What to Expect When Starting Dialysis: A Guide for Patients & Families

What to Expect When Starting Dialysis: A Guide for Patients & Families

Dialysis is a life-sustaining therapy that removes excess fluids, toxins, and waste from the body when the kidneys can no longer do the job. According to the American Kidney Fund, “Of the roughly 131,000 Americans newly diagnosed with kidney failure in 2022 (most recent data), nearly 97% of them began dialysis.”¹ 

Starting dialysis is a major transition that can bring physical, emotional, and logistical challenges for people with chronic kidney disease (CKD). Whether treatment happens at home or in a dialysis center, being prepared helps patients and their families adjust with greater confidence and less stress.

This guide offers insight into what new dialysis patients and their loved ones can expect. 

Understanding Your Dialysis Options

There are two main types of dialysis: peritoneal dialysis and hemodialysis. Peritoneal dialysis uses the lining of the abdomen as a natural filter and is usually done at home. Hemodialysis utilizes an external filtering device to cleanse the blood. Hemodialysis can be performed at home or in a treatment center. 

Home Dialysis

Patients who are medically suitable and willing to manage their care directly may benefit from performing their dialysis treatments at home. It allows for greater scheduling flexibility, fewer trips to clinics, and typically, an overall improved quality of life. In addition, home dialysis can support better health outcomes such as improved blood pressure control, fewer medications, and a less restrictive diet. At Healthmap Solutions, we often advocate for home dialysis options for members in our Kidney Population Health Management program, when appropriate.

Your nephrologist will guide you in selecting the right approach based on your medical status, lifestyle, and personal preferences.

Preparing for Home Dialysis vs. In-Center Dialysis

The preparation process differs depending on the type of dialysis you begin.

Home Dialysis:

• Training: Patients and their care partners receive training on how to operate equipment, maintain sterile procedures, and monitor vital signs such as your blood pressure or heart rate.
• Equipment Setup: Your home may require minor modifications to accommodate supplies and machines. This is typically arranged with help from your care team.
• Self-Management: You’ll learn how to recognize and respond to treatment-related issues, with support from your dialysis nurse and care team.
• Lifestyle Integration: At-home treatment can often be scheduled around work, sleep, or travel, giving many patients more autonomy.

In-Center Dialysis (in a hospital dialysis unit or free-standing clinic):

• Scheduling: You’ll be assigned set treatment days and times, typically three times per week for 3–5 hours per session. While some may appreciate the structure and clinical support, the fixed schedule can make it harder to manage work or family responsibilities. If you need to miss a scheduled session, make sure you contact the treatment center to reschedule it, rather than skipping the appointment entirely.
• Transportation: Patients must arrange reliable transportation to and from the center. If you don’t have easy access to a vehicle or public transit, talk to your dialysis center or health insurance company to see if they can help you with transportation. Members in Healthmap’s program can also get assistance with finding transportation resources through our Care Navigation team.
• Clinical Monitoring: Nurses and technicians perform treatments and monitor you during each session.

Regardless of the modality, most patients will need a surgical procedure to create vascular access (for hemodialysis) or to insert a catheter (for peritoneal dialysis). Healing time and early education are part of the preparation process.

Physical Adjustments

Dialysis affects the body in different ways, especially at first. Patients may feel tired after treatments, especially with in-center hemodialysis. Others experience symptoms such as low blood pressure, cramping, or nausea, which often improve as a person adapts to incorporating new lifestyle changes.

With home dialysis, many patients report feeling more stable and less fatigued, especially with more frequent or gentler sessions (e.g., peritoneal dialysis can be performed overnight, while you sleep). Your provider will help monitor side effects and adjust the treatment plan as needed.

Maintaining vascular access or a peritoneal catheter site is also part of the physical adjustment. Good hygiene and monitoring for signs of infection are essential. Your care team will teach you how to manage this at home or explain what to expect if your care is in a center.

Emotional and Psychological Impact

Dialysis can feel like a major life disruption. Many patients experience anxiety, sadness, or grief in the early stages. Family members may also struggle to adjust to caregiving roles or changes in routine.

Opting for home dialysis may give patients a greater sense of control and independence, which can reduce emotional strain. Still, emotional support, whether from a counselor, peer group, or social worker, is vital. 

Patients experiencing emotional struggles should speak to their dialysis team. Healthmap’s Care Navigation team can also assist members with identifying support groups or other resources to help with these challenges.

Lifestyle and Daily Routine Changes

Both in-home and in-center dialysis approaches require adjustments. Home dialysis allows for more scheduling flexibility, potentially allowing you to continue working, traveling, or caring for family.

In-center dialysis involves more rigid scheduling and longer recovery time for some patients, but it may reduce the burden of self-management.

Whatever the setting, dialysis is a long-term therapy. For those eligible for a kidney transplant, dialysis is considered a necessary step until a kidney transplant becomes available. It helps to build new routines, so ask for help when needed, and stay connected to the activities and people you enjoy.

Logistical Considerations

Dialysis introduces new routines and responsibilities, but with planning and support, these can be manageable. 

Home dialysis: Preparation includes setting up equipment, creating space for supplies, and coordinating regular deliveries. Patients also learn to monitor their treatments and maintain records, with guidance from their care team. While it requires more self-management, many patients appreciate the flexibility it offers.

In-center dialysis: Treatment will be on a fixed schedule, typically three times a week, and will require you to have reliable transportation to and from the dialysis clinic. This can be challenging for those with mobility issues or limited access to transportation. 

Regardless of the setting, managing appointments, supplies, and communication with care providers can be complex. Healthmap’s Kidney Population Health Management program helps streamline these logistics by coordinating care, supporting treatment planning, and connecting patients with the resources they need to stay on track.

Building a Support System

A solid support system including family, friends, and your care team can help make the transition to starting dialysis feel more comfortable. Their role is not only to help you manage the practical demands of dialysis but also to provide encouragement and companionship during this physically and emotionally demanding time. Don’t hesitate to let your support team know what you need. 

For members in Healthmap’s program, our Care Navigation team is here to support you throughout your dialysis journey. We work with your full team of healthcare providers to ensure you receive personalized, coordinated care, especially when you’re managing dialysis at home.

External organizations, such as the National Kidney Foundation, also offer resources, patient mentors, and educational tools to help you and your loved ones feel more confident and informed.

Final Thoughts

Starting dialysis is a big step, but it doesn’t have to be a step into the unknown. By understanding your treatment options and the changes ahead, you can move forward with confidence.

¹ “Quick Kidney Disease Facts and Stats,” www.kidneyfund.org/all-about-kidneys/quick-kidney-disease-facts-and-stats