At a glance
Hemodialysis is a treatment that does the kidney's filtering work when the kidneys can no longer do it adequately on their own. Blood is drawn from the body, passed through an artificial filter called a dialyzer, and returned clean to the bloodstream. The dialyzer removes waste products such as urea and creatinine, extra fluid, and minerals like potassium that would otherwise build up to dangerous levels.
Each session typically lasts three to five hours, and most patients need treatment three times a week. The process is continuous and ongoing: hemodialysis manages kidney failure but does not repair the kidneys themselves.
Medical Condition
Hemodialysis is used when the kidneys have lost so much function that waste and fluid accumulate faster than the body can handle. This can happen suddenly or after years of gradual decline.
- End-stage renal disease (ESRD): permanent, severe kidney failure where less than about one-tenth of normal kidney function remains.
- Acute kidney injury (AKI): a sudden, rapid loss of kidney function caused by severe infection, surgery, or certain medications, where the kidneys need temporary support while they recover.
- Dangerous build-up of potassium in the blood (hyperkalemia) that cannot be controlled by diet or medication alone.
- Severe fluid overload causing breathlessness or heart strain that other treatments have not relieved.
- Poisoning or drug overdose where the toxic substance can be removed by the dialyzer.
- Uremia (a toxic build-up of waste in the blood) causing confusion, nausea, or other serious symptoms.
Hemodialysis is not suitable for every patient with kidney failure. Your nephrologist (kidney specialist) will weigh several factors before recommending it.
- Patients whose blood pressure is too unstable to tolerate the fluid shifts that dialysis causes may need a different form of dialysis, such as peritoneal dialysis.
- Patients who cannot have reliable vascular access (a working connection to blood vessels) may not be candidates for hemodialysis.
- Some elderly or very ill patients, after discussion with their care team and family, choose comfort-focused care rather than dialysis.
Risks & Complications
Hemodialysis is a well-established treatment, but because it is repeated many times over months or years, both short-term side effects and longer-term complications are possible.
- Low blood pressure (hypotension) during a session, causing dizziness, nausea, or faintness. This is the most common side effect.
- Muscle cramps, often in the legs, as fluid and minerals shift during treatment.
- Itching of the skin, related to the build-up of waste products between sessions.
- Headache and fatigue after a session, sometimes called dialysis headache.
- Infection at the access site (the point where the needle or catheter enters the body), which can occasionally spread to the bloodstream.
- Blood clotting or narrowing of the arteriovenous fistula (AV fistula), a surgically created connection between an artery and a vein used as access.
- Anaemia (low red blood cell count) because damaged kidneys produce less erythropoietin (the hormone that triggers red blood cell production).
- Bone disease over time, because failing kidneys cannot regulate calcium and phosphorus balance properly.
- Heart and blood vessel problems, which are more common in people on long-term dialysis.
- Air embolism (air entering the bloodstream through the circuit), a rare but serious technical complication.
Preparation & Procedure
Before starting a regular hemodialysis program, the care team will carry out several steps to make treatment as safe and effective as possible. The exact sequence depends on whether the situation is planned or urgent.
For patients starting planned dialysis, preparation usually begins weeks or months in advance. Creating the vascular access, most commonly an AV fistula, requires minor surgery and then a waiting period of four to six weeks for the fistula to mature before it can be used. Patients are usually asked to protect the arm that will carry the fistula and to avoid blood pressure cuffs or blood draws on that arm.
Your team will review all current medications. Blood thinners may be adjusted because the dialysis circuit uses an anticoagulant (a medication that prevents clotting inside the machine). Some blood pressure medications are typically given after, not before, a session to avoid a sharp drop in pressure during treatment.
Tests run before and at the start of a dialysis program commonly include:
- Blood tests measuring kidney function markers such as urea, creatinine, potassium, and bicarbonate.
- A full blood count to check for anaemia.
- Tests for hepatitis B, hepatitis C, and HIV, which are standard before dialysis begins and are used to assign patients to the correct machine to prevent cross-infection.
- Heart tracing (ECG/EKG) to check heart rhythm.
- Chest X-ray to assess fluid around the lungs and heart size.
- Ultrasound of the blood vessels in the arm that will be used for access.
On the day of each session, the steps generally follow this order:
- 1. The patient's weight is recorded and compared to the weight at the end of the last session. The difference represents fluid that has accumulated and needs to be removed.
- 2. Blood pressure, pulse, and temperature are checked.
- 3. The access site is cleaned carefully. For a fistula, two needles are inserted; for a central venous catheter (a tube placed in a large neck or chest vein), the cap is removed and the lines are flushed.
- 4. Blood flows out through one needle or line, into the dialyzer where it is filtered, then returns through the second needle or line.
- 5. During the session, blood pressure and symptoms are monitored regularly. The session is paused or adjusted if blood pressure falls.
- 6. At the end, the needles are removed and firm pressure is applied to stop bleeding. Weight is recorded again to confirm fluid removal.
Aftercare
Life on regular hemodialysis requires ongoing adjustments to diet, fluid intake, medications, and daily habits. The dialysis team, which usually includes a nephrologist, dialysis nurses, and a dietitian, works with the patient over the long term.
- Fluid restriction: because the kidneys can no longer remove excess fluid, patients are typically advised to limit how much they drink between sessions. The allowed daily amount is set individually.
- Dietary changes: foods high in potassium (such as bananas, oranges, and potatoes) and phosphorus (such as dairy products and nuts) are usually limited. A renal dietitian will provide a personalised meal plan.
- Medications: most patients take phosphate binders (tablets taken with meals to prevent phosphorus absorption), and many need injections or tablets to manage anaemia. Blood pressure medications are also common.
- Access site care: the AV fistula or graft must be checked daily for signs of infection, unusual swelling, or loss of the normal vibrating sensation (called a thrill) that shows blood is flowing through it. A missing thrill needs prompt medical attention.
- Activity and rest: most patients can return to light daily activities between sessions, but fatigue after treatment is common and rest is appropriate.
- Regular blood tests: usually monthly, to monitor potassium, phosphorus, calcium, haemoglobin, and other markers, so that the dialysis prescription can be adjusted.
- Follow-up appointments with the nephrologist to review overall health, assess whether kidney function has changed, and discuss longer-term options such as kidney transplantation.
- Vaccinations: patients on dialysis are advised to keep hepatitis B vaccination up to date, as well as annual flu vaccination, because their immune response is reduced.
Cost & What Determines It
Hemodialysis is unusual among medical treatments because it is not a single event but a lifelong or long-term program. The total cost depends on how many sessions are needed, how complex each session is, and where it is carried out.
- Frequency and duration of sessions: three sessions per week is standard, but some patients require more frequent or longer sessions, which raises costs proportionally.
- Access type and any related procedures: creating or repairing an AV fistula, placing a tunnelled catheter, or treating an infected access site each adds to overall cost.
- Hospital class and country: a dialysis centre within a university hospital or internationally accredited facility charges differently from a community-based dialysis unit. Costs also vary substantially between countries.
- Medications given alongside dialysis: erythropoiesis-stimulating agents (injections that help the body produce red blood cells), intravenous iron, phosphate binders, and blood pressure medications all affect the total bill.
- Additional tests: monthly blood panels, periodic imaging of the fistula, and occasional cardiac evaluations are usually separate from the session fee.
- Management of complications: hospitalisation for an infected catheter, surgery to revise a blocked fistula, or treatment of a cardiac event increases costs unpredictably.
- High-flux or specialised dialysis membranes: some centres offer higher-specification dialyzer membranes at a premium.
- Home or nocturnal dialysis programmes: where available, these may involve equipment rental or purchase costs not present in centre-based dialysis.
A hospital package for hemodialysis commonly covers the session fee, the dialyzer, bloodlines, nursing supervision, and routine saline and anticoagulant use. Items typically billed separately include the initial access creation surgery, monthly blood tests, specialist consultations outside the dialysis schedule, medications taken at home, and treatment of any complications that arise.
Indonesian patients travelling abroad for dialysis should be aware that BPJS Kesehatan does not cover treatment outside Indonesia, and most standard Indonesian private health insurance policies also exclude overseas care. Patients generally pay out of pocket or through an international health insurance policy that explicitly covers chronic dialysis abroad. Before travelling, request a written cost estimate from the receiving dialysis centre that specifies the per-session fee, the expected number of sessions, and what each charge includes. This makes it possible to compare options clearly and avoid unexpected bills.
Frequently Asked Questions
How many hemodialysis sessions will I need?
Most people with kidney failure need three sessions every week, and this schedule continues for as long as the kidneys are not working well enough on their own. Each session is ongoing treatment, not a short course, so your nephrologist (kidney specialist) will review your schedule regularly based on blood test results and how you feel.
What does hemodialysis actually feel like during the session?
Most patients feel a small sharp sting when the needle is placed in the fistula (the access point created in your arm), but the session itself is usually not painful. Some people feel tired, lightheaded, or have muscle cramps toward the end, especially in the first few weeks while the body is still adjusting to the process.
How soon will I feel better after starting hemodialysis?
Many patients notice less fatigue and clearer thinking within the first few weeks as waste products and excess fluid are removed from the blood. Improvement is gradual, and some symptoms may take longer to ease depending on how long the kidneys have been struggling and other health conditions you have.
How much does hemodialysis cost?
The cost depends on how frequently you need sessions, the class of hospital or dialysis centre you choose, and whether additional monitoring or medications are included in the package. A written estimate from the hospital will give you a clear picture of what is covered per session and what may be billed separately.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
