If you’re reading this from a hospital bed, you might still be asking yourself how you got here. A lot of my patients tell me they never thought it would come to this, that dialysis was something that happened to other people. If you feel that way, nothing is wrong with you. Denial is normal. It just means this is big, and your heart is still catching up to what your labs already said.
Here’s what I want you to know before your first treatment.
Why it’s happening here, in the hospital
In the hospital, dialysis usually starts because your kidneys need help right now, sometimes after surgery, an infection, or an injury pushed them past what they could handle. For some patients, the kidneys recover and dialysis is temporary. For others, this is the beginning of a longer road. Either way, what happens in this room is the same: We’re giving your body the support it needs today.
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What the machine actually does
Your kidneys can’t clean your blood well enough on their own right now. The dialysis machine does that job for them: It draws your blood out, filters out the waste and extra fluid, and returns it. Your doctor decides how often you need it here. In the hospital that might mean every day, or every other day; it’s based on what your body needs, not a fixed weekly schedule like the outpatient centers use.
What it looks like at the bedside
There’s no dialysis center here; the machine comes to you. We’ll wheel it to your bedside and connect it to your catheter, a temporary line usually placed in your neck, chest, or groin. The first treatment is gentler than the ones that may follow: about two to three hours, with slow blood and dialysate flow rates, and usually little to no fluid removed. We start slow on purpose, to let your body ease into it. The machine will beep and alarm sometimes. That is normal. It’s just the machine telling us it needs attention, the way hospital equipment always does. Bring headphones if you have them. A lot of patients doze off.
Before we start
Tell us every medication and supplement you take, including over-the-counter pills. If you can, have a family member nearby for the first treatment; it’s a lot to take in, and a second pair of ears helps. And ask us anything, even twice. We’d rather explain it again than have you lie there worried.
About the fear
Being afraid doesn’t mean something will go wrong. It means you’re paying attention to something that matters, in a place where a lot is already happening to you. That’s a lot for anyone.
About the sadness
This part matters, so hear me: Losing your kidney function, even temporarily, is a loss, and grief is the honest response to it. Hospital rooms are lonely places to face that. If the sadness sticks around (no appetite, no energy, not wanting visitors), tell your nurse or doctor. There is help for that, and asking for it is part of your treatment, not a failure of it.
The parts nobody warns you about
Two things surprise most first-timers. First, the catheter: It’s temporary, and it’s only for while you’re here. Keep the dressing dry and let us know right away if you notice bleeding, swelling, or redness around it. A fever is also worth reporting; it can mean your body is fighting an infection somewhere, even if the catheter site itself looks fine. Second, the fluid and diet changes may start while you’re still admitted. You’ll hear about fluid limits and foods to watch: phosphorus, potassium, salt. The dietitian will walk you through it one step at a time.
What happens after the hospital
If your kidneys recover, dialysis stops, and we’ll celebrate that with you. If you need to continue, you’ll transition to an outpatient dialysis center, where treatments settle into a regular weekly routine. Either way, the hospital is the hardest setting to start in. You’re dealing with everything at once: the illness that brought you here, plus this.
The thing I most want you to believe: Starting dialysis in a hospital bed does not define the rest of your story. The first treatment is the scariest. Then it becomes something your body, and you, learn to get through. And we’ll be right there with you.
Henry Mercines is a nurse.
