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Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription

CPT4 code

Name of the Procedure:


  • Common Name: Dialysis
  • Technical/Medical Terms: Renal Replacement Therapy, HD


Hemodialysis is a medical treatment that involves filtering your blood through a machine to remove waste products and excess fluids when your kidneys are not functioning properly. The procedure may require repeated evaluations and adjustments to the dialysis prescription to ensure optimum effectiveness.


  • Medical Condition: Chronic kidney disease, acute kidney injury, end-stage renal disease.
  • Goals: To remove waste products, excess fluid, and toxins from the blood, maintain a proper balance of electrolytes, and manage blood pressure. The ultimate goal is to support kidney function and improve overall health.


  • Severe kidney dysfunction or failure.
  • Symptoms such as fatigue, swelling, shortness of breath, and persistent high blood pressure.
  • Blood tests showing high levels of waste products like urea and creatinine.
  • Specific patient criteria: Usually those with less than 15% kidney function.


  • Patients may need to follow dietary restrictions and fluid limits.
  • Medication adjustments: Certain medications may need to be stopped or dosages adjusted.
  • Diagnostic tests: Blood tests, and sometimes imaging studies, to evaluate kidney function and overall health.

Procedure Description

  1. Access Creation: A vascular access point (usually a fistula, graft, or catheter) is created to connect to the dialysis machine.
  2. Blood Withdrawal: Blood is withdrawn from the body through the access point and pumped into the dialysis machine.
  3. Filtration: The machine filters waste, extra fluids, and electrolytes through a dialyzer (artificial kidney).
  4. Blood Return: The cleansed blood is returned to the patient’s body.
  5. Evaluation: Repeated assessments are conducted, and dialysis prescription may be adjusted based on patient’s response.
    • Tools & Equipment: Dialysis machine, dialyzer, bloodlines, anticoagulants.
    • Anesthesia: Typically not required; local anesthesia for access creation.


  • Initial Access Surgery: 1-2 hours.
  • Each Dialysis Session: Typically 3-5 hours, occurring 3 times a week.


  • Typically performed in a dialysis clinic or hospital’s dedicated unit.
  • Some patients may opt for home hemodialysis after proper training.


  • Nephrologists (kidney specialists)
  • Dialysis nurses and technicians
  • Vascular surgeons (for access creation)

Risks and Complications

  • Common Risks: Low blood pressure, muscle cramps, itching, nausea, headaches.
  • Rare Risks: Infections at the access site, blood clots, reactions to dialysate or anticoagulants.
  • Management: Immediate medical attention for serious complications, regular monitoring to minimize risks.


  • Effective removal of waste and excess fluids.
  • Improved symptoms of kidney failure.
  • Potentially prolongs life and improves quality of life.


  • Short recovery time: Usually able to resume normal activities soon after each session.
  • Post-procedure care: Monitor access site for signs of infection, follow dietary and fluid intake guidelines.
  • Regular follow-up appointments with healthcare provider.


  • Peritoneal Dialysis: Uses the lining of your abdomen to filter blood inside the body.
  • Kidney Transplant: Surgical procedure to replace a failed kidney with a healthy donor kidney.
  • Pros and Cons: Each alternative has specific benefits and risks. Peritoneal dialysis can be done at home, but might not be suitable for everyone. Kidney transplantation offers a long-term solution but requires compatible donor and lifelong immunosuppressive therapy.

Patient Experience

  • During the Procedure: You might feel discomfort from needle insertion and some fatigue afterward.
  • After the Procedure: Possible tiredness, dietary and fluid restrictions. Pain management available for any discomfort from the access site.
  • Regular evaluation to ensure treatment efficacy and adjust as needed to improve comfort and outcomes.

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