Haemodialysis
A treatment that uses a machine to filter waste and excess fluid from your blood when your kidneys can no longer do it.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Haemodialysis filters your blood with a machine when your kidneys have failed; it manages kidney failure but does not cure it.
- It usually means around 4 hours, 3 times a week, and you need reliable bloodstream access, ideally a fistula, which is planned well in advance.
- It is one option among several: peritoneal dialysis, a kidney transplant and supportive care are alternatives to discuss.
- Diet, fluid limits and looking after your access are a big part of staying well, and a line carries more risk of infection than a fistula.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Removes waste products and excess fluid your kidneys can no longer clear
For some frail people with several other serious illnesses, supportive (conservative) care without dialysis may give similar length but better quality of...
A fistula needs several weeks to mature before it can be needled. You will be shown how to check it is working (a buzzing feeling called a thrill) and...
A named kidney team and an out-of-hours advice line for access and fluid problems.
A fistula needs several weeks to mature before it can be needled. You will be shown how to check it is working (a...
The team works out how much fluid to remove and adjusts your treatment. You may feel washed out afterwards while...
Symptoms such as swelling and breathlessness usually improve. Fluid and diet limits, medicines and the routine of...
Regular blood tests fine-tune your dialysis, medicines for anaemia and bone health, and diet. Your access is...
What is haemodialysis?
Haemodialysis is a treatment for kidney failure. Your blood is passed through a machine with a special filter that removes waste products and extra fluid, then returned to your body. It does the job your kidneys can no longer do well enough.
Most people have treatment in a dialysis unit, usually around four hours, three times a week. Some are trained to dialyse at home, which can offer more flexibility. To connect to the machine you need reliable access to your bloodstream, usually a fistula (a joined-up artery and vein in your arm) or, less ideally for the long term, a tube (line) into a large vein.
Haemodialysis controls the build-up of waste and fluid and helps manage symptoms, but it is not a cure and replaces only part of normal kidney function. It is one of several options for kidney failure, alongside peritoneal dialysis, a kidney transplant and, for some people, supportive care without dialysis.
Starting dialysis is a major change to daily life, and the choice between options should be made with your kidney team based on your health, your priorities and what fits your life.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Haemodialysis access compared
| Access | Main advantage | Main drawback |
|---|---|---|
| Fistula | Lowest infection risk, lasts longest | Needs weeks to mature; needling |
| Graft | Usable sooner than a fistula | More clotting and infection |
| Line (catheter) | Works immediately | Highest infection and vein-damage risk |
A fistula is preferred for long-term dialysis, which is why access is planned well before you are likely to start.
Preparing for your treatment
- Have a full discussion of all the options, in-centre or home haemodialysis, peritoneal dialysis, transplant and supportive care, before deciding.
- Plan access early: a fistula needs creating weeks to months before you are likely to start, so it has time to mature.
- Protect the veins in your non-dominant arm from blood tests and drips so they can be used for a fistula.
- Ask about a dietitian, as fluid, salt, potassium and phosphate limits are an important part of treatment.
- Arrange transport and think about how three sessions a week will fit with work and family life.
- Discuss vaccinations, including hepatitis B, especially if you might dialyse away from home or abroad.
- Talk about whether a transplant assessment is right for you, as transplantation is the closest thing to restoring kidney function.
What happens
Before regular dialysis starts, you usually have an operation under local anaesthetic to create a fistula in your arm, or a line placed into a large vein if treatment is needed sooner. A fistula needs several weeks to mature before it can be used.
At each session, two needles are placed into your fistula (or your line is connected), and your blood flows through the machine, where waste and excess fluid are removed, before being returned to you. A typical session is about four hours, three times a week. You can usually read, rest or use a device during treatment.
The team monitors your blood pressure and how much fluid is removed, and checks blood results regularly to fine-tune your treatment, medicines and diet. If you train for home haemodialysis, you learn to set up the machine, needle your fistula and run treatment safely yourself.
Between sessions, looking after your access, sticking to fluid and diet advice and taking your medicines all help you stay well.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- For some frail people with several other serious illnesses, supportive (conservative) care without dialysis may give similar length but better quality of life, and should be discussed honestly.
- A fistula may not be possible if your veins are unsuitable, in which case a graft or line is considered.
- Haemodialysis at home is not suitable without adequate space, training and reliable support.
- Dialysis is not a cure, so it should never be presented as restoring normal kidney function.
Delay or rearrange if…
- There is an active, untreated infection, especially at a potential line or access site.
- Access has not been planned and you are not yet in urgent need, so a fistula can be created and allowed to mature.
- The full range of options, including transplant and supportive care, has not been discussed.
- You feel pushed toward one option without your priorities and circumstances being explored.
Alternatives to discuss
- Peritoneal dialysis, which uses the lining of your abdomen and is done at home.
- Kidney transplant, which usually offers the best quality and length of life for suitable people.
- Supportive (conservative) care without dialysis for some people, focusing on symptoms and quality of life.
- Continuing to optimise medicines and diet in earlier kidney disease before dialysis is needed.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Removes waste products and excess fluid your kidneys can no longer clear
- Helps control symptoms such as swelling, breathlessness, nausea and itching
- Helps keep blood chemistry, such as potassium, in a safer range
- Can be done at home for some people, allowing more flexibility
- Keeps you well enough to consider a kidney transplant if you are suitable
Risks & complications
- Low blood pressure during sessions, causing dizziness, cramps or feeling washed out
- The time commitment and tiredness around treatment days
- Fluid and diet restrictions that affect daily life
- Discomfort from needling the fistula
- Fistula problems: failure to mature, narrowing or clotting, sometimes needing another procedure
- Infection, especially with a line; line infections can become serious
- Anaemia, bone and mineral problems needing medicines and monitoring
- Access affecting blood flow to the hand, causing a cold or painful hand
- Serious bloodstream infection (sepsis), particularly from a line
- Severe access-related reduction in hand blood flow that can threaten the hand
- Serious reactions or complications during a session, which the unit is set up to manage
The biggest ongoing risks relate to your access and to infection. A fistula is preferred because lines carry a much higher infection risk and can damage veins. Ask how your access will be created and protected, what the plan is if a fistula clots or fails to mature, and what warning signs of access infection or hand problems to watch for. Many people on dialysis are also living with other conditions that affect overall risk.
Published figures to discuss
Risks vary with your access type, other illnesses and how long you have been on dialysis. Some access figures have reasonably consistent ranges; many outcomes depend heavily on individual factors, so we give cautious figures only where the evidence is solid and use plain-English wording otherwise. We do not quote precise survival percentages, which depend strongly on age and other conditions.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Fistula failing to mature or needing a further procedure | Up to around 1 in 5 in some series | Varies with vein quality, surgeon and how it is monitored; some need a graft or line instead. | NHS - Dialysisnhs.ukPublished figure |
| Access-related reduction in hand blood flow (ischaemia) | Symptoms reported in up to around 8% in some reports | Often mild, but a cold, painful or weak hand needs prompt review as severe cases can threaten the hand. | NHS - Dialysisnhs.ukPublished figure |
| Blood pressure drop during dialysis | Common | Fluid removal, heart disease and medicines can cause cramps, dizziness or faintness during treatment. | Guide sourcesClinical context |
| Line or access infection | Higher with central venous catheters | Fever, rigors during dialysis, redness or discharge around access need urgent dialysis-unit review. | NHS - Dialysisnhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Here, recovery is about how you respond to dialysis and adjust to it as a long-term treatment, plus a short physical recovery after access surgery. There is no end-point in the way there is after an operation; the aim is steady, well-controlled treatment that fits your life.
- Feeling tired or washed out after sessions, especially at first
- Cramps or a drop in blood pressure during treatment that the team manages
- Adjusting to fluid and diet limits over the first weeks
- A maturing fistula gradually becoming easier to needle
Aftercare
- Protect your fistula arm: no blood pressure cuffs, blood tests or drips in it, and check daily for the buzzing thrill.
- Keep to the fluid, salt, potassium and phosphate advice from your dietitian.
- Take medicines for blood pressure, anaemia, bone health and phosphate as prescribed.
- Keep line dressings clean and dry if you have a catheter, and watch for redness, discharge or fever.
- Attend all sessions; skipping dialysis allows dangerous waste and fluid to build up.
- Keep dental and skin infections in check and report them, as infection is a particular risk.
- Discuss travel well in advance so dialysis away from base can be arranged safely.
- A way to check your fistula thrill daily
- Dietitian advice on fluid, potassium and phosphate
- An up-to-date medicines list
- Line care supplies, if you have a catheter
- Transport arranged for sessions
- Vaccinations, including hepatitis B, up to date
- Unit contact number and out-of-hours advice line
Scars and how they heal
Creating a fistula or graft leaves a small surgical scar on the arm, and the fistula itself shows as an enlarged, buzzing vein under the skin. Repeated needling can leave marks and areas of firmness over time. A line leaves a small scar at the insertion site. Ask your team how to care for the skin over your access.
⚠ Get urgent help if…
- Your fistula stops buzzing (no thrill) or the arm becomes painful, cold or swollen, contact the unit urgently
- Redness, swelling, discharge or pain at a line or fistula site, or a fever, possible infection
- Bleeding from the access that does not stop with pressure, seek emergency help
- Severe breathlessness, unable to lie flat, or marked swelling, suggesting fluid overload
- Chest pain, palpitations or feeling faint, which can relate to fluid or potassium
- A cold, white, painful or weak hand on the access side
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
Well-run haemodialysis controls the build-up of waste and fluid, eases symptoms and keeps blood chemistry in a safer range, helping you feel and function better. It replaces only part of normal kidney function, so it manages kidney failure rather than curing it.
Good treatment is reflected in your symptoms, blood pressure, fluid balance and blood results over time, not in a single test. Many people live for years on dialysis, though it is demanding, and a kidney transplant, where suitable, usually offers a better quality and length of life.
Haemodialysis is usually a long-term, often lifelong, treatment unless you receive a kidney transplant. A fistula can last for years with good care but can narrow or clot and may need procedures to keep it working; grafts and lines tend to need replacing sooner. Your treatment is adjusted over time as your health, weight and blood results change. For many people, transplantation is the option most likely to extend life and reduce the burden of treatment.
Related tests, treatments or support
Haemodialysis goes hand in hand with medicines for anaemia, bone and mineral health, blood pressure and sometimes phosphate binders taken with food, plus dietitian input. Vaccinations, including hepatitis B, are recommended. Many people are assessed in parallel for a kidney transplant, and dialysis keeps you well while you wait. Travel needs dialysis away from base arranged in advance.
Follow-up & long-term care
You are reviewed regularly by the kidney team, with blood tests guiding adjustments to dialysis, medicines and diet, and your access checked at every session. You will usually have periodic clinic reviews, dietitian and sometimes social-work or psychology support, and ongoing discussion about whether a transplant is right for you.
- Regular blood tests to fine-tune dialysis, anaemia and bone-health treatment
- Daily checks and protection of your fistula or graft
- Ongoing fluid and diet management with a dietitian
- Keeping vaccinations up to date and managing infections promptly
- Periodic review of transplant suitability
- Procedures from time to time to keep access working
Repeat, follow-on and what comes next
- Fistulas and grafts often need procedures over time to keep them open, such as angioplasty, or may need to be redone.
- Lines may need replacing if they become infected or stop working, and are best swapped for a fistula where possible.
- Your dialysis prescription is adjusted regularly as your health and blood results change.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named kidney team and an out-of-hours advice line for access and fluid problems.
- Regular blood tests and review of dialysis adequacy, anaemia, bone health and blood pressure.
- Dietitian input and clear fluid and diet plans.
- Proactive access monitoring and a plan to convert lines to fistulas where possible, plus ongoing transplant discussion.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether care is NHS or private
- In-centre versus home haemodialysis, including home setup and training
- The access procedure (fistula, graft or line) and any procedures to keep it working
- Medicines for anaemia, bone health, blood pressure and phosphate
- Frequency and length of sessions
- Transport to and from a unit
- Any dialysis away from base when travelling
- What each session and the access procedure include
- Whether home haemodialysis setup, training and support are covered
- Cost of medicines and monitoring blood tests
- What happens, and who pays, if your access fails or you need admission
- Transport arrangements and costs
- Arrangements and costs for dialysis away from base
- How transplant assessment fits in
On the NHS? Haemodialysis is routinely provided by the NHS for people with kidney failure; private provision exists but most long-term dialysis in the UK is NHS-funded.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not presenting transplant and supportive care as genuine alternatives.
- Starting with a line for convenience without a clear plan to create a fistula.
- Underplaying the lifestyle impact, fluid and diet limits, and the commitment of treatment.
- Not explaining that dialysis manages, but does not cure, kidney failure.
- Failing to plan for travel, infection risk and vaccination.
Marketing red flags
- Any claim to 'cure' kidney failure or 'restore' kidney function with dialysis, supplements or detox programmes.
- Promising a fistula will never need further procedures.
- Downplaying the infection risk of lines.
- Selling home dialysis without honest discussion of training, support and safety.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which type of access do you recommend for me, and what is the plan if it fails?
- Would home haemodialysis or peritoneal dialysis suit my situation?
- Am I a candidate for a kidney transplant, and how do I get assessed?
- What fluid and diet limits will I need, and can I see a dietitian?
- What warning signs about my access or fluid should prompt urgent contact?
- How can I arrange dialysis if I want to travel?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does haemodialysis cure kidney failure?
How often and how long is each session?
Why do I need a fistula rather than just a tube?
Can I still travel?
Can I dialyse at home?
Is haemodialysis the only option?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS - Dialysis NHS - Dialysis: how it is performed UK Kidney Association - vascular access guideline Kidney Care UK - Haemodialysis NICE NG107 - Renal replacement therapy and conservative management
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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