Living well on dialysis

Dialysis is not a cure — but it lets you keep living your life. You can still work, care for your family, travel, and enjoy the people around you. This guide walks you through how it works and how to feel as well as possible on it.

Adapted with permission from renalcarematters.com.

What dialysis does — and what it cannot

Three times a week, a machine takes over part of your kidneys' job. It removes waste, extra fluid, and dangerous electrolytes from your blood, and prevents the build-up of toxins that would otherwise be harmful. Think of it as a life-sustaining treatment that replaces the filtering your kidneys used to do — not a cure, but the thing that keeps you well enough to carry on with your life.

It helps to know its limits too. Dialysis cleans your blood and pulls off excess fluid, but it does not do everything your kidneys once did. It does not make the hormone that keeps your blood count up (so many patients need medicine for anemia), it does not activate vitamin D (so your bones need protecting), and it cannot clear every toxin. That is why your dialysis always comes packaged with medicines and supplements — they fill in the gaps the machine cannot.

How hemodialysis actually works

Your blood passes through a dialyzer — often called an artificial kidney. Inside it are millions of tiny hollow fibres bathed in a special cleansing fluid called dialysate. As your blood flows through the fibres, waste and extra water cross the thin walls into the fluid, and clean blood returns to your body. The nurses set up the machine, watch it the whole session, and adjust it to you.

A standard schedule is three sessions a week — usually Monday-Wednesday-Friday or Tuesday-Thursday-Saturday — each lasting about four hours. Your team measures how well each session cleans your blood (a number called spKt/V, with a target of at least 1.4) roughly once a month, so they can tell if your dialysis is doing enough.

Please don't skip or shorten sessions. Each session removes roughly 2 kg of fluid and clears toxins your kidneys can no longer handle. Missing even one lets potassium and fluid build up dangerously between treatments — which can be life-threatening. Keeping your schedule is the single most protective thing you can do. If you truly cannot come for any reason, call your dialysis centre right away so they can help.

What happens during each session

Knowing the routine makes it feel much less daunting. A typical session goes like this:

Arrival and check. The staff weigh you and check your blood pressure, pulse, and temperature. Your weight is compared with your dry weight — the target weight after all extra fluid is removed — and the difference tells the team how much fluid to take off today. Always mention any symptoms you had since your last visit.
Connecting your access. Two needles go into your fistula (or your catheter is connected) — one draws blood out, one returns it. For most people this is the least comfortable part, so tell your nurse if you feel anxious or sore.
The four hours of filtering. Your blood circulates through the dialyzer while you rest. You can read, watch TV, chat, or doze — but don't sleep through the whole session, as the staff need to check on you. If you feel dizzy or get cramps (your blood pressure can dip during treatment), say so straight away.
Finishing up. The needles come out and pressure is held over the sites. Your weight and blood pressure are checked again. Stand up slowly — your pressure is often lower right after dialysis, so sit for a few minutes first.

Your dry weight is not fixed forever. If you gain or lose muscle, or your appetite changes, your team will re-set it — so report any unplanned weight loss or poor appetite so it can be adjusted.

Protecting your fistula — your lifeline

Your AV fistula is made by a small operation that joins an artery to a vein, usually in your forearm. Over time the vessel grows strong enough to take the dialysis needles again and again. It is your most important asset as a dialysis patient, so it is worth guarding carefully.

Get into the habit of checking it every day. Rest two fingers gently over it and feel for a "thrill" — a soft vibrating buzz. You can also put your ear close and listen for a "bruit", a whooshing sound. If the thrill or bruit is gone or noticeably weaker than usual, go to your dialysis centre or the emergency room at once — it may mean the fistula is clotting.

A few simple do's and don'ts protect it for years:

Do: check the thrill daily, keep the skin clean and moisturised, report any redness, swelling, or warmth early, sleep on your other arm, and keep the fistula arm strong with a squeeze ball.
Don't: let anyone take your blood pressure, put in an IV line, or draw blood from the fistula arm. Don't wear tight sleeves, watches, or bracelets on it, and don't sleep with your full weight resting on it.

Your key lab numbers, and why they matter

Every month or so your team checks a set of blood tests. You don't need to memorise them, but it helps to know what they are watching and why — these numbers are how they keep you safe between sessions:

Hemoglobin (blood count). Low levels cause tiredness and strain the heart; treated with an anemia medicine plus iron.
Potassium. Too high can trigger dangerous heart rhythms — controlled by diet and, if needed, medicine.
Phosphorus and calcium. High phosphorus causes itching, bone disease, and hardening of blood vessels; both are balanced with diet and phosphate binders.
Albumin. A marker of nutrition — a low value warns of protein malnutrition, so your team wants it kept up.
spKt/V. Your dialysis adequacy score — it should stay at or above 1.4.
Blood pressure. Kept under control because high pressure is the leading heart risk for dialysis patients.

Eating well on dialysis

Diet on hemodialysis is different from the diet you may have followed before dialysis. This surprises many patients: because dialysis itself removes some nutrients, your protein needs are now higher, not lower. If you were on a low-protein diet before, those old rules no longer apply — keeping protein too low on dialysis leads to muscle wasting, which is genuinely dangerous.

At the same time, potassium, phosphorus, and sodium still need careful control. In practice that means leaning on kidney-friendly Filipino choices and going easy on the risky ones:

Good protein: egg whites, fish such as bangus and tilapia, chicken breast, tofu. Go easy on processed meats like longganisa and tocino — high in salt and phosphorus.
Lower-potassium foods: white rice, cabbage, green beans, apple, pineapple, grapes. Limit high-potassium items like coconut water, banana, kamote, squash, and tomato.
Watch phosphorus: avoid dark colas, processed cheese, nuts, and organ meats; choose fresh fish, rice, bread, and corn.
Cut the salt: ease off patis, toyo, bagoong, instant noodles, chips, and canned goods. Season with garlic, calamansi, and herbs instead — less salt also means less thirst.

A simple kitchen trick — leaching — lowers the potassium in vegetables like kamote, patatas, pechay, kangkong, and sitaw. Peel and cut them small, soak in plenty of water for at least two hours (changing the water once), then boil in fresh water and throw the boiling water away. This can remove 30 to 50 percent of the potassium.

One reminder that catches many people out: take your phosphate binders with your meals, not before or after. They only work when they are in your stomach at the same time as the food. If you snack during dialysis, take a binder with that snack too.

Don't quietly stop eating. Up to half of dialysis patients develop protein-energy wasting — a slow loss of muscle and fat from poor appetite, inflammation, and the nutrients dialysis removes. It raises the risk of infection and hospital stays. Warning signs are unplanned weight loss, weakness, and a falling albumin. If you are eating poorly or losing weight, tell your nephrologist right away — it is very treatable when caught early.

Managing your fluids

Because your kidneys make little or no urine, fluid builds up between sessions. Too much causes swollen legs, breathlessness, high blood pressure, and strain on your heart. The goal is to gain less than 2.5 kg between sessions — ideally under 1 kg a day.

A rough daily allowance is your urine output plus about 500 mL; for someone making little urine that often works out to 2 to 3 cups a day. Remember this counts all fluids, not just water — soup and sabaw, juice, coffee, tea, ice, halo-halo, softdrinks, beer, and even watery fruits like watermelon and cucumber all add up. Ask your nurse to help you work out your personal limit.

Three habits make the limit much easier to keep:

Control thirst at the source. Thirst is driven by salt, so the less you eat, the less you crave. Suck an ice chip (it still counts as fluid), chew sugar-free gum, or rinse your mouth with cold water and spit it out.
Weigh yourself every morning after the toilet and before eating, on the same scale. If you are more than 1 kg up overnight, cut back on fluid and tell your team.
Watch the hidden fluids in broth, ice, and soft, watery foods — they are the ones people forget.

Staying active — exercise, work, and travel

One of the biggest myths is that dialysis means the end of an active life. It doesn't. Regular light exercise — a walk, some stretching, gentle cycling — actually makes your dialysis work better, eases fatigue, and lifts your mood. Even 20 to 30 minutes of walking on your non-dialysis days helps your heart. Just avoid heavy lifting with your fistula arm.

Many patients keep their jobs and still travel. Dialysis is available in every major city in the Philippines and abroad, so a trip is possible with a little planning — arrange guest sessions at your destination about four to six weeks ahead, and ask your nephrologist for a short medical summary letter to bring along. The aim is to fit dialysis around your life, not the other way around.

Your mood, sleep, and relationships

Living with dialysis is as much emotional as it is physical, and these parts of life deserve the same attention as your lab results.

Mood. Feelings of loss, grief, tiredness, and dependence are normal — and depression affects up to 4 in 10 dialysis patients. This is not weakness, and it is treatable. Talk to your nephrologist; a referral to a counsellor is completely appropriate. The support of your family is one of your most powerful medicines.

Sleep and fatigue. Tiredness and poor sleep are among the most common — and most overlooked — complaints. Don't accept them as just part of dialysis. They can come from anemia, sleep apnea, restless legs, under-dialysis, or low mood, and each of those has a treatment. Bring it up, keep a steady sleep schedule, and stay lightly active even on dialysis days.

Intimacy. Changes in sex drive and function are common on dialysis and are rarely talked about — but they are a genuine medical issue, often driven by hormones, anemia, medicines, or fatigue. Raise it with your nephrologist; there are real options, from correcting anemia to reviewing your medicines. Close relationships are part of a good life and worth caring for.

Vaccinations and staying protected

Dialysis lowers your body's defences, so keeping your vaccinations up to date really matters. Your team will usually make sure you are covered against hepatitis B (a higher-dose series, with a yearly antibody check), get a flu shot every year, receive the pneumonia vaccines, and stay current with COVID-19 shots per Department of Health guidance. Ask about your status at your next visit if you are unsure.

Go to the emergency room or call your dialysis centre right away if you have: no thrill or bruit in your fistula, or fistula bleeding that won't stop within 20 minutes; severe breathlessness or you can't lie flat; chest pain or an irregular heartbeat; muscle weakness or paralysis (possible high potassium); fever with chills and shaking (possible catheter infection); confusion or difficulty waking; a weight gain of more than 3 kg since your last session; or a seizure. When in doubt, get seen — these are not symptoms to wait out at home.

You can still live your life

Dialysis asks a lot of you, but it also gives a lot back: time with your family, the ability to keep working, and years of active living. With a good routine, a kidney-friendly diet, careful fluids, and an open line to your care team, most patients build a full and meaningful life on dialysis. Our dietitian, nurses, and social worker are here to help you shape treatment around your life.

Talk to our team

Adapted with permission from renalcarematters.com. Medically reviewed by a nephrologist. This guide is educational and not a substitute for consultation.