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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

In-center hemodialysis

In short

Most people on in-center hemodialysis go three times a week for about 4 hours, on a fixed Monday-Wednesday-Friday or Tuesday-Thursday-Saturday slot (NIDDK). Between sessions, fluid, potassium and salt build up, so your diet changes: protein goes up and fluid goes down. The long weekend gap is the riskiest time of the week (Foley 2011). Never skip or shorten a session. With type 1 diabetes, glucose is often lowest after a session, so check before and after and carry fast sugar (JBDS–Renal Association).

Your numbers

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

What Typical number Source
Sessions 3 a week, about 4 hours each; at least 3 hours if your own kidneys make little urine NIDDK; KDOQI 2015
Dialysis dose (spKt/V) with 3 sessions a week: target 1.4 per session, with a minimum of 1.2 KDOQI 2015, guideline 3.1
Fluid about 1,000 mL (32 oz) a day plus the urine you pass; the app starts at 1,500 mL AKF; DaVita
Weight gain between sessions your team's limit; gains above 3.5 % of body weight are linked to death (about 2.5 kg or 5.4 lb at 70 kg) Cabrera 2015
Protein 1.0–1.2 g/kg a day (70–84 g at 70 kg) KDOQI 2020, statement 3.0.4; KDIGO 2022, practice point 3.1.2
Potassium often 2,000–3,000 mg a day; the app starts at 2,500 mg DaVita
Phosphorus the app starts at 1,000 mg; binders, if prescribed, go with meals NKF
Sodium under 2,000 mg a day KDIGO 2024

Tests to expect

Test How often
Calcium and phosphate every 1–3 months
PTH every 3–6 months
Hemoglobin, ferritin and TSAT at least every 3 months
Kt/V (dialysis dose) and potassium regularly, from blood taken before and after a session

Sources: KDIGO 2017 (recommendation 3.1.2); KDIGO 2026 anemia; KDOQI 2015. See Dialysis adequacy.

What changes now

The weekend gap. In a US study of over 32,000 people, deaths on the day after the long 2-day gap were 22.1 per 100 person-years, compared with 18.0 on other days. Hospital stays for heart failure and heart rhythm problems were also much more common on that day (Foley 2011). Fluid, potassium and salt pile up for an extra day. The app adds up your potassium, sodium and fluid since your last session, so you can see the weekend total (Targets and warnings).

Never skip or shorten. In the international DOPPS study, skipping one or more sessions a month was linked to a 30 % higher risk of death (DOPPS 2003). If you cannot get to a session, call your unit straight away to rearrange it.

Food and drink. Protein goes up. Dialysis removes some amino acids (the building blocks of protein) and makes the body break down muscle, and a little more protein may also help prevent lows with diabetes (KDIGO 2022, practice point 3.1.2; KDOQI 2020). Choose high-quality protein such as eggs, fish and poultry (NIDDK). Fluid goes down, because there is little or no urine to get rid of it. Salt makes you thirsty, so cutting salt is one of the best ways to keep to your fluid limit (DaVita; KDOQI 2015, guideline 4.2). See Dialysis days and Fluid.

Your access. Feel your fistula or graft for the buzz (thrill) every day. Never let anyone put a blood pressure cuff on that arm, and do not let anyone take blood or put a drip in it unless your dialysis team says it is OK. Avoid tight sleeves, watches and bracelets over it, do not sleep on it, and do not carry heavy bags on that arm (NKF). Watch for redness, warmth, swelling, pain or drainage (NKF; NIDDK).

Diabetes on dialysis days (JBDS–Renal Association):

  • Check your glucose before and after each session. Glucose often falls during a session and is often lowest late in it or afterwards; most lows happen within 24 hours of dialysis (JBDS 2022). Tell the nurse at once if you feel low during a session.
  • Units should use dialysis fluid that contains glucose for people on insulin.
  • Many people need less insulin on dialysis days. Your team sets this; you do not change it yourself.
  • You should be able to treat a low at any time, including on the way to and from the unit. Carry glucose tablets.
  • Some units give a carbohydrate snack at the start of a session if your glucose is on the low side beforehand (JBDS suggests this below 126 mg/dL, 7 mmol/L). Ask what your unit does.

See Insulin and dialysis.

How people usually feel

During a session some people get muscle cramps, or feel weak, dizzy or sick when blood pressure drops (NIDDK). Tell the nurse straight away. Some people feel "washed out" after a session; people on more frequent home sessions often feel less so (NKF). Large fluid gains mean more fluid must be removed in each session. Your team may then suggest a longer or an extra session (KDOQI 2015).

What to do

  • Weigh yourself every morning and before each session. Write it down.
  • Ask your unit for your fluid allowance and your weight-gain limit, and enter them in the app (your fluid allowance in Profile, see First setup; your weight-gain limit in Settings).
  • Set your dialysis days in the app so it totals the gap between sessions.
  • Plan the weekend: lighter on salt, potassium and fluid from Friday (or Saturday) to Monday (or Tuesday).
  • Take phosphate binders, if prescribed, with meals and snacks, not after.
  • Feel for your access thrill every morning.
  • Pack a dialysis-day bag: glucose tablets, a snack your unit allows, your meter or CGM reader, your medicine list.
  • Check glucose before and after every session, and treat any low straight away.
  • Make an emergency plan (below).

Examples

Your weight-gain limit. If you weigh 70 kg (154 lb), 3.5 % is about 2.5 kg (5.4 lb). About 1,000 mL of fluid adds about 1 kg (DaVita). So two extra 12 oz (355 mL) cans of soda a day over the long weekend gap (Friday to Monday is close to 3 days) add over 2 kg on their own (2 × 355 mL × 3 days = 2,130 mL).

A protein top-up. Going from 56 g to 70–84 g of protein a day means about 14–28 g more. One large egg has about 6 g and 2 oz of roast chicken breast about 18 g (USDA).

A low after dialysis. Your CGM alarms at 65 mg/dL (3.6 mmol/L) on the bus home. Take 4 glucose tablets now (no fluid, no potassium), recheck in 15 minutes (ADA 2026 §6), and tell the unit at your next session (Treating a low).

An emergency plan

Storms, power cuts and closed roads can stop dialysis. CMS advises (CMS):

  • Know your unit's emergency number and a back-up unit. Keep your address and phone number up to date with the unit, and have a back-up ride.
  • Keep a 5–7 day supply of all your medicines, insulin, test strips and glucose tablets or gel, and glucagon.
  • If you miss a session, start your unit's 3-day emergency diet and fluid limit, and always try to get dialysis within 3 days of your last treatment. If you have diabetes, keep fast sugar for lows.

Ask your care team

  1. What is my fluid allowance, and what weight gain between sessions is too much for me?
  2. What was my last Kt/V? Is my session long enough?
  3. What should I eat before, during and after dialysis?
  4. How should my insulin change on dialysis days? Can I have it in writing?
  5. Do you give a snack if my glucose is low before a session?
  6. What is the plan if the unit closes in an emergency?

Get help now if…

Call 911 (or your local emergency number)

Chest pain; severe breathlessness or not being able to lie flat (fluid overload); fainting or a very slow or irregular pulse; bleeding from your fistula or graft that is heavy or spurting, or that has not stopped after 10–15 minutes of firm pressure, or starts again: press hard on gauze with two fingers and keep pressing while you call (AKF); a low the person cannot treat themselves (give glucagon, then call); possible DKA: blood ketones of 3.0 mmol/L or more, or any ketones with vomiting, deep fast breathing or fruity breath. On dialysis, DKA can come with lower ketone readings, so these signs count even under 3.0 (2024 consensus). Full list: Get help now.

Call your unit today

No buzz (thrill) in your fistula or graft; redness, pus or fever around an access or catheter; a missed session; weight gain above your limit; new swelling; repeated lows after sessions.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.