Feeling nervous before your first dialysis session is completely normal. Many patients and families don't know what will happen, how long it takes or how it will feel. Knowing what to expect can make the first day a lot calmer.
This guide walks through a first haemodialysis session at a dialysis centre: before, during and after treatment. Every centre has its own routine, so follow your own doctor's and nurses' instructions. If you have chosen peritoneal dialysis instead, read haemodialysis or peritoneal dialysis?.
Before your first day
A few things usually need to be in place before a centre can start your treatment:
- A referral letter from your nephrologist, with a summary of your medical history.
- Recent blood test results, including screening for hepatitis B, hepatitis C and HIV. Centres need these to place you on the right machine and keep every patient safe.
- A vascular access that is ready to use: an arteriovenous fistula (AVF), a graft or a catheter.
- Confirmation of payment or aid, such as approval from PERKESO (SOCSO), zakat, your insurer or a guarantee letter, if you have one.
Ask the centre about your shift. Haemodialysis is usually done three times a week, for example Monday, Wednesday and Friday, or Tuesday, Thursday and Saturday, in a morning, midday or evening shift.
On the day, eat as usual unless you have been told otherwise. Ask your doctor whether to take your blood pressure tablets before the session, as some are held back on dialysis days. Wash your access arm with soap and water.
What to bring
- Your MyKad and referral documents
- A list of your current medicines, or the medicines themselves
- Comfortable, loose clothing with short sleeves, or sleeves that roll up easily so your access can be reached
- A sweater or small blanket, as treatment rooms are often cold
- Your phone, charger, earphones, a book or something to pass the time
- A light snack, if the centre allows it
- A family member's phone number in case the team needs to reach them
Tip: Arrive early on your first day. There are usually forms to fill in and a short briefing on how the centre runs.
During the session
Pre-dialysis checks
A nurse will weigh you and check your blood pressure, pulse and temperature. Your weight before the session helps the team decide how much fluid to remove. Your access will also be checked.
Connecting to the machine
If you have a fistula or graft, the nurse will insert two needles: one to take blood to the machine and one to return it. The needles can hurt at first; ask whether a numbing cream or spray can be used. If you have a catheter, it is connected straight to the machine's lines with no needles.
The treatment
Your blood flows slowly through a filter (the dialyser), which works as an artificial kidney to remove waste and extra fluid. The cleaned blood is returned to your body at the same time.
A typical session takes about four hours. The first few sessions are often shorter and gentler so your body can adjust. The nurses will check your blood pressure regularly. You can sit or lie back, read, watch something or sleep. Keep your access arm still and in view.
Tell the nurse straight away if you feel dizzy, sick, crampy or unwell in any way.
After the session
- The needles are removed and the sites are pressed until the bleeding stops. You may be taught to do this yourself.
- You are weighed again. The difference shows how much fluid was removed.
- Get up slowly, as your blood pressure can drop after treatment.
- Avoid driving yourself home after your first session. Ask a family member to come with you.
- Remove the plasters when your nurse tells you to.
How you might feel
In the first few weeks, these are common:
- Tiredness or feeling washed out after a session. Many people feel more energetic after a few weeks, once the body has adjusted.
- Muscle cramps, often in the legs, usually when a lot of fluid is removed.
- Dizziness or low blood pressure, especially when standing up.
- Headache or nausea, more often in the first few sessions.
- Itchy skin, which is worth raising with your doctor.
Feeling low, anxious or angry is normal too. Talking to your nurses, your family or other patients can help.
How much you drink and what you eat make a big difference to how you feel during and between sessions. Read the guide to diet and fluids on dialysis.
When to get urgent help
Call 999 or go to the emergency department straight away if you have:
- chest pain or breathlessness, including breathlessness when lying flat
- bleeding from a needle site that does not stop with firm pressure
- confusion, a fit or fainting
- severe muscle weakness or an irregular heartbeat
Contact your dialysis centre the same day if you have a fever or chills (especially if you have a catheter), if your weight goes up quickly between sessions, or if you can no longer feel the buzz in your fistula.
If you have a catheter: Keep the dressing clean and dry, never open the caps, and don't let anyone other than your dialysis team use it.
Next steps
- Learn how to care for your AV fistula every day.
- Plan ahead with the guide to dialysis costs and financial aid.
- Find a dialysis centre close to home or work.