment varies, depending on your situation:

• In-center hemodialysis. Many people get hemodialysis three times a week in sessions of 3 to 5 hours each.
• Daily hemodialysis. This involves more-frequent, but shorter sessions — usually performed at home six or seven days a week for about two hours each time.

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.

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.

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.

• Preparation. Your weight, blood pressure, pulse and temperature are checked. The skin covering your access site — the point where blood leaves and then reenters your body during treatment — is cleansed.
• Starting. During hemodialysis, two needles are inserted into your arm through the access site 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.
• Symptoms. You may experience nausea and abdominal cramps as excess fluid is pulled from your body — especially if you have gained a significant amount of fluid in between dialysis sessions. 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.
• 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.
• Finishing. When hemodialysis is completed, the needles are removed from your access site 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.