What to Expect in Your First Month on Dialysis

No amount of preparation makes starting dialysis easy. But knowing what to expect can make the transition less disorienting. This is an honest overview of what the first month typically looks like for patients starting in-center hemodialysis.

The first few sessions

Your first dialysis sessions will likely feel strange rather than painful. Most patients describe a sense of fatigue during or after treatment, particularly in the early weeks. Your body is adjusting to having fluid and waste removed at a pace it is not used to.

Common first-week experiences:

• Muscle cramps — Usually in the legs, especially toward the end of a session. Tell your care team; they can adjust the treatment rate or fluid removal target.
• Low blood pressure — Called intradialytic hypotension, this can cause lightheadedness, nausea, or a feeling of fading. It typically happens when too much fluid is removed too quickly.
• Fatigue after sessions — Many patients need several hours of rest after each treatment. This often improves over weeks as your body adapts.
• Itching — Common in dialysis patients due to accumulated waste products. It usually improves as dialysis clears these toxins more consistently.

None of these mean something is wrong. They are normal parts of the adjustment period.

The vascular access question

If you are starting dialysis urgently via a central venous catheter, one of the first things your care team should discuss is getting a permanent vascular access — specifically an arteriovenous (AV) fistula.

Fistulas take 6 to 8 weeks to mature before they can be used, so the sooner one is created, the sooner you can move away from catheter access. Catheters have significantly higher infection rates than fistulas. Ask your nephrologist early about fistula creation if you have not already had this conversation.

Lab work and diet adjustments

Dialysis patients have blood drawn regularly — typically monthly at minimum — to monitor kidney function markers, phosphorus, potassium, calcium, hemoglobin, and other values. Your first month will involve getting familiar with which numbers matter and what to do about them.

The dietary changes are significant:

• Potassium — Found in bananas, potatoes, tomatoes, and many other foods. High potassium can cause dangerous heart rhythm problems between sessions.
• Phosphorus — Found in dairy, nuts, cola drinks, and processed foods. Elevated phosphorus weakens bones and hardens blood vessels over time.
• Fluid — Most dialysis patients need to restrict fluid intake between sessions to avoid excessive weight gain.

A renal dietitian should be part of your care team from the beginning. If you have not been connected with one, ask.

The schedule is the hardest part

Three sessions per week, typically three to four hours each, plus travel time and recovery time. For most patients, dialysis consumes 15 to 20 hours of each week — forever, until a transplant.

The schedule disruption is one of the most common sources of stress in the first month. Work schedules, childcare, transportation, social plans — all of it has to reorganize around dialysis. There is no shortcut through this. Most patients describe a period of grief around this loss of time and freedom before they reach a new equilibrium.

Ask about home dialysis

Home hemodialysis and peritoneal dialysis are options for a significant portion of dialysis patients, though not everyone is a candidate. Home dialysis allows for more frequent, shorter sessions on a schedule you control — which many patients report improves their quality of life substantially.

If your facility has not discussed home dialysis with you, ask. If they discourage it without a clear medical reason, that is worth noting. Some clinics have financial incentives to keep patients on in-center treatment schedules.

The transplant conversation

Start it early. Ask your nephrologist in your first month whether you are a candidate for kidney transplant evaluation. If the answer is yes, ask when the referral will be submitted. If the answer is no, ask specifically what disqualifies you and whether that can change.

Getting on the transplant waitlist takes time — often years. Starting the process early is one of the most important things you can do for your long-term outcomes.