About Your Dialysis Treatment

This information explains your dialysis treatment at MSK.

Your kidneys and their functions

Your kidneys are 2 bean-shaped organs located in the back of your abdomen (belly) (see Figure 1). Your kidneys have important functions, including:

• Filtering your blood to remove extra fluid and waste products (see Figure 2).
• Balancing fluids and electrolytes (minerals in your blood).
• Making a hormone called erythropoietin (EPO) that helps you make red blood cells.
• Making hormones that keep your blood pressure and calcium levels steady.

Kidney disease

Kidney disease happens when your kidneys can’t work as they normally should.

There are 2 types of kidney disease: 

 Acute kidney injury (AKI)

• AKI can start suddenly, over a few hours or days. The damage to your kidneys may be temporary. 
• Major blood loss, severe (very bad) dehydration (not having enough water in your body), infections that affect your kidneys, or contrast dyes used for diagnostic tests can cause AKI.
• Some over-the-counter pain relievers can cause AKI. These include aspirin, ibuprofen (Motrin, Advil) and naproxen (Aleve®).   
• Dialysis (a type of treatment for kidney disease) may help your kidneys start working again. 

Chronic kidney disease (CKD)

• CKD develops slowly over many years and usually has no symptoms until later in the disease. 
• The damage is permanent, and your kidneys won’t work again. 
• The 2 most common causes of CKD are diabetes and high blood pressure. 
• CKD can be treated with dialysis.  

Signs and symptoms of AKI and CKD

• Peeing less than usual
• Trouble breathing
• Fatigue (feeling more tired than usual)
• Confusion
• Chest pain or pressure
• An irregular heartbeat
• Swelling in your legs, arms, abdomen (belly), and face
• Nausea (feeling like you’re going to throw up)
• Vomiting (throwing up)
• Loss of appetite

Your healthcare provider may order blood tests to check your blood urea nitrogen (BUN), creatinine, and electrolyte levels. Your blood results may be higher than normal if you have kidney disease.

About dialysis 

• Dialysis is a treatment that replaces the normal functions of your kidneys. The dialysis machine removes waste products and extra fluids from your blood. 
• Your blood travels outside your body and through a filter called a dialyzer (artificial kidney). 
• The dialyzer cleans your blood. The dialysis machine then returns the clean blood to your body (see Figure 3). 
• Dialysis treatments usually last 2 to 4 hours. 

Getting dialysis at MSK

At MSK, we only offer dialysis to patients admitted to the hospital.  

If you need to start dialysis while admitted to MSK

The nephrology (kidney) team will talk with you about your treatment plan. If you decide to start dialysis:

• Your nephrology team will explain the benefits of dialysis and what to expect.
• You will sign a consent form before you start dialysis. You will need to sign a new consent form each time you’re admitted to MSK. 

If you already get outpatient dialysis and are admitted to MSK

• Tell your primary healthcare provider that you are a dialysis patient.   
• Your healthcare provider will tell the MSK nephrology team who will manage your dialysis during your hospital stay. 
• Tell your nurse if you have an AVF (arteriovenous fistula) or AVG (arteriovenous graft).
• Your nurse will place a special band on your arm with your dialysis access. This band reminds your care team not to take blood pressure or draw blood from that arm. 
• You will need to sign a new consent form for dialysis each time you’re admitted to MSK.

Before your dialysis treatment  

Your healthcare provider will arrange to have your dialysis catheter placed before you start dialysis.  

Your dialysis catheter:

• Is a central venous catheter (CVC). It’s a thin, flexible tube that’s placed into a large vein in your neck, chest, or groin area (see Figure 4). 
• Has 2 lumens (tubes) that stay outside your body. One is red and one is blue.
  • The red lumen carries blood from your body to the dialyzer to be cleaned. 
  • The blue lumen carries the cleaned blood back into your body. 

The Interventional Radiology (IR) or Intensive Care Unit (ICU) team can place your dialysis catheter. Your healthcare provider will tell you what to expect during the procedure.  You will need to sign a consent form before your catheter is placed.   

What to expect during dialysis 

On the day of your dialysis treatment:

• A transport team member will take you to the dialysis treatment area. 
• You will meet the dialysis nursing team and shown the treatment room and equipment.   
• Your dialysis nurse will explain what will happen during your treatment.  
• Your nephrology care team will answer any questions you have. They will also make sure you have signed the consent form for dialysis.  

At the start of your dialysis treatment:

• You will be placed on a heart monitor to check your vital signs (blood pressure, temperature, heart rate and rhythm). 
• Your dialysis nurse will connect you to the dialysis machine to start your treatment when your vital signs are within normal ranges.

During your dialysis treatment:

• Your dialysis nurse will monitor you closely during your treatment. They will report any changes to your nephrology team. 
• Your vital signs will be taken every 15 minutes, or more often if needed. 
• You can sleep, watch television, read, or use your electronic devices. 
• You cannot eat or have visitors during your treatment.

When your dialysis treatment is over:

• The dialysis machine will return clean blood to your body.
• Your dialysis nurse will disconnect you from the dialysis machine. 
• Your dialysis nurse will check your vital signs again and tell your primary nurse how your treatment went. 
• A transport team member will take you to your room.

How often will you have dialysis at MSK

Your MSK nephrologist will decide how often you will have dialysis. 

If you’re starting dialysis 

• Your first dialysis treatment will be 2 hours. This gives your body time to get used to dialysis. 
• You may have dialysis for 2 to 3 days in a row when you start. 
• After that, you may have dialysis 3 times a week for 3 to 4 hours at a time. 
• Your nephrology team will review your daily weight, blood test results, and other medical needs to plan your dialysis treatments.

If you already get dialysis outside of MSK 

• Your nephrology team will plan your dialysis schedule when you’re admitted to MSK. 
• Your schedule will be based on your daily weight, blood test results and medical needs. 
• Your inpatient dialysis schedule may be different from your usual outpatient dialysis schedule.
• Before you leave MSK, your nephrology team will return you to your outpatient dialysis schedule.  

Daily weight and blood tests  

While you’re admitted to MSK, your care team will weigh you and do blood tests every day. You will need to have your blood test done by 5:00 a.m.  

Your nephrology team will review your daily weight and blood test results. They will use these results to plan your dialysis treatments.. 

Getting dialysis outside of MSK

Before you leave MSK, your nephrology team will talk with you about whether you need to continue dialysis. 

If you need to continue dialysis after you leave MSK: 

• Your case manager will help you find an outpatient dialysis center in your area.
• They will give you a list of dialysis centers to choose from. 
• Your case manager will work with the center you choose to arrange your dialysis schedule before you leave MSK.  

If you already get dialysis at an outpatient center: 

• Your case manager will confirm your schedule with your outpatient dialysis center before you leave MSK. 

If your kidneys recover their function and you no longer need dialysis:

• Your dialysis catheter will be removed before you leave MSK. 

Treatment area hours and location 

Dialysis is given in 2 treatment rooms in the ICU. The ICU is located at:

Memorial Sloan Kettering 1275 York Avenue (between East 67^th and East 68^th Streets)
New York, NY 10065
Take the M elevator to the 11^th floor 

Dialysis treatments are available Monday to Saturday from 7:00 a.m. to 5:00 p.m. 

Contact information

If you have any questions or concerns about your dialysis treatment, tell a member of your care team.  They will contact the nephrology team.

Resources

American Kidney Fund
800-638-8299
www.kidneyfund.org

American Association of Kidney Patients
800-749-2257
www.aakp.org

Kidney School
608-833-8033
www.kidneyschool.org