Hemodialysis is the method of choice for those who are in irreversible renal failure.
The renal specialist inserts an inner tube into the wrist or elbow in order to join an artery with a vein (arteriovenous, or A-V, fistula). This tube is made of a combination of silicone and plastic (silastic) and can be pierced a few times with a needle without leaking blood. After the nurse inserts the needle into the A-V fistula, the dialysis machine draws all the patient's arterial blood into it for cleansing and then pumps it back into the veins. The blood circulates through the machine, which contains a dialyzer (artificial kidney). The dialyzer has a thin membrane that separates two spaces. Blood passes on one side of the membrane, and dialysis fluid passes on the other. The wastes and excess water pass from the blood through the membrane into the dialysis fluid, which is then discarded. The machine pumps the cleaned blood back to the patient's bloodstream. Although some patients and family members learn to do it themselves without a nurse, in my view the dialysis nurse should remain at the bedside from start to finish. This flow has to be monitored continuously, or there could be dire consequences. The complications commonly associated with hemodialysis are loss of blood volume (with nausea, vomiting, a sudden drop in blood pressure, and shock), blood infection such as hepatitis, AIDS, and staphylococcus), and worsening of anemia.