What is (are) Kidney Failure: Choosing a Treatment That's Right for You ? 
 Purpose of Hemodialysis
                
The purpose of hemodialysis is to filter your blood. This type of dialysis uses a machine to remove harmful wastes and extra fluid, as your kidneys did when they were healthy. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium, calcium, and bicarbonate, in your blood. Hemodialysis is not a cure for kidney failure; however, it can help you feel better and live longer.
                
How Hemodialysis Works
                
Before you can begin dialysis, a surgeon will create a vascular access, usually in your arm. A vascular access lets high volumes of blood flow continuously during hemodialysis treatments to filter the largest possible amounts of blood per treatment.
                
Hemodialysis uses a machine to move your blood through a filter, called a dialyzer, outside your body. A pump on the hemodialysis machine draws your blood through a needle into a tube, a few ounces at a time. Your blood then travels through the tube, which takes it to the dialyzer. Inside the dialyzer, your blood flows through thin fibers that filter out wastes and extra fluid. After the dialyzer filters your blood, another tube carries your blood back to your body. You can do hemodialysis at a dialysis center or in your home.
                
Hemodialysis can replace part of your kidney function. You will also need dietary changes, medicines, and limits on water and other liquids you drink and get from food. Your dietary changes, the number of medicines you need, and limits on liquid will depend on where you receive your treatmentsat a dialysis center or at homeand how often you receive treatmentsthree or more times a week.
                
Pros and Cons of Hemodialysis
                
The pros and cons of hemodialysis differ for each person. What may be bad for one person may be good for another. Following is a list of the general pros and cons of dialysis center and home hemodialysis.
                
Dialysis Center Hemodialysis
                
Pros
                
- Dialysis centers are widely available.  - Trained health care providers are with you at all times and help administer the treatment.  - You can get to know other people with kidney failure who also need hemodialysis.  - You dont have to have a trained partner or keep equipment in your home.
                
Cons
                
- The center arranges everyones treatments and allows few exceptions to the schedule.  - You need to travel to the center for treatment.  - This treatment has the strictest diet and limits on liquids because the longer time between treatments means wastes and extra fluid can build up in your body.  - You may have more frequent ups and downs in how you feel from day to day because of the longer time between sessions.  - Feeling better after a treatment may take a few hours.
                
Home Hemodialysis
                
Pros
                
- You can do the treatment at the times you choose; however, you should follow your doctors orders about how many times a week you need treatment.  - You dont have to travel to a dialysis center.  - You gain a sense of control over your treatment.  - You will have fewer ups and downs in how you feel from day to day because of more frequent sessions.  - You can do your treatments at times that will let you work outside the home.  - You will have a more manageable diet and fewer limits on liquids because the shorter time between sessions prevents the buildup of wastes and extra fluid.  - You can take along a hemodialysis machine when traveling.  - You can spend more time with your loved ones because you dont have to go to the dialysis center three times a week.
                
Cons
                
- Not all dialysis centers offer home hemodialysis training and support.  - You and a family member or friend will have to set aside a week or more at the beginning for training.  - Helping with treatments may be stressful for your family or friend.  - You need space for storing the hemodialysis machine and supplies at home.  - You will need to learn to put dialysis needles into your vascular access.  - Medicare and private insurance companies may limit the number of treatments they will pay for when you use home hemodialysis. Few people can afford the costs for additional treatments.
                
Questions to Ask My Doctor
                
You may want to ask your doctor these questions:
                
- Is hemodialysis the best treatment choice for me? Why?   - If Im treated at a dialysis center, can I go to the center of my choice?  - What should I look for in a dialysis center?  - Will my kidney doctor see me at the dialysis center?  - What does hemodialysis feel like?  - How will hemodialysis affect my ____ [blood pressure, diabetes, other conditions]?  - Is home hemodialysis available in my area? What type of training will I need? Who will train my partner and me?  - Will I be able to keep working? Can I have treatments at night? Will I be able to care for my children?  - How much should I exercise?   - Whom do I contact if I have problems?  - Who will be on my health care team? How can the members of my health care team help me?  - If I do home hemodialysis, will my insurance pay for more than three sessions a week?  - With whom can I talk about finances, sex, or family concerns?   - How/where can I talk with other people who have faced this decision?
                
More information about Hemodialysis and Home Hemodialysis is provided in the NIDDK health topics, Treatment Methods for Kidney Failure: Hemodialysis and Home Hemodialysis. See also the Kidney Failure Treatment Comparison Chart in this booklet, which compares hemodialysis, peritoneal dialysis, and transplantation.