Ten tips for the first hemodialysis sessions

The start of hemodialysis is a particularly vulnerable phase in a patient's journey through various stages of kidney disease: Early mortality is high, functional decline is common, and many patients feel poorly informed and unprepared for what dialysis entails. Decisions made during this phase shape long-term trajectories. Here, we aim at providing "suggestions for colleagues" rather than guideline-like recommendations. In our six tips regarding dialysis consent, transplant candidacy, pill check, vaccination, exercise, and nutrition, we cover the direct patient-doctor axis. In our four tips on volume management, modality, anticoagulation, and incremental hemodialysis, we provide advice that may benefit patients through the prescription itself. Our choice of items is incomplete, as important aspects like vascular access, anemia management, mineral bone disorder, patient-reported symptoms, and dialysate composition are missing. Altogether, we hope that our contribution can emphasize, that hemodialysis may be viewed as the cradle rather than the dead end of nephrology, and enthusiasm for the accomplishments of hemodialysis over the years can ultimately outperform frustration over the burden it imposes on patients. Today's many options to modify hemodialysis for the better represent professional challenges, but these can ultimately be used, right from the start, such as to build the perfect, individualized patient package that should be hemodialysis treatment today.