What Haemodialysis Is Like Week-to-Week

The journey to your first haemodialysis session begins well before you actually sit in the dialysis chair. Ideally, your nephrologist will have discussed treatment options with you at CKD stage 4, giving you time to prepare both practically and emotionally. The most important preparatory step is creating your vascular access — the permanent connection point that allows your blood to flow to and from the dialysis machine.

An arteriovenous (AV) fistula is the gold standard for vascular access. It is created through a relatively minor surgical procedure, usually in your non-dominant arm, where a surgeon connects an artery directly to a vein. This connection causes the vein to enlarge and strengthen over time — a process called maturation — which typically takes six to twelve weeks but can sometimes take longer. Your renal team will monitor the fistula's development and let you know when it is ready for use.

If a fistula is not possible due to your vein anatomy, an AV graft (a synthetic tube that bridges artery and vein) may be used instead. In urgent situations where dialysis needs to start before a fistula or graft is ready, a central venous catheter — a tube placed in a large vein in your neck or chest — can provide temporary access. Catheters carry higher risks of infection and are generally considered a bridge to a more permanent access.

Before your first session, you will likely attend a pre-dialysis education programme or series of appointments. These cover what to expect during treatment, how to care for your access, dietary guidelines, and what medications you will need. Many units also offer the chance to visit the dialysis floor, meet the nursing team, and see the equipment in person. Taking advantage of these opportunities can significantly reduce the anxiety that many people feel before starting dialysis.

It is completely normal to feel anxious, scared, or even angry about starting dialysis. These are valid emotions, and your renal team has seen them many times. Let them know how you are feeling — they can connect you with a renal social worker, psychologist, or peer support volunteer who has been through the same experience.

When you arrive at the dialysis unit, you will be weighed and have your blood pressure checked. Your weight is compared to your "dry weight" — the target weight your body would be at without any excess fluid. The difference tells the clinical team how much fluid has accumulated since your last session and needs to be removed during this treatment.

Next, you settle into your dialysis chair (most units have reclining chairs, and some have beds) and the nurse accesses your fistula or graft by inserting two needles. One needle draws blood from your body to the dialysis machine, and the other returns the cleaned blood. Most patients describe the needle insertion as a brief, sharp discomfort rather than severe pain, and many find that it becomes less bothersome over time. Numbing cream can be applied to the access site beforehand to reduce sensation.

Once connected, the dialysis machine does most of the work. Blood flows through the dialyser at a carefully controlled rate, waste products are filtered out, excess fluid is removed, and the cleaned blood is returned to your body. Your nurse will monitor your blood pressure, heart rate, and the machine's readings throughout the session. The treatment typically lasts three and a half to four and a half hours, though some patients require longer sessions.

During the session, most patients read, watch television or films on a tablet, sleep, work on a laptop, or simply rest. Many units provide televisions, and some have WiFi access. It is worth bringing items that help you pass the time comfortably — headphones, a book, a tablet, snacks (if permitted by your dietary plan), and a blanket, as some patients feel cold during treatment.

At the end of the session, the nurse removes the needles, applies pressure to the access site, checks your blood pressure, and weighs you again to confirm that the target fluid removal was achieved. You may feel slightly tired or light-headed after treatment, so many patients arrange transport rather than driving themselves, particularly during the first few weeks as they adjust.

Haemodialysis structures your week in a way that becomes familiar over time, even if it feels disruptive at first. Most patients attend three sessions per week on alternating days — typically Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday. Sessions are usually assigned to a morning, afternoon, or evening slot depending on your unit's schedule and your preference (where flexibility exists).

A common pattern that many HD patients describe is the distinction between "dialysis days" and "off days." On dialysis days, the treatment itself, plus travel time and any post-session fatigue, can consume a large portion of the day. Off days are when you tend to have the most energy and freedom to pursue work, hobbies, socialising, and errands.

The day after a long gap between sessions (for example, Monday after a weekend off, or Tuesday after a weekend off) is often when patients feel the most unwell, because waste products and fluid have had an extra day to accumulate. Many patients learn to be particularly careful with fluid and dietary intake on these longer intervals to minimise the "Monday morning" effect.

Over time, most patients develop their own weekly rhythm. You learn which days you have the most energy, when to schedule important activities, and how to pace yourself. Some patients find it helpful to batch their errands and social activities on their best days, while keeping dialysis days relatively quiet. This is not giving in to the illness — it is intelligent planning that helps you live as fully as possible within the reality of treatment.

Home haemodialysis can significantly alter this weekly pattern. Patients on home HD may choose to dialyse more frequently (five to six times per week) for shorter sessions, or do longer overnight sessions. More frequent dialysis can smooth out the peaks and valleys of the conventional three-times-per-week cycle, reducing the accumulation of fluid and waste between sessions and the dramatic swings in how you feel.

Haemodialysis is an effective treatment, but it does come with side effects that most patients experience to varying degrees. Understanding these side effects and how to manage them is an important part of living well on HD.

Post-dialysis fatigue is the most common complaint. Many patients describe feeling "washed out" for several hours after a session, and some experience fatigue that lasts into the following day. The intensity of fatigue often improves as your body adjusts to dialysis over the first few months. Strategies that may help include ensuring adequate nutrition on dialysis days, staying as active as possible between sessions, and discussing session parameters with your team if fatigue is severe.

Low blood pressure (hypotension) during or after sessions is another frequent issue, caused by the removal of fluid from your bloodstream. Symptoms include feeling dizzy, light-headed, nauseous, or experiencing muscle cramps. Your dialysis team can adjust the rate and total amount of fluid removal to reduce these episodes. Maintaining your fluid and sodium intake within recommended limits between sessions — so that less fluid needs to be removed each time — is one of the most effective things you can do on your end.

Muscle cramps typically occur towards the end of a session, particularly when a large volume of fluid is being removed. They can be painful but are usually short-lived. Strategies include ensuring you are not exceeding your fluid allowance between sessions, stretching during treatment, and adjusting your dry weight target if needed.

Headaches and nausea can occur during or after sessions, particularly in the early weeks of treatment. These often improve as your body adjusts. If they persist, discuss them with your clinical team, as adjustments to your dialysis prescription — such as the blood flow rate, dialysate composition, or session length — may help.

It is important to report all side effects to your dialysis team, even if they seem minor. Small adjustments to your treatment parameters can often make a significant difference in how you feel. You should not simply accept feeling terrible after every session as an unavoidable part of dialysis — in many cases, improvements are possible.

Diet is one of the most challenging aspects of life on haemodialysis, and it is an area where many patients struggle, particularly in the early months. The fundamental issue is that your kidneys are no longer effectively removing certain substances from your body, so you need to limit your intake of those substances between dialysis sessions.

Fluid is typically the most restrictive element. Most HD patients are advised to limit their daily fluid intake to around 500 to 1000 millilitres plus the volume of any urine they still produce. This is surprisingly little — it includes not just drinks but also soups, ice cream, jelly, and the liquid content of foods like yoghurt and fruit. Managing thirst is a daily challenge for many HD patients. Strategies include sucking on ice cubes (which feel more satisfying than the same volume of water), rinsing your mouth without swallowing, avoiding very salty or sweet foods that increase thirst, and using a measured water bottle so you can track your intake throughout the day.

Potassium must be controlled because high levels can cause dangerous heart rhythm problems. Foods particularly high in potassium include bananas, oranges, tomatoes, potatoes, dried fruit, chocolate, and many nuts. Your renal dietitian will help you understand which foods to limit and which lower-potassium alternatives you can enjoy freely.

Phosphorus tends to accumulate between sessions and contributes to bone disease and cardiovascular problems over time. High-phosphorus foods include dairy products, processed foods, cola drinks, and many processed meats. Most HD patients also take phosphate-binding medications with meals to reduce the amount of phosphorus absorbed from food.

Sodium (salt) restriction is important because sodium drives thirst and fluid retention. Reducing your salt intake makes it much easier to manage your fluid allowance. This means avoiding added salt at the table, reducing processed and packaged foods, and learning to season food with herbs, spices, lemon juice, and vinegar instead.

Your renal dietitian is one of your most important allies on haemodialysis. They can help you develop meal plans that are both medically appropriate and enjoyable, work around your food preferences and cultural dietary practices, and troubleshoot specific challenges. Ask for a referral if you have not already been connected with a dietitian.

One of the biggest concerns for people starting haemodialysis is the impact on their ability to work and travel. While HD does impose real constraints, many patients continue working and travelling with careful planning.

Working on HD is achievable for many patients, though it often requires adjustments. If your employer is supportive, you may be able to arrange your dialysis sessions around your work schedule — for example, opting for an evening slot or negotiating flexible working hours on dialysis days. In the UK, chronic kidney disease is generally considered a disability under the Equality Act 2010, which entitles you to reasonable adjustments from your employer. Your renal social worker can advise you on your rights and help facilitate conversations with your employer if needed.

Some patients find that they are too fatigued to work on dialysis days and instead work on their off days. Others manage part-time work or shift their career to less physically demanding roles. There is no single right answer — it depends on your job, your energy levels, and your financial situation. What matters is exploring your options rather than assuming that work is impossible.

Travelling on HD requires planning but is entirely possible. Within the UK, your renal unit can usually help you arrange holiday dialysis at a centre near your destination. It is best to start planning well in advance — at least six to eight weeks — as availability at holiday dialysis units can be limited, especially during peak holiday periods. You will need to provide your dialysis prescription and recent blood test results to the receiving unit.

International travel is more complex but still feasible. Some patients use specialist holiday dialysis booking services, while others contact overseas units directly. Costs may apply if treatment abroad is not covered by reciprocal healthcare agreements. Travel insurance that covers pre-existing conditions including kidney disease is essential, and some specialist insurers cater specifically to dialysis patients.

Home haemodialysis patients may find it easier to maintain employment, as they can schedule sessions in the evening or overnight. However, travelling away from home on HD typically requires reverting to centre-based treatment for the duration of the trip.

Starting haemodialysis is a major life change, and the emotional impact is real and significant. Many patients experience a complex mix of feelings — relief that treatment is helping them feel better physically, but also grief for the life they had before, frustration at the loss of freedom and spontaneity, and anxiety about the future. These are all completely normal responses.

Depression and anxiety are more common in dialysis patients than in the general population. Research suggests that up to 25 to 30 per cent of dialysis patients experience clinically significant depression. This is not a sign of weakness — it is a recognised consequence of living with a chronic, life-altering condition. If you notice persistent feelings of sadness, hopelessness, loss of interest in things you used to enjoy, sleep disturbance, or difficulty concentrating, talk to your renal team. Treatment is available and effective, including counselling, cognitive behavioural therapy, and, where appropriate, medication.

The loss of control that many patients feel is one of the hardest aspects to cope with. Your schedule is partly dictated by your treatment, your diet is restricted, and your body may not feel like your own. Finding areas where you can exercise choice and control — even small ones, like choosing what to watch during sessions, planning a holiday dialysis trip, or becoming more involved in managing your treatment parameters — can help restore a sense of agency.

Relationships often change when you start dialysis. Partners and family members may take on a caring role, which can shift the dynamic of your relationship. Open communication is essential — let the people close to you know how you are feeling and what kind of support is most helpful. Some patients find that their partner or family members benefit from their own support, and many renal units offer resources for carers as well.

Peer support can be remarkably powerful. Talking to someone who has been through the same experience — who truly understands what it is like to sit in a dialysis chair three times a week — can provide a kind of support that even the most empathetic clinician or family member cannot. Ask your renal unit about peer support programmes, or look for kidney patient communities online and in person.