Haemodialysis at KIMS Secunderabad — 24/7 Dialysis, HDF Technology, and a Clear Path to Transplant
At a glance — Haemodialysis at KIMS
- Availability: 24 hours a day, 7 days a week — including emergency and acute dialysis
- Technology: Haemodiafiltration (HDF) machines as well as standard HD — HDF achieves superior removal of mid-molecular uraemic toxins compared to conventional haemodialysis
- Session frequency: Standard: 3 sessions per week · Each session: 4 hours
- Same nephrology team: The KIMS nephrologist who manages a patient's CKD continues through initiation of dialysis and long-term dialysis management — no transfer to a different team
- Transplant programme: 1,500+ kidney transplants — KIMS views dialysis as a bridge to transplant for eligible patients, not an indefinite endpoint. Transplant evaluation begins concurrently with dialysis initiation where appropriate.
- Aarogyasri coverage: Haemodialysis sessions covered under Aarogyasri (PMJAY) · CGHS and EHS also empanelled
- Dialysis adequacy: Kt/V monitoring at regular intervals — KIMS targets internationally recommended adequacy thresholds (Kt/V ≥ 1.2 per session)
- Accreditation & Appointments: NABH · NABL · Nursing Excellence | 040 - 44885000 · assistance@kimshospitals.com
Beginning haemodialysis — what it means and what to expect
A diagnosis of end-stage renal disease requiring dialysis is one of the most significant moments in a person's medical journey. It is natural to feel overwhelmed. What dialysis represents practically — three sessions per week, four hours each time, for the foreseeable future — is a major reorganisation of daily life. What it represents medically is the continuation of that life: haemodialysis keeps the body in balance by performing the filtration function that the failed kidneys can no longer manage.
Haemodialysis works by circulating a patient's blood — at a rate of approximately 300 to 400 ml per minute — through a dialyser (an artificial filter membrane). On one side of the membrane flows the blood; on the other side flows dialysate fluid (a specifically formulated solution). Waste products — urea, creatinine, potassium, excess fluid, and other accumulated metabolites — move from the blood across the membrane into the dialysate and are discarded. Cleaned blood is returned to the patient continuously. Over a four-hour session, the blood volume is processed multiple times.
At KIMS Secunderabad, haemodialysis is available 24 hours a day, seven days a week — for planned sessions for established patients, for acute initiation in newly diagnosed ESRD patients, and for emergency dialysis in critically ill patients with sudden kidney failure or dangerous electrolyte disturbances (hyperkalaemia, pulmonary oedema). The KIMS haemodialysis programme operates under the direct supervision of DM Nephrology-qualified nephrologists who manage each patient's entire CKD and ESRD journey — from the first detection of failing kidney function through dialysis initiation, optimisation, and — where eligible — to kidney transplant.
KIMS views haemodialysis not as an endpoint but as a bridge. For every dialysis patient who is medically eligible for kidney transplant, the KIMS team begins transplant evaluation concurrently with dialysis initiation — assessing donor availability, ABO compatibility, immunological workup, and surgical fitness. With 1,500+ kidney transplants performed at KIMS, the path from dialysis to transplant is well-travelled.
What happens during a haemodialysis session at KIMS
Understanding what happens at each dialysis session removes much of the anxiety associated with starting treatment. A haemodialysis session at KIMS follows a consistent, structured process:
| Stage | What happens at KIMS |
|---|---|
| 1 — Arrival and pre-dialysis assessment | Weight measured (to calculate target fluid removal), blood pressure recorded, and a brief clinical assessment by the dialysis nurse to identify any inter-dialytic symptoms — breathlessness, swelling, reduced urine output, or pain. Pre-dialysis blood tests (electrolytes, urea, creatinine) are taken at regular scheduled intervals. |
| 2 — Vascular access connection | The dialysis circuit is connected to the patient through their vascular access — either an AV fistula (the preferred long-term access), an AV graft, or a central venous catheter (for patients without established fistula access). Two needles are placed into the fistula — one to draw blood out to the machine, one to return cleaned blood. |
| 3 — Dialysis session | Blood circulates through the dialyser at 300–400 ml/min for 4 hours. Dialysate fluid flows on the opposite side of the membrane. Fluid removal (ultrafiltration) occurs simultaneously — the target volume to be removed is calculated pre-session based on the patient's weight and dry weight target. |
| 4 — HDF mode (where indicated) | For patients on HDF (Haemodiafiltration) — available at KIMS — convective transport is added to diffusive clearance. A large volume of substitution fluid is infused online, increasing the clearance of mid-molecular weight uraemic toxins (beta-2 microglobulin, cytokines) that standard HD removes less efficiently. HDF is associated with better cardiovascular outcomes and reduced dialysis-related amyloidosis over the long term. |
| 5 — Monitoring throughout | Blood pressure, pulse, and patient comfort monitored every 30 minutes throughout the session. The dialysis machine displays blood flow rate, dialysate flow, transmembrane pressure, and conductivity continuously — the KIMS nursing team responds to any alarm immediately. |
| 6 — Post-dialysis assessment | Post-session weight measured to confirm target fluid removal achieved. Blood pressure and pulse recorded. A brief symptom check by the nurse before the patient is cleared for discharge. |
| 7 — Exit and scheduling | Session duration: 4 hours. Total visit including pre- and post-session assessment: approximately 5 hours. Next session scheduled before departure. |
HDF (Haemodiafiltration) — why technology matters in dialysis
Standard haemodialysis (HD) removes waste primarily by diffusion — small molecules (urea, creatinine, potassium) move across the dialyser membrane down their concentration gradient. HD is highly effective at removing these small solutes. However, mid-molecular weight uraemic toxins — molecules such as beta-2 microglobulin, FGF-23, and inflammatory cytokines — are removed much less efficiently by diffusion because they are too large to diffuse easily across conventional dialyser membranes. These molecules accumulate over years on standard HD and contribute to dialysis-related complications including carpal tunnel syndrome, amyloid deposits in joints, chronic inflammation, and cardiovascular disease.
Haemodiafiltration (HDF) adds convective transport to diffusive clearance — a large volume of sterile substitution fluid is infused online while a corresponding volume of fluid and dissolved toxins is removed through a high-flux membrane. The convective flow 'drags' larger molecules across the membrane far more effectively than diffusion alone. High-volume HDF (with substitution volumes above 21 litres per session) has been associated in several large clinical trials with improved survival, reduced cardiovascular events, and better quality of life compared to standard HD.
| Feature | Standard HD | HDF (at KIMS) |
|---|---|---|
| Clearance mechanism | Diffusion only | Diffusion + convection |
| Small molecule removal (urea, creatinine) | Excellent | Excellent |
| Mid-molecule removal (beta-2 microglobulin, cytokines) | Limited | Significantly superior |
| Cardiovascular outcomes (long term) | Standard | Improved in high-volume trials |
| Dialysis-related amyloidosis risk | Accumulates over years | Substantially reduced |
| Blood pressure stability during session | Standard | Better — convective cooling effect |
| Availability at KIMS | Yes | Yes — KIMS operates HDF machines |
Not every dialysis patient requires HDF — the choice between standard HD and HDF is made by the KIMS nephrologist based on the patient's clinical status, comorbidities, and how long they are expected to remain on dialysis. Patients who will proceed to kidney transplant in the near term may be managed on standard HD. Patients on long-term dialysis who are not transplant candidates benefit most from HDF technology.
Vascular access — the lifeline of haemodialysis
Haemodialysis requires reliable, repeated access to the bloodstream at high flow rates. The choice and care of vascular access is one of the most important determinants of dialysis quality and patient safety over the long term. KIMS creates, monitors, and manages vascular access for all haemodialysis patients through the vascular surgery and nephrology team.
AV Fistula (Arteriovenous Fistula) — the gold standard. A surgical connection between an artery and a vein in the forearm or upper arm, creating a high-flow vessel large enough for dialysis needles. The fistula takes 4 to 8 weeks to mature (enlarge and develop adequate blood flow) after creation. Once mature, an AV fistula has the lowest infection risk, the best long-term patency, and the fewest complications of any access type. KIMS aims to have every new haemodialysis patient's fistula planned and created before dialysis initiation is anticipated — ideally 3 to 6 months before ESRD is reached. See our AV Fistula treatment page for full details.
AV Graft — when fistula creation is not possible. A synthetic tube connecting artery and vein where the patient's own vessels are unsuitable for fistula creation (due to vessel calibre, previous surgery, or obesity). A graft can be used sooner after creation than a fistula — typically within 2 weeks. Grafts have somewhat higher infection and thrombosis rates than fistulae and require surveillance for stenosis.
Central Venous Catheter (CVC) — temporary access only. A catheter placed into a central vein (internal jugular or femoral vein) provides immediate dialysis access but carries significantly higher infection and thrombosis risk than fistulae or grafts. At KIMS, CVCs are used only for patients who have not yet developed adequate fistula access or as a temporary bridge during fistula creation. Every patient with a CVC has an active plan for transition to permanent access.
Dietary and fluid management on haemodialysis
Between dialysis sessions, the kidneys are no longer regulating fluid, electrolytes, or waste product levels. Managing diet and fluid intake between sessions is an essential part of haemodialysis — poor dietary adherence leads to dangerous fluid overload (pulmonary oedema), hyperkalaemia (high potassium, causing fatal arrhythmias), and inadequate dialysis adequacy. The KIMS nephrology team provides detailed, personalised dietary counselling at each patient's dialysis initiation and regular review throughout:
- Fluid restriction: Most haemodialysis patients limit fluid intake to approximately 500 to 800 ml per day above their residual urine output — to prevent accumulation of 2 to 3 litres between sessions (the target inter-dialytic weight gain)
- Potassium restriction: Avoiding high-potassium foods (bananas, tomatoes, potatoes, legumes, dried fruit, fruit juices) — hyperkalaemia is dangerous and can cause cardiac arrest between sessions
- Phosphate restriction: Limiting dairy, nuts, whole grains, and processed foods high in phosphate — high phosphate levels cause itching, vascular calcification, and bone disease over time. Phosphate binders (sevelamer, calcium carbonate) are prescribed with meals
- Protein: Adequate protein intake (1.2 g/kg/day) is important on haemodialysis — amino acids are lost across the dialyser membrane during sessions
- Salt restriction: Reduces thirst and the tendency to drink beyond the fluid limit
- Potassium and sodium content of foods is reviewed by the KIMS dietitian at the initiation visit and updated at regular intervals as the patient's clinical status and residual kidney function change
Hyperkalaemia — dangerously high blood potassium — is the most acute life-threatening complication between dialysis sessions. Symptoms include muscle weakness, palpitations, and in severe cases cardiac arrest. Any KIMS haemodialysis patient who misses a session and develops these symptoms should call 040 - 44885000 immediately and come directly to the KIMS emergency department for urgent dialysis.
Dialysis adequacy — how KIMS monitors treatment quality
Not all haemodialysis is equally effective. The adequacy of each patient's dialysis is quantified using a measurement called Kt/V — where K is the dialyser clearance, t is the session time, and V is the patient's body water volume. A Kt/V of 1.2 per session (for patients dialysing three times weekly) is the internationally recommended minimum threshold — below this level, solute clearance is insufficient and long-term outcomes are significantly worse. KIMS monitors Kt/V at every scheduled blood test interval and adjusts dialysis prescription — session time, blood flow rate, dialyser size, or session frequency — to maintain adequacy above the recommended threshold. Patients with inadequate Kt/V receive a clinical explanation and a prescription change, not just a number.
Haemodialysis as a bridge to kidney transplant
For every KIMS haemodialysis patient who is medically eligible for kidney transplant, the nephrology team begins transplant evaluation concurrently with dialysis initiation — not after years on dialysis. Pre-emptive evaluation means the patient reaches transplant readiness as quickly as possible, minimising time on dialysis and maximising the long-term benefit of transplantation.
Kidney transplant provides a dramatically better quality of life and survival advantage over long-term dialysis. Patients who receive a transplant after 1 to 2 years on dialysis have better outcomes than those who wait 5 to 10 years. KIMS's 1,500+ transplants — including ABO-incompatible and swap transplants that many centres cannot offer — mean that patients whose donor is blood group incompatible are not left on dialysis indefinitely when a transplant option exists.
If you are starting haemodialysis and have a potential living donor, tell the KIMS nephrologist at the very first session. The donor evaluation process takes 2 to 4 months. Beginning it early means transplant can happen sooner — with less time spent on dialysis. Even if your donor has a mismatched blood group, KIMS performs ABO-incompatible transplants. No potential donor should be dismissed without a KIMS transplant evaluation.
Why choose KIMS Secunderabad for haemodialysis?
24/7 availability — including emergency and acute dialysis
Kidney failure does not keep business hours. Hyperkalaemia, pulmonary oedema, and acute uraemia require urgent dialysis at any hour. KIMS operates its dialysis programme around the clock — new patients can be initiated on dialysis as an emergency at any time, and established patients can receive unscheduled sessions when clinically needed. The 24/7 availability is backed by the full KIMS emergency and critical care infrastructure, including CRRT for haemodynamically unstable patients.
HDF technology — better long-term outcomes
KIMS operates HDF machines for patients on long-term dialysis — providing superior mid-molecular solute clearance, better blood pressure stability during sessions, and reduced cardiovascular risk compared to standard HD alone. The choice between HD and HDF is made individually based on clinical status and transplant timeline — not applied uniformly.
Same nephrology team — from CKD to dialysis to transplant
The KIMS nephrologist who first detected a patient's falling eGFR at CKD Stage 3 is the same physician managing their dialysis sessions and planning their transplant evaluation. This continuity means no loss of clinical history, no repeat investigations, and no re-explanation of a complex comorbidity profile. It is particularly important in the transition from pre-dialysis management to dialysis initiation.
Aarogyasri, CGHS, and EHS coverage
Haemodialysis is a lifetime treatment for non-transplant ESRD patients — the financial burden without coverage is catastrophic. KIMS is empanelled under Aarogyasri (PMJAY), CGHS, and EHS — making dialysis accessible for patients covered under government health schemes. The KIMS billing team assists with scheme paperwork and pre-authorisation at every stage.
Our haemodialysis and dialysis care team at KIMS Secunderabad
FAQ SECTION
Haemodialysis is a form of renal replacement therapy that performs the filtration function of failed kidneys artificially. The patient's blood is drawn from a vascular access point (AV fistula, graft, or catheter), circulated at 300 to 400 ml per minute through a dialyser — an artificial membrane filter — and returned to the body. On the other side of the dialyser membrane flows dialysate fluid. Waste products (urea, creatinine, potassium, excess fluid) move from the blood across the membrane into the dialysate and are discarded. Clean blood returns to the patient. A standard session at KIMS runs for 4 hours, three times per week — each session processes the blood volume multiple times, achieving the weekly solute clearance the kidneys would normally provide continuously.
Haemodiafiltration (HDF) is an enhanced form of haemodialysis that adds convective transport to standard diffusive clearance. Standard HD removes small molecules (urea, creatinine) effectively by diffusion but is less efficient at clearing mid-molecular uraemic toxins that accumulate over years of dialysis. HDF infuses a large volume of sterile substitution fluid online — the convective flow drags larger toxins across the membrane far more effectively. High-volume HDF has been associated in clinical trials with improved survival, reduced cardiovascular events, and better blood pressure stability during sessions compared to standard HD. KIMS operates HDF machines — the decision to use HD or HDF is made by the nephrologist based on each patient's clinical situation and expected duration on dialysis.
Yes — haemodialysis sessions are covered under Aarogyasri (PMJAY) at KIMS Secunderabad. KIMS is also empanelled under CGHS and EHS. The Aarogyasri coverage includes defined dialysis sessions under the ESRD package. The KIMS billing team assists Aarogyasri card holders with scheme paperwork, pre-authorisation, and session reconciliation. Contact 040 - 44885000 or visit the KIMS billing desk with your Aarogyasri card and current medical reports to register for the scheme.
Standard haemodialysis is three sessions per week, four hours per session — totalling 12 hours of dialysis per week. This schedule is determined by the need to achieve adequate solute clearance and fluid removal between sessions, given that dialysis is intermittent (unlike the kidneys, which work continuously). Some patients with larger body size, higher solute generation, or residual urine output may require schedule adjustments — the KIMS nephrologist prescribes the optimal frequency and duration based on Kt/V adequacy monitoring and clinical assessment. Patients who miss sessions are at significant risk of dangerous electrolyte accumulation and fluid overload between sessions.
The haemodialysis session itself is not painful. The only discomfort associated with the procedure is needle insertion into the AV fistula at the beginning of the session — two needles placed into the fistula vein, which most patients describe as equivalent to a standard blood draw. Patients with a newly created fistula may experience more sensitivity until the fistula matures fully. During the session, most patients watch television, read, sleep, or use their phone. Some patients experience cramps or nausea during the session — usually from rapid fluid removal — which the KIMS nursing team addresses by adjusting the ultrafiltration rate. Post-session fatigue is common, typically lasting 1 to 2 hours.
Yes — many haemodialysis patients work, maintain family responsibilities, and live active lives. The primary adjustment is scheduling three 4-hour sessions per week into daily life. KIMS offers morning, afternoon, and evening session slots to accommodate working patients. Some patients choose peritoneal dialysis (CAPD or APD) as an alternative to haemodialysis — PD is performed at home and does not require three hospital visits per week, giving more schedule flexibility. The KIMS nephrology team discusses HD vs PD at dialysis initiation for every patient who is suitable for both options. See our Peritoneal Dialysis treatment page for details.
Yes — and KIMS actively plans for this. Haemodialysis is a bridge to kidney transplant for every eligible patient, not a permanent state. KIMS begins transplant evaluation concurrently with dialysis initiation — assessing donor availability, blood group compatibility, immunological workup (crossmatch and PRA), cardiac fitness, and any other contraindications. With 1,500+ kidney transplants performed — including ABO-incompatible and swap (paired exchange) transplants — KIMS can transplant patients whose donors have mismatched blood groups. If you are on dialysis and have a potential donor, tell your KIMS nephrologist immediately. Beginning the evaluation process early minimises time spent on dialysis.
KIMS Secunderabad — 24/7 haemodialysis including emergency and acute sessions, HDF machines for enhanced solute clearance, DM Nephrology-qualified nephrologists managing the programme directly, same nephrology team from CKD to dialysis to transplant (1,500+ transplants performed), dialysis adequacy monitored with Kt/V at every scheduled interval, Aarogyasri and CGHS and EHS empanelled. NABH and NABL accredited. Times Healthcare Achievers — Best Hospital of the Year in Nephrology.