As healthcare providers, many of us have cared for patients who depend on dialysis. Even so, it’s common to wonder what’s really happening during treatment. A dialysis RN arrives, the room fills with machines, the sink is suddenly off-limits, and a faint smell of bleach lingers after everything is packed up. A few hours later, your patient is tired but more stable.
So what is dialysis, exactly? And how can nurses best support patients before, during, and after treatment?
This guide breaks down dialysis in a clear, approachable way, covering how it works, why it’s needed, and practical tips for nurses who may encounter dialysis patients in acute or inpatient settings.
What Is Dialysis and Why Do Patients Need It?
Dialysis is a life-sustaining treatment that partially replaces the work of the kidneys when they can no longer function effectively. Healthy kidneys remove waste products, balance electrolytes, regulate fluid levels, and help maintain a balance of acids and bases. When kidney function declines, often due to chronic kidney disease (CKD) or acute kidney injury (AKI), dialysis steps in to help manage these essential tasks.
At its core, dialysis:
- Cleans waste products from the blood
- Removes excess fluid
- Helps balance electrolytes like potassium and sodium
- Corrects acid-base imbalances
Most patients undergoing hemodialysis receive treatment three times a week, with each session lasting three to four hours.
The Two Main Types of Dialysis
When it comes to dialysis treatment, there are two main types.
1. Hemodialysis (HD)
Hemodialysis is the most common form of dialysis encountered in hospitals. Blood is removed from the patient, filtered through a dialyzer (an artificial kidney), and then returned to the body.
Key features:
- Performed in hospitals, outpatient dialysis centers, or occasionally at home
- Requires vascular access (catheter, fistula, or graft)
- Closely monitored by dialysis-trained nurses
This article primarily focuses on hemodialysis, as it’s what most inpatient and bedside nurses encounter.
2. Peritoneal Dialysis (PD)
Peritoneal dialysis uses the lining of the abdomen (the peritoneum) as a natural filter. Dialysis fluid is infused into the abdomen and later drained, removing waste and excess fluid in the process.
Key features:
- Often performed at home
- Uses a peritoneal catheter
- Less commonly seen in acute care settings
For a more in-depth comparison, the National Kidney Foundation provides a helpful overview of hemodialysis versus peritoneal dialysis.
How Dialysis Works: Diffusion and Fluid Removal
While dialysis machines appear complex, the treatment itself relies on two core physiological principles: diffusion and fluid removal. Understanding these processes helps nurses anticipate patient responses, recognize complications, and provide clearer education to patients and families.
Diffusion and Electrolyte Balance
Dialysis works largely through diffusion, which is the movement of solutes from an area of higher concentration to lower concentration. Electrolytes such as potassium are corrected using dialysate that is prescribed specifically for each patient.
It’s important to note that dialysis balances electrolytes in the bloodstream first. Electrolytes stored in tissues continue shifting into the blood during treatment, which is why lab values are not considered accurate until at least one hour after dialysis ends.
Fluid Removal and Blood Pressure Changes
Excess fluid is removed by applying negative pressure across the dialysis filter, pulling fluid from the bloodstream into the dialysate. Typically, two to four liters of fluid may be removed during a single treatment.
Fluid removal can lead to hypotension if it occurs faster than the patient’s body can tolerate. Blood pressure and vital signs are monitored closely (often every 15 minutes) and patients commonly feel fatigued after treatment due to these fluid shifts
Practical Tips for Nurses Caring for Dialysis Patients
Caring for dialysis patients often requires small but critical adjustments to routine nursing care. From protecting access sites to timing medications and labs appropriately, these considerations can have a significant impact on patient safety and comfort.
Before Dialysis
- Verify access type and location
- Hold antihypertensives if ordered
- Check pre-dialysis weight
During Dialysis
- Monitor blood pressure closely
- Communicate any changes in patient condition to the dialysis RN
- Avoid interrupting the circuit unless absolutely necessary
After Dialysis
- Expect fatigue and lower blood pressure
- Reassess weight and vital signs
- Delay lab draws unless clinically urgent
Understanding Dialysis Supports Better Patient Care
Dialysis may seem complex, but understanding how it works can make a meaningful difference in patient safety and outcomes. For nurses in any setting, even a foundational knowledge of dialysis supports better communication, stronger advocacy, and more confident care for patients who depend on this life-sustaining treatment.
For nurses who want to take their expertise further, dialysis nursing offers a rewarding career path with opportunities across hospitals, outpatient clinics, and travel assignments nationwide. Whether you’re exploring your first dialysis role or looking to expand your experience, working with a trusted healthcare career partner like Medical Solutions can help you find the right fit for your goals and lifestyle. If you’re ready to explore new opportunities or advance your career in dialysis nursing, apply now to take the next step.
