Hemodialysis

What Is Hemodialysis?

Hemodialysis is a treatment that filters waste products, excess salt and extra fluid from your blood when your kidneys can no longer do this work themselves. Blood is drawn from your body through a vascular access, passed through a filter called a dialyzer, and returned to your bloodstream once it has been cleaned. It is used by people with kidney failure — either as a long-term therapy for advanced chronic kidney disease, or as a temporary measure while kidneys injured by illness, surgery or medication recover.

Being told you need dialysis is a serious and often emotional moment. Most people want honest answers to the same questions: what will dialysis feel like, how often is it needed, can work and family life continue, and what happens if something goes wrong between sessions. This page answers those questions plainly. Dialysis does not reverse kidney failure, and no responsible clinician will tell you otherwise. What it can do is take over the most essential kidney functions — clearing toxins, balancing certain electrolytes and removing fluid — reliably enough that many people build a stable routine around it for years.

Timely, well-managed hemodialysis can ease symptoms caused by the build-up of waste and fluid: severe fatigue, swelling, shortness of breath, nausea, itching, poor appetite and confusion. It also gives physicians a way to control dangerous shifts in potassium, acid levels and fluid balance. Because every patient’s kidney condition, heart health, vascular access, medication list and daily life are different, dialysis is always planned and monitored by a nephrology team rather than delivered as a standard package.

What is dialysis?

Dialysis is the general name for any treatment that replaces the filtering work of failed kidneys. There are two main forms. Hemodialysis cleans the blood outside the body using a machine and a dialyzer, usually in a dialysis centre or hospital. Peritoneal dialysis cleans the blood inside the body, using the lining of the abdomen as a natural filter and a special fluid that is exchanged through a soft catheter. Which form suits you depends on your medical condition, your anatomy, your home situation and your preferences — a decision made with a nephrologist, not from a list.

If you have come across the spellings dealises or dayalases while searching, these are simply common misspellings of dialysis. The treatment they refer to is the one described on this page.

How does hemodialysis work?

Hemodialysis works by moving blood past a thin membrane while a specially prepared fluid, called dialysate, flows on the other side. The dialyzer contains thousands of tiny hollow fibres. Blood flows inside the fibres; dialysate flows around them. Waste products such as urea and creatinine, along with excess potassium and other unwanted substances, move across the membrane out of the blood, following the natural tendency of dissolved substances to spread from higher to lower concentration. Blood cells and important proteins are too large to cross, so they stay in your circulation.

Fluid removal works differently. The machine applies a carefully controlled pressure difference across the membrane, drawing excess water out of the blood at a rate your care team prescribes. This is how dialysis relieves fluid overload — the swelling and breathlessness that build up when failed kidneys cannot produce enough urine. The whole prescription — session length, blood flow, dialysate composition, fluid removal target — is adjusted to your blood results, weight, blood pressure and symptoms, and it changes over time as your condition changes.

What does a dialysis machine do?

A dialysis machine pumps your blood through the circuit at a controlled rate, prepares and warms the dialysate from purified water and concentrate, controls exactly how much fluid is removed, and monitors pressures, temperature, conductivity and air detection continuously throughout the session. If any value moves outside safe limits, the machine alarms and, where necessary, stops blood flow until the team responds. The machine does not make clinical decisions — it executes a prescription written by your nephrologist and is supervised at all times by trained dialysis staff. Understanding this division of labour helps many patients feel less anxious: the technology is precise, but the judgement remains human.

Who May Need Dialysis?

Dialysis becomes necessary when kidney function has declined to the point that waste products, fluid, acids and electrolytes can no longer be controlled safely with diet, medication and other medical care. This can happen gradually, over months or years of chronic kidney disease, or suddenly, in acute kidney injury following severe infection, major surgery, trauma or drug toxicity.

People arrive at this point by different routes. Some feel progressively unwell for a long time. Others have remarkably few symptoms until kidney function is severely reduced, and the problem is found through blood tests. This is why laboratory monitoring — not how you feel on a given day — is central to diagnosis and planning.

Common symptoms that lead to evaluation

• Persistent fatigue, weakness or reduced exercise tolerance
• Swelling in the legs, ankles, feet, hands or around the eyes
• Shortness of breath caused by fluid overload
• Nausea, vomiting, poor appetite or unintended weight loss
• Itching, dry skin, sleep problems or restless legs
• Changes in urination, including very little urine output
• Confusion, difficulty concentrating or drowsiness in advanced cases
• High blood pressure that becomes difficult to control
• Chest discomfort or palpitations related to fluid or electrolyte imbalance

Diagnosis usually begins with blood and urine tests. Key blood tests include creatinine, blood urea nitrogen, estimated glomerular filtration rate, potassium, bicarbonate, calcium, phosphorus, haemoglobin, albumin and, where relevant, markers of inflammation or infection. Urine tests assess protein, blood, infection and output. Kidney ultrasound helps evaluate kidney size, obstruction, cysts and structural abnormalities. In selected cases, a kidney biopsy is needed to identify the underlying cause of the kidney disease, because the cause can shape the whole treatment plan.

The decision to start hemodialysis is never based on a single laboratory number. Nephrologists weigh symptoms, fluid status, nutrition, potassium and acid–base balance, blood pressure, heart and lung function, and the expected course of the disease. Planning ahead matters enormously, because the best long-term vascular access — an arteriovenous fistula — usually needs weeks to months to mature before it can be used safely.

How serious is being on dialysis?

Needing dialysis means your kidney disease is advanced, and that is serious — there is no honest way to soften it. At the same time, dialysis is a structured, well-established therapy, and many people on regular treatment continue to work, travel, raise families and pursue the things that matter to them. How demanding life on dialysis is depends heavily on the rest of your health: heart disease, diabetes, frailty and infection risk all influence how well treatment is tolerated. What consistently makes the difference is attending every session, protecting the vascular access, managing fluid and diet between treatments, and staying in close contact with the nephrology team. Dialysis restricts your schedule; it does not have to define your life.

Conditions and Indications Hemodialysis Addresses

Hemodialysis is used for a range of kidney conditions and urgent metabolic problems. The most common indication is end-stage kidney disease — kidney failure in which function is permanently reduced and ongoing renal replacement therapy is required unless a kidney transplant is performed.

Chronic kidney disease may progress to this stage because of diabetes, high blood pressure, glomerulonephritis, polycystic kidney disease, autoimmune disorders, recurrent kidney infections, congenital kidney problems or long-standing obstruction of the urinary tract. In these situations, hemodialysis becomes part of a long-term plan once kidney function can no longer support the body’s needs.

Hemodialysis is also used in acute kidney injury, which can follow severe infection, major surgery, trauma, dehydration, heart failure, medication toxicity, contrast exposure, obstruction or critical illness. In acute cases, dialysis may be temporary — though whether the kidneys recover depends on the cause of the injury and the patient’s overall condition, and no team can promise recovery in advance.

Medical situations where hemodialysis may be recommended

• Advanced chronic kidney disease: when kidney function is too low to maintain safe fluid, electrolyte and waste balance.
• Acute kidney injury: when sudden kidney failure causes dangerous complications or does not improve quickly with medical treatment.
• Severe hyperkalemia: when potassium is high enough to threaten heart rhythm and cannot be controlled rapidly by other measures.
• Fluid overload: when excess fluid causes breathing difficulty, uncontrolled blood pressure or strain on the heart.
• Metabolic acidosis: when the blood becomes too acidic and does not respond adequately to medication.
• Uremic complications: inflammation around the heart, encephalopathy, severe nausea, bleeding tendency or nerve symptoms caused by toxin build-up.
• Certain poisonings or drug toxicities: when a substance can be removed effectively by dialysis and the situation requires urgent clearance.

In every case, the care team evaluates whether hemodialysis is the right approach, whether another dialysis method suits the patient better, and whether kidney transplantation is an option. A good treatment plan reflects the medical evidence and the patient’s values, daily routine and long-term goals — not one or the other.

Hemodialysis, Peritoneal Dialysis and Other Options

Peritoneal dialysis is the main alternative to hemodialysis for people who need long-term kidney replacement. Instead of filtering blood through an external machine, it uses the peritoneum — the membrane lining the abdomen — as the filter. Dialysis fluid is introduced into the abdominal cavity through a soft, permanently placed catheter, absorbs waste and excess fluid across the membrane, and is then drained and replaced. It is typically done at home, either through manual exchanges during the day or with a small cycler machine overnight. You can read more on our peritoneal dialysis page.

Neither method is universally better. Hemodialysis concentrates treatment into scheduled sessions supervised by professionals; peritoneal dialysis spreads gentler treatment across every day and gives more independence, but requires training, a suitable abdomen and a clean home environment. Some patients switch between methods over the years as their circumstances change. Kidney transplantation, for suitable candidates, remains the option that most closely restores natural kidney function, and dialysis often serves as the bridge while a transplant is evaluated or awaited. For some patients — usually those with severe frailty or other advanced illness — supportive kidney care without dialysis is a legitimate, carefully considered path.

Children with kidney failure need a distinctly different approach: dosing, access, equipment, growth and schooling all require specialist paediatric planning. Our pediatric dialysis page covers how treatment is adapted for younger patients.

How a Hemodialysis Session Is Performed

Hemodialysis is a highly structured treatment. The process can seem daunting at first, but most patients become familiar with the routine within a few weeks, and the predictability itself becomes reassuring. A trained team monitors you before, during and after every session, and your nephrologist adjusts the prescription as your needs change.

Preparation before starting dialysis

Preparation begins with a full nephrology assessment: your diagnosis, the trend of your kidney function over time, medical history, current medications, allergies, previous surgery, heart condition, infection risks, vaccination status and recent laboratory results. If you have received dialysis elsewhere, prior records — access history, viral serology, medication lists, dry weight and recent hospital summaries — allow the team to plan safely rather than starting from scratch.

The single most important preparation step is vascular access. Hemodialysis needs reliable, repeated entry to the bloodstream, and there are three main options. An arteriovenous fistula, created surgically by joining an artery and a vein in the arm, is generally preferred for long-term dialysis because it tends to carry lower infection and clotting risks than the alternatives — but it needs time to mature before use. An arteriovenous graft, a synthetic tube connecting artery and vein, is used when the patient’s own veins are not suitable. A central venous catheter, placed in a large vein, allows dialysis to start immediately and can be lifesaving in urgent situations, but it is usually not the preferred long-term solution when other options are available.

Before each session, you are weighed and checked: blood pressure, pulse, temperature, swelling, breathing and the condition of your access. The team reviews how much fluid should be removed, your recent blood results, current symptoms and anything that has changed since the last visit — an illness, a hospital stay, a medication change or a missed treatment.

What happens during a dialysis session

A typical session follows a consistent sequence:

1. The vascular access is cleaned thoroughly. With a fistula or graft, two needles are placed — one carrying blood to the dialyzer, one returning it. With a catheter, the dialysis lines are connected to the catheter ports using sterile technique.
2. The machine begins circulating blood through the dialyzer at the prescribed flow rate.
3. Dialysate flows on the other side of the membrane, drawing out waste products and correcting electrolyte levels.
4. The machine removes the prescribed amount of excess fluid gradually across the session.
5. Blood pressure and symptoms are checked at regular intervals throughout.
6. At the end, blood in the circuit is returned to your body, needles are removed and pressure is applied until bleeding stops, or catheter ports are cleaned and capped.
7. You are weighed again and assessed before leaving.

Anticoagulation may be used during the session to reduce clotting in the circuit, depending on your bleeding risk and clinical condition — a decision your treating team makes and revisits regularly. Any problems during treatment — blood pressure changes, cramping, nausea, headache, dizziness, itching, chest discomfort or access difficulties — are addressed promptly by staff who are there for exactly this reason.

What do patients do during dialysis?

Most people simply pass the time in whatever way suits them: reading, sleeping, watching films or series on a tablet, listening to music or podcasts, working on a laptop, or talking with family and staff. Sessions last several hours, and dialysis chairs are designed for long sitting. Patients with heart disease, unstable blood pressure, active infection or a recent hospital admission may be monitored more closely and asked to limit activity during treatment. Over time, many patients treat their sessions as protected time — an enforced pause in the week — which is a healthier framing than treating each one as an ordeal.

Technology used in hemodialysis care

Modern dialysis relies on computerised machines that track pressures, flow rates, temperature, conductivity and alarms continuously. Water quality is a quiet but critical foundation: dialysate is prepared from purified water, so dedicated water treatment systems are essential in any serious dialysis unit. Dialyzers are selected to match the patient’s size, blood results and prescription. Laboratory systems track trends in anaemia, nutrition, mineral balance, inflammation, infection markers and dialysis adequacy — the measured confirmation that each session is actually clearing enough waste.

Ultrasound and vascular imaging are used to map blood vessels before access surgery and to investigate access complications such as narrowing or clotting. Cardiac testing, chest imaging and extended laboratory work come into play when patients develop fluid overload, breathlessness, low blood pressure or other complex problems. The point of all this technology is not spectacle — it is to make treatment measurable, adjustable and safer for your specific situation.

How long does each session take, and how do you feel afterwards?

Most outpatient hemodialysis sessions last several hours and are performed multiple times per week. The exact duration depends on body size, remaining kidney function, fluid gained between treatments, laboratory results, the dialyzer used, blood flow rates and how well you tolerate treatment. Hospitalised patients may follow a different schedule depending on urgency and stability.

Afterwards, some tiredness is common, particularly early in treatment or after larger fluid removal — many patients rest for part of the day following a session. Others feel noticeably better as fluid overload and uremic symptoms lift. Both responses are normal, and how you feel after sessions is itself useful information that your team uses to fine-tune the prescription.

Why Acting Early Matters

Early nephrology involvement changes the course of kidney failure management. When dialysis is planned rather than started in a crisis, you have time to understand your options, prepare a durable vascular access, optimise medications, address anaemia and bone-mineral problems, adjust nutrition, receive appropriate vaccinations and, where suitable, begin transplant evaluation.

Delaying necessary hemodialysis carries real risks. Waste products can build to levels that affect the brain, stomach, nerves, immune system and blood clotting. Potassium can rise suddenly and disturb the heart’s rhythm. Fluid overload can cause severe breathlessness, uncontrolled blood pressure, strain on the heart and unplanned hospital admission. Worsening acidosis undermines energy, breathing, bone health and overall metabolic stability.

Delay also narrows your access options. Patients who start dialysis urgently usually need a central venous catheter, because no fistula or graft is ready. Catheters do their job in emergencies, but they carry higher infection and clotting risks than a mature permanent access. This is why patients with advanced chronic kidney disease are often referred to a vascular access team well before dialysis becomes urgent.

To be clear: acting early does not mean starting dialysis before it is needed. It means timely evaluation, accurate monitoring and a plan that can be activated safely when the clinical picture calls for it.

What Hemodialysis Can Do for You

Hemodialysis supports essential body functions when the kidneys can no longer maintain safe internal balance on their own.

Benefit	What It Means for You
Removal of waste products	Dialysis clears toxins that contribute to nausea, fatigue, itching, confusion, poor appetite and other symptoms of uremia.
Fluid control	Removing excess fluid may reduce swelling, improve breathing and decrease strain on the heart and blood vessels.
Electrolyte balance	Treatment helps manage potassium and other electrolytes essential for heart rhythm, muscle function and overall safety.
Support for long-term kidney failure care	Regular dialysis anchors a structured plan that includes medications, nutrition, anaemia management, bone-mineral care and transplant assessment where appropriate.
Close medical monitoring	Frequent visits let the care team follow blood pressure, access health, laboratory trends, symptoms and treatment tolerance over time.

Adjusting to Dialysis: A Typical Timeline

Hemodialysis is ongoing for most patients, but there is a recognisable pattern of physical and practical adjustment after treatment begins.

Time Period	What Patients Can Expect
Day 1	The first session may be shorter or more closely monitored, especially if dialysis is urgent or the patient is medically unstable. Some patients feel tired afterwards; others notice relief from fluid overload or nausea.
First Week	The team adjusts the dialysis prescription, fluid removal goals, blood pressure treatment and symptom management. Patients learn access care, diet and fluid guidance, and what to report to the team.
First Month	Energy, appetite, breathing, swelling and sleep may improve as waste and fluid balance stabilise. Laboratory trends guide changes in anaemia treatment, mineral balance, nutrition and dialysis adequacy.
Longer Term	Dialysis becomes part of a regular routine. Long-term stability depends on consistent attendance, access protection, medication adherence, nutrition, infection prevention and ongoing nephrology follow-up.

Life on Long-Term Hemodialysis

These are the questions patients ask most often once treatment becomes part of daily life. The honest answers are more individual than most websites admit.

How long can you live on hemodialysis?

There is no single answer, and any page that gives you one number is oversimplifying. Many people live for many years on hemodialysis; how long depends far more on the rest of your health — age, heart disease, diabetes, nutrition, infection history — than on the dialysis itself. What is consistently true is that outcomes are better when treatment is regular and complete, the vascular access is well maintained, fluid gains between sessions are controlled, and other conditions are actively managed alongside the kidney care. Your own nephrologist, who knows your history and test results, is the only person who can discuss your individual outlook meaningfully.

How long do you stay on dialysis?

For chronic kidney failure, dialysis continues indefinitely unless a kidney transplant becomes possible — the kidneys do not regain function once end-stage disease is established. For acute kidney injury, dialysis may last days to weeks and can often be stopped if the kidneys recover, although recovery depends on the cause and cannot be promised in advance. Some patients also move between treatments over time: from hemodialysis to peritoneal dialysis, from either to transplant, or back to dialysis if a transplant later fails.

Can you do hemodialysis at home?

Yes — in some healthcare systems, home hemodialysis is an established option. It requires a suitable machine at home, adaptations to the water supply, structured training for the patient and often a care partner, a reliable vascular access and regular remote follow-up with the dialysis team. Home treatment offers flexibility and, in some programmes, more frequent or longer gentle sessions. It is not suitable for everyone: medical stability, home environment, dexterity and confidence all matter. For many patients who want home-based treatment, peritoneal dialysis is the more accessible route, since it uses simpler equipment. Availability of both options varies considerably between countries and health systems.

What are the common side effects of kidney dialysis?

The most frequent side effects during or after hemodialysis are drops in blood pressure, muscle cramps, tiredness, headache, nausea and itching. Most are related to how much fluid is removed and how quickly, which is why controlling fluid gains between sessions makes treatment noticeably more comfortable. Access-related problems — bleeding, bruising, narrowing, clotting and, particularly with catheters, infection — are the other main category, and they are the reason access care is taught so insistently. Longer term, patients on dialysis need monitoring for anaemia, bone-mineral disorders and cardiovascular health. Side effects are common but manageable; the pattern you experience feeds directly back into how your team adjusts the prescription.

Factors That Influence Your Results

The effectiveness and comfort of hemodialysis depend on several interconnected factors, most of which are at least partly in your hands.

Attendance comes first. Missing or shortening sessions leads to fluid overload, uncontrolled potassium, worsening blood pressure and a higher chance of needing emergency care. Dialysis works when the prescribed schedule is followed consistently — there is no way around this.

Access quality shapes everything else. A well-functioning fistula or graft delivers the blood flow needed for efficient treatment and prevents interruptions. Patients are taught to protect the access arm, avoid blood pressure cuffs or blood draws on that arm when instructed, check daily for the characteristic vibration known as a thrill, and report redness, swelling, pain, prolonged bleeding or any change in how the access feels to their care team.

Fluid management between sessions matters more than most patients expect. Large fluid gains force faster removal during treatment, which causes cramping, low blood pressure, headaches and post-dialysis exhaustion. Controlling dietary sodium — including the hidden salt in bread, processed food and restaurant meals — and following individualised fluid guidance makes sessions genuinely more tolerable and reduces strain on the heart.

Nutrition is a balancing act. Patients on hemodialysis usually need enough protein to maintain strength while managing phosphorus, potassium, sodium and fluid intake. The right diet varies with blood results, urine output, diabetes status, heart disease, appetite and cultural food preferences. A renal dietitian’s job is to translate the restrictions into meals you will actually eat.

Medication management is complex in kidney failure. Many patients take treatments for anaemia, bone-mineral disorders, blood pressure, diabetes, cholesterol or heart disease. Some medicines are removed by dialysis and need careful timing; others need dose changes because kidney function is reduced. All of these decisions belong to your treating nephrologist. Your team also needs to know about any over-the-counter medicines, herbal products, supplements or pain relievers you use, because some are unsafe when the kidneys have failed.

Underlying conditions set the frame. Diabetes, heart failure, vascular disease, infection, frailty, liver disease, cancer and autoimmune disorders all affect how well dialysis is tolerated. Complex patients benefit from coordinated care across nephrology, cardiology, endocrinology, infectious diseases, vascular surgery, intensive care and nutrition.

Finally, the emotional side is real. Dialysis reshapes schedules, work, travel, family life and self-image. Anxiety, low mood, disturbed sleep and treatment fatigue are common and deserve attention, not stoicism. Patients who understand their treatment and feel heard by their team consistently manage the adjustment better.

How Much Does Hemodialysis Cost?

There is no honest single figure, because hemodialysis is an ongoing treatment rather than a one-off procedure, and its cost varies enormously between countries, health systems and funding arrangements. Rather than quote a number that would mislead most readers, it is more useful to understand what drives the cost of dialysis care:

• Frequency and duration: maintenance dialysis means several sessions every week, indefinitely, so annual cost depends on the full schedule, not the price of one session.
• Setting: hospital-based dialysis, outpatient centre treatment and home programmes are priced differently.
• Vascular access: fistula or graft surgery, catheter placement and any procedures to repair or revise the access are separate from the sessions themselves.
• Medications and monitoring: anaemia treatment, bone-mineral medication, regular laboratory panels and imaging all add to the overall cost of care.
• Coverage: in many countries, dialysis for kidney failure is funded or subsidised by national health systems or insurance; what a patient actually pays depends on their coverage, not just the list price.

Before starting or transferring treatment anywhere, ask for an itemised explanation of what a quoted arrangement includes — sessions, access care, medications, laboratory work and emergency cover — so you are comparing complete care, not headline figures.

Travelling While on Dialysis

Being on hemodialysis does not rule out travel, but it removes spontaneity: sessions must be arranged at the destination before you book anything. Practical planning includes confirming that a suitable dialysis unit can take you on the dates you need, sharing your recent records in advance — access type, dry weight, dialysis prescription, viral screening results, medication list and any recent complications — and building your itinerary around the treatment schedule rather than squeezing treatment around the itinerary. Time zones, flight length and fluid management on travel days all deserve thought. Your current dialysis team and the receiving unit will need to exchange records well ahead of the trip, and it helps to carry a written summary of your prescription and recent laboratory results with you in case plans change on the road.

Hemodialysis Care at Acibadem

Patients considering hemodialysis away from home usually need more than a slot in a treatment schedule. They need careful medical review before the first session, dependable scheduling, clear communication, coordination with the physicians who already know them, and access to hospital-level expertise if their condition becomes complicated. At Acibadem, hemodialysis is provided within a broader hospital environment, so kidney failure is evaluated in context rather than treated as an isolated appointment.

Nephrologists work alongside experienced dialysis nurses and, where needed, physicians from vascular surgery, cardiology, endocrinology, infectious diseases, intensive care, radiology and nutrition. This multidisciplinary structure matters most for patients with diabetes, heart disease, difficult vascular access, recurrent infections, complex medication regimens or a recent hospital admission. In complex cases, specialist discussion and board-based decision-making help align treatment with evidence-based protocols and the patient’s overall goals.

Diagnostic pathways may include comprehensive laboratory testing, kidney and vascular ultrasound, cardiac evaluation, imaging, infection screening and assessment of dialysis adequacy. On the technical side, care draws on dialysis machines with continuous monitoring, dedicated water purification systems, laboratory trend tracking, vascular imaging and hospital resources for urgent evaluation when a situation changes. The aim throughout is a dialysis prescription tailored to the individual, not a one-size-fits-all protocol.

For patients already on dialysis in another country, continuity depends on documentation: recent dialysis records, access type and history, hepatitis and infection screening results, current medications, allergies, dry weight, recent laboratory values and any complications during prior sessions. When this information is available in advance, the nephrology team can plan treatment more safely and efficiently. For patients newly diagnosed with advanced kidney disease, evaluation can cover the full range of options — hemodialysis planning, vascular access referral, peritoneal dialysis where appropriate, and kidney transplant assessment for suitable candidates — with a plan that accounts for care continuing between countries.

Moving Forward With Clarity

Hemodialysis feels overwhelming at the start. It is also one of the most structured, most closely monitored and best understood therapies in medicine, and it allows many people with kidney failure to live safely and fully. What matters most is an accurate evaluation and a plan built around your actual condition — your symptoms, vascular access, laboratory trends and long-term goals — rather than a generic protocol.

Whatever team you work with, the strongest position you can be in is an informed one: complete recent records, an honest understanding of your options, a vascular access planned before it becomes urgent, and a clear picture of what each week of treatment will look like. Dialysis asks a great deal of patients. Good planning gives a great deal back.