Starting dialysis: what to expect

The unknown is the scariest part. Here is what actually happens when you start dialysis — who you will meet, what to bring, and how a session really goes — so you can walk in prepared instead of anxious.

Adapted with permission from renalcarematters.com.

You are not starting from behind

If your kidney doctor has recommended dialysis, it is because your kidneys can no longer clean your blood and manage fluid on their own — and dialysis takes over that job for them. This is a treatment, not a defeat. Thousands of Filipinos live full lives on dialysis: working, caring for grandchildren, celebrating fiestas. The first weeks feel like the biggest change; within a month or two, most people tell us it has become a familiar routine rather than a frightening event.

Seeing a kidney doctor early helps

A nephrologist is a physician who specialises in the kidneys. Patients who are connected to one before they need urgent dialysis tend to do better — fewer emergency hospital stays, a properly prepared dialysis access, and more time to understand their options and plan. If you are reading this early, you are already ahead. If dialysis is starting suddenly, do not worry: the care team will guide you through every step.

What dialysis actually does

Healthy kidneys filter waste, remove extra fluid, balance minerals like potassium and phosphorus, and help control blood pressure. When they fail, those wastes and fluid build up and make you feel unwell. Hemodialysis — the most common type in Philippine centers — uses a machine and a special filter to gently clean your blood a little at a time, then return it to your body. Some patients instead use peritoneal dialysis, done at home using the lining of the abdomen. Your nephrologist will recommend the type that fits your body and your life.

Dialysis replaces kidney function; it does not cure kidney disease. That is why it becomes a regular part of life. But it also means you can feel much better — less swelling, more energy, a clearer head — once treatment is underway.

What to bring to your first visit

Bringing the right papers on day one saves time and helps the team make good decisions for you. Try to have:

Lab results from the past 12 months (or longer) — creatinine, potassium, hemoglobin, and any others you have. The trend over time matters more than one value.
A full list of everything you take — prescriptions, over-the-counter medicines, supplements and herbal remedies, with doses.
Notes on your symptoms — swelling, breathlessness, urine changes, tiredness, itching, poor appetite: when they started and what makes them better or worse.
Home blood-pressure readings, if you have them — about a week of morning and evening readings is ideal.
Previous imaging (kidney ultrasound or CT reports and films) and any letter from your referring doctor.
A valid ID and your PhilHealth Member Data Record (MDR), so enrollment for dialysis benefits can begin right away.
A trusted companion — a spouse, adult child, or friend to listen with you and remember what is said.

Please don't stop your medicines before the visit unless a doctor told you to. Your care team needs to see how you are doing on your current treatment before making any changes.

Who you will meet

Dialysis is a team effort, and you will get to know several people who look after you:

Your nephrologist — the kidney doctor who sets your dialysis prescription and adjusts it over time.
Dialysis nurses — the people you will see most. They connect and monitor you during every session and are trained to spot and manage any problem early.
A renal dietitian — helps you eat well within kidney-friendly limits for potassium, phosphorus, sodium, and fluid, using familiar Filipino foods.
A medical social worker — helps with PhilHealth, Z-benefit enrollment, financial assistance, and the practical worries.
Access care — the surgeon or team who create and look after your dialysis access (the fistula, graft, or catheter used to reach your bloodstream).

About your dialysis access

To clean your blood, the machine needs a reliable way to draw it out and return it. This is called your access, and there are three common kinds: an AV fistula (a connection made between an artery and a vein in your arm, the longest-lasting option), an AV graft (a soft tube joining them), or a catheter in a large vein in the neck or chest (often used when dialysis must start quickly). A fistula takes weeks to mature before it can be used, which is one more reason early planning helps. Your team will show you how to protect your access and keep it clean.

What happens during a session

Here is how a typical hemodialysis session goes, step by step:

Check-in and weighing. You are weighed so the team knows how much extra fluid to remove, and your blood pressure and temperature are taken.
Getting connected. A nurse connects two lines to your access — one carries blood to the machine, the other returns it. With a fistula or graft this means two small needles; a catheter connects without needles.
The treatment. You sit or recline in a comfortable chair while the machine gently cleans your blood and removes extra fluid over a few hours. Many patients rest, sleep, pray the rosary, read, chat, or watch something on a phone.
Monitoring. Nurses watch you and the machine the whole time, checking your blood pressure regularly. Tell them at once if you feel dizzy, crampy, or unwell — small adjustments fix most of it.
Finishing up. The blood is returned, the needles are removed, and pressure is held over the sites until any bleeding stops. You are weighed again to confirm the fluid target was met.

How long and how often

Most patients on hemodialysis come in three times a week, with each session lasting about three to four hours. It may sound like a lot at first, but it becomes a predictable rhythm — the same days, often the same chair and the same nurses. Peritoneal dialysis, by contrast, is done daily at home in shorter exchanges. Your nephrologist decides the schedule based on your body size, remaining kidney function, and lab results, and will fine-tune it as you go.

How you might feel

Everyone is different. Some people feel a little tired or washed out after a session, especially in the first few weeks, and prefer to rest afterward. Others feel noticeably better as the extra fluid and waste come off. Occasional cramps, a drop in blood pressure, or lightheadedness can happen during treatment — always tell the nurse, because these are common and manageable. Over time, as your body settles into the routine and your dry weight is dialed in, most patients feel steadier.

Questions worth asking your team

Appointments move fast. Writing your questions down beforehand keeps you on track. Good ones to start with:

What type of dialysis is best for me, and why?
What kind of access will I need, and when should it be prepared?
How many sessions a week, and how long is each one?
What is my target weight, and how much fluid can I drink each day?
Which foods and medicines should I avoid?
What warning signs mean I should call or go to the ER?
What will PhilHealth cover, and what help is available for the rest?

Eating and fluids around dialysis

Diet becomes an important part of feeling well on dialysis. Your dietitian will guide you, but the usual themes are limiting salt (to control thirst and blood pressure), watching potassium (found in many fruits, vegetables, and coconut-based dishes) and phosphorus, and managing how much you drink between sessions so too much fluid does not build up. The good news: this is done with everyday Filipino food, not an unfamiliar diet, and small, steady changes work better than drastic ones.

PhilHealth and the cost of care

Ongoing dialysis is a real financial commitment, but you are not on your own. PhilHealth covers a set number of outpatient hemodialysis sessions per year for qualified members, along with related benefits. Ask the clinic's medical social worker about the Z-benefit package for kidney disease, indigency assistance, and other government and local programs. Bring your PhilHealth MDR to your first visit so enrollment can begin early — sorting this out at the start prevents stress later.

Go to the emergency room right away if you develop severe shortness of breath or cannot lie flat, chest pain or a racing heartbeat, sudden confusion or a severe headache, a large drop in how much urine you pass, or bleeding from your access that will not stop. When in doubt, be seen — kidney emergencies are treatable when caught early.

Settling into the routine

The hardest part is usually the anticipation. Once you have sat through a few sessions, met the nurses, and learned the flow, dialysis stops being an event and becomes part of your week. Keep your follow-up labs on schedule, protect your access, ask questions freely, and lean on your family and the care team. Our nurses, renal dietitian, and social worker are here to help you carry this — you do not have to figure it out alone.

Request your first visit

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