Inpatient Hemodialysis
A Guide to Acute Care Inpatient Hemodialysis
Have You Met. . . .
Your Dialysis Doctor ___________________
Your Primary Nurse ____________________
Your Dietician _________________________
Your Social Worker _____________________
A Financial Counselor ___________________
A Surgeon for graft or fistula placement___________________
What is Hemodialysis?
Hemodialysis means “cleaning the blood”. Blood is moved through a machine with a special
filter called a dialyzer. The dialyzer removes wastes and extra fluids. The clean blood is then
returned to your body. Taking out the harmful wastes, extra salt, and fluids helps control your
blood pressure and keeps the proper balance of chemicals like potassium and sodium in your
body.
What is a kidney?
The kidneys are two bean-shaped organs that remove unwanted chemicals and waste from the
blood. These wastes are turned into urine by the kidneys. The kidneys are in the back of the
abdomen (stomach) on both sides of the spine.
What is Acute Kidney Injury?
Acute Kidney Injury occurs when one or both kidneys suddenly stop working. It may take only
a few hours or up to a few weeks for the kidneys to fail. Acute Kidney Injury can occur because
of diabetes, hypertension, hypotension, sepsis, trauma, drugs, dehydration, liver failure, and
repeated kidney infections. Acute Kidney failure can sometimes become a long term health
problem which is called chronic renal failure.
What is Chronic Renal failure?
It is a long-term disease of the kidneys. This occurs when the kidneys are slowly working less
and less until they no longer work at all. By working less, your kidneys cannot remove
unwanted chemicals and waste.
How does the dialyzer clean my blood?
The dialyzer is a large tube that has thousands of small fibers which your blood passes through.
Dialysis solution, the cleaning fluid, is pumped around these fibers. The fibers allow wastes and
extra fluids to pass from your blood into the fluid that carries them away. The dialyzer is
sometimes called the artificial kidney.
How do you feel during treatment?
Symptoms like cramps, headaches, nausea or feeling dizzy can occur but are not common. If
you have these symptoms let your dialysis care team know how you are feeling so they can help
you.
How long are the treatments?
The treatment time depends on:
y How much your kidneys are working.
y How much fluid weight you gain between treatments.
y How much you weigh.
y How much waste you have in your blood.
What Is a Hemodialysis Access?
It is either a tube that is placed or a surgical change in your blood vessels which allows access to
both a vein and an artery. It is needed to provide a
safe place to connect tubing during hemodialysis.
The Temporary Catheter
Your doctor may select a temporary catheter. These
are used for a short period of time (up to three
months). During this time, a more permanent dialysis
access (either peritoneal or hemodialysis) may be
placed and allowed to heal. A temporary catheter can
be used right away for treatment after the access is
placed.
The Permanent Catheter
The permanent catheter is designed to last longer than a temporary catheter. A permanent
catheter should last a few months to a year. This type of catheter is placed through your skin and
then tunneled or threaded under your skin for a short distance before going into a large vein in
your neck.
The Fistula
An arterial-venous fistula (A-V fistula) is
a surgical connection between an artery
and a vein usually in your upper or lower
arm. When this connection is created, the
high-pressure arterial blood rushes into
the low pressure vein. Over time the vein
becomes larger and the vein wall thicker.
The blood from these veins can be used
for dialysis.
The Graft
A graft is like a fistula because it is placed
during a minor surgical procedure and
connects an artery to a vein. It is used for
dialysis in the same way as a fistula. The
graft is made of a thin, hollow, semi-rigid
tube of a man-made material placed under
the skin.
Daily Medicine: See your Pharmacist for further instructions.
Type/Name
Purpose
Method Given
Phosphate Binders
Sevelamar
Phoslo
Calcium Carbonate
Tums
Keeps phosphorous low in
the blood which keeps
calcium in your bones
By mouth with meals
Multivitamin
Nephrocap
To supplement elemental and
trace vitamins
By mouth after dialysis
Epoietin or Darbepoetin
To increase Red Blood Cells
(Hematocrit)
Intravenously with dialysis or
subcutaneously
Iron
Iron Sulfate
Iron Sucrose
To increase iron stores in the
body to help Epoetin to work
and raise red blood cells
(Hematocrit)
By mouth or Iron Sucrose
intravenously with dialysis
To treat low Vitamin D
levels
Intravenously with dialysis
Paricalcitol
Zemplar
Hectorol
Rocaltrol
Do not take with iron
supplements.
Do not take with calcium
supplements.
Monthly Lab Tests
Blood Test
Potassium
(K+)
Normal
Value for
Dialysis
3.5 – 5.0
Too High
Too Low
Cause/Side Effects/What to Do
Cause/Side Effects/What to Do
Cause: Eating too many foods
high in potassium
Side Effects: Tiredness, irregular
heartbeat, muscle weakness,
tingling, death
What to do: Decrease the amount
of fruits and vegetables in your
diet especially bananas, tomatoes,
potatoes, oranges.
Cause: Not eating enough fruits and
vegetables, lasix, vomiting, diarrhea.
Side Effects: Muscle weakness,
shaking, irregular heart rate, tingling,
death.
What to do: Increase fruits and
vegetables in your diet i.e., one
banana, tomatoes, potatoes. Change
or stop lasix (if still taking this
medicine). Treat vomiting or
diarrhea per doctor's advice.
Monthly Lab Tests
Blood Test
Normal
Value for
Dialysis
Too High
Cause/Side Effects/What to Do
Too Low
Cause/Side Effects/What to Do
Calcium
(CA+)
8.5 – 10.5
Cause: Taking too many calcium
supplements (i.e. TUMS, Elemental
Calcium) or vitamin supplements or
hormonal imbalance.
Side Effects: Calcium deposits in
tissues, arteries, or heart.
What to do: Decrease the number
of calcium supplements you are
taking.
Cause: Not taking enough calcium
supplements, Chronic Kidney
Disease,
Side Effects: Bone disease, tingling
in fingers, and may cause
abdominal cramps.
What to do: Increase the number of
calcium supplements
Phosphorus
(PO4)
3.5 – 5.0
Cause: Not taking calcium
supplements with meals; need to
take more calcium supplements.
Eating too much beans, nuts, milk,
processed lunch meats, or hotdogs,
"dark" sodas.
Side Effects: itching, easily broken
bones, hardening of blood vessels
which can cause a heart attack,
problems breathing, and painful
joints.
What to do: Take calcium
supplements with meals, check with
RN/MD about increasing the
amount of calcium supplements you
take.
Cause: Taking too many calcium
supplements.
Side Effects:
What to do: Decrease the amount
of calcium supplements you take
after checking with your nurse or
doctor. Eat/drink more beans, nuts,
milk, processed lunch meat or hot
dogs.
Albumin
3.3-4.7
Cause: Rare to be too high.
Side Effects:
What to do:
Cause: Not eating enough proteins
and/or calories. Recent infection.
Side Effects: Swelling in ankles,
muscle weakness, and/or
breakdown, increase chance of
infection.
What to do: Increase the amount of
protein/calories you are eating.
Speak to a dietitian
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Department of Nursing. HF#6910