Starting Dialysis
Introduction
The decision has been made to start dialysis.
You probably aren’t feeling well and have noticed some of these symptoms.
This is a sign that your kidneys aren’t working and usually means it is time to start dialysis.
You might be feeling a lot of different emotions.
Many patients tell us they experience feeling overwhelmed, anxious, sad and angry during this time.
There is a supportive healthcare team here to help you through this.
This video will help prepare you to start dialysis and give you an idea of what your next steps might be.
There are different ways of starting dialysis. You and your healthcare team might have planned a date to start dialysis or this might be an unexpected start.
You are going to need to choose a therapy, so let’s explore the choices.
Home Dialysis
General Points
Dialysis can be done at home with either peritoneal dialysis or hemodialysis.
You will need to complete training to learn how to do it yourself.
During these training sessions, you will be supported by a healthcare team member who will teach you how to complete dialysis so that you feel comfortable and safe at home.
The healthcare team can help you make transportation arrangements if needed.
Parking is paid for while you are there for training.
You and your healthcare team may have been planning your dialysis start for a while now or you may not have had the chance to think about your dialysis options until now.
Some patients need to urgently start on peritoneal dialysis or hemodialysis first and then can take the time to find the dialysis therapy that fits best for them.
Home dialysis allows you to have more freedom and flexibility out of the dialysis options. You can live your life and fit dialysis into it, day or night.
Regardless of your type of dialysis treatment, you shouldn’t feel any discomfort once the treatment has started. If you suddenly feel unwell, make sure you tell your nurse or call the unit
Once you are set up at home, you will have access to support 24/7
Peritoneal Dialysis (PD)
One of the home options is peritoneal dialysis.
With peritoneal dialysis, you are connected to a system that fills your abdomen with fluid, which cleans your blood and removes waste products from your body.
Someone from the healthcare team will give you instructions on when you will be starting and where to go.
Normally, you will be in the peritoneal dialysis clinic for 4 days from 9:30-2:30.
In this time the healthcare team will perform the therapy for you in the clinic and teach you how to safely do peritoneal dialysis until you are ready to go home.
Some people need more or less time to learn peritoneal dialysis; we can adjust the training times based on the needs of you and your family or support person
All of the supplies you need will be delivered to your home to allow you to start dialysis at home.
The healthcare team will make sure you feel ready to start on your own.
You will not need to pay for the supplies or equipment, and you won’t need to make any home renovations or modifications to complete peritoneal dialysis at home.
Home Hemodialysis
You can also do hemodialysis in the comfort of your own home.
Hemodialysis is where you are connected to a machine that cleans your blood.
One of the many benefits is that you can dialyze on a schedule that best fits your lifestyle.
Before you go home you will receive training, which will be organized at the home hemodialysis clinic.
On your first day of training you will be there for 2-3 hours which will gradually increase up to 5 hours per day.
Training is typically 4 days a week for 4-6 weeks or until you feel comfortable to dialyze at home.
The training is completed while you dialyze at the Home Hemodialysis clinic.
Your nurse will explain the process to you, organize supplies and start your dialysis treatment by connecting your access to the dialysis machine.
You will need to make plumbing and electrical changes to your home.
Once you have completed your training and are comfortable to go home the healthcare team will make sure that your house is ready for your dialysis machine and will help organize delivery and supplies.
The program pays for the home modifications and all supplies.
Hospital or Clinic Hemodialysis
A lot of people start on hemodialysis in a clinic or hospital setting.
Someone from the healthcare team will give you instructions on where and when you will be starting.
When you come to the reception desk at the unit, you will be greeted by a healthcare team member.
You will meet your nurse who will explain the process to you.
They will get the supplies organized and connect your access to the dialysis machine.
This could be done through a catheter or fistula.
Depending on if you have a catheter or a fistula, you will want to wear loose clothing for easy access.
When you first start dialysis the treatment time is shorter (around 2 hours) and gentle.
Over the next few sessions this will usually increase to 4 hours 3 times a week. It will take more than one treatment until you start to feel better.
You shouldn’t feel any discomfort once the treatment has started.
If you suddenly feel unwell, make sure you tell your nurse.
During the treatment your blood pressure is taken frequently and a nurse will be monitoring the treatment and how you are feeling.
You might be visited by the doctor who will see how your treatment is going. They will review your medications.
Once your treatment is completed, you can go home and resume your day.
You will be given a schedule when your next few dialysis sessions are scheduled.
Urgent Start
Some people need to start dialysis right away, this is referred to as an urgent start.
Urgent dialysis can be done with both peritoneal dialysis and hemodialysis.
Urgent start hemodialysis can be done by a nurse either in hospital or in clinic.
If you want to do home hemodialysis you will be transferred to the home hemodialysis unit after you have started.
Peritoneal dialysis can also be done urgently, however, we will need to take special care to your peritoneal dialysis catheter until it has time to heal.
If you choose to do urgent home peritoneal dialysis, it can be started right away, but will be done by a nurse either in hospital or in clinic until your peritoneal dialysis catheter site has healed, you are feeling better, and have had time to be trained to do the procedure.
As everyone is different, there might be important things to keep in mind for each type of urgent dialysis.
Your doctor will talk to you about these items.
General – (Healthcare Team Support)
It’s not unusual to feel overwhelmed with many emotions when you start dialysis.
Most people feel a mix of emotions.
It is a big change in your life that not only affects you but your friends and family.
These feeling are normal but there are things that you can do to help you feel more in control.
Your healthcare team is also there to support you.
Here are some people you will meet and support you in this journey (show healthcare team document).
Social worker: For you and your family, adjusting to life with dialysis can take time.
This experience is different for everyone.
The social worker can help you and your partner or family adjust to the changes in your life.
They can also find community supports that will help with transportation, parking, home support, financial aid, employment, or advanced care planning.
Nurse: Your nurse will talk with you about your health concerns, review your blood tests, and ask how you’re feeling.
They will work with you to make a care plan that meets your healthcare goals.
Nurses also assess your current health and then start your treatment. If you have questions about your treatment, ask your nurse.
Kidney Doctor (nephrologist): The nephrologist is a doctor who has advanced education related to diseases of the kidneys.
Your nephrologist will stay the same throughout all of your treatment choices. You may meet other nephrologists to help manage daily concerns.
Dialysis changes your life, not just in the obvious way of starting a life-sustaining treatment/therapy, but it also affects you physically, emotionally and socially.
Many people feel overwhelmed during this time.
At times, you may even feel tired, you may have aches and pains and have moments when you are angry, frustrated, or sad.
The healthcare team is here to support you, not only through this experience but also as you navigate the days ahead.
Dialysis Summary Points
Remember that if your dialysis therapy turns out to not be the right option for you, you can always change your mind and switch therapy.
