A dialysis nurse (also called a nephrology nurse or renal nurse) is a registered nurse who cares for people with kidney disease, especially patients whose kidneys have failed and who need dialysis to stay alive. Dialysis nurses assess patients before, during and after treatment, manage dialysis machines and vascular access, give medications, watch for complications like low blood pressure and high potassium, teach patients how to manage diet, fluids and home dialysis and support them through a lifelong, life-changing condition.
This guide covers what dialysis nurses do, the stages of chronic kidney disease, hemodialysis vs peritoneal dialysis, dialysis access (fistulas, grafts and catheters), common dialysis complications, dialysis nurse vs dialysis tech, how to become a dialysis nurse, CNN and CDN certification, salary and Nephrology Nurses Week.
In this guide
- What is a dialysis nurse?
- What does a dialysis nurse do?
- The stages of chronic kidney disease
- Hemodialysis vs peritoneal dialysis
- Dialysis access: fistulas, grafts and catheters
- Common dialysis complications
- Where do dialysis nurses work?
- Dialysis nurse vs dialysis tech
- How to become a dialysis nurse
- CNN and CDN certification
- How much do dialysis nurses make?
- What is it like to be a dialysis nurse?
- A short history of dialysis
- When is Nephrology Nurses Week?
- Gifts for dialysis nurses
- Dialysis nurse humor
- Frequently asked questions
What is a dialysis nurse?
Dialysis is a treatment that does some of the work of healthy kidneys: removing waste, extra fluid and excess electrolytes like potassium from the blood. People need dialysis when their kidneys stop working well enough, a condition called kidney failure or end-stage kidney disease (ESKD). Without dialysis or a kidney transplant, kidney failure is fatal.
Dialysis nurses are part of the broader specialty of nephrology nursing, which includes caring for patients at every stage of kidney disease, before dialysis, during dialysis and after kidney transplant. Most dialysis patients come for treatment several times a week for years, so dialysis nurses build long-term relationships with their patients.
What does a dialysis nurse do?
- Pre-treatment assessment: checking weight, vital signs, fluid status, lung sounds, swelling and lab results before each treatment
- Vascular access care: assessing fistulas and grafts, cannulating access with needles and caring for dialysis catheters
- Running treatment: setting up and monitoring dialysis machines, adjusting fluid removal goals and watching patients throughout the session
- Medication administration: giving medications during dialysis, such as anemia treatments, iron, vitamin D and antibiotics
- Managing complications: responding to low blood pressure, cramping, bleeding, chest pain or reactions during treatment
- Lab monitoring: tracking potassium, phosphorus, hemoglobin and how well dialysis is clearing waste
- Patient education: teaching about fluid limits, a kidney-friendly diet, medications, access care and treatment options
- Home dialysis training: teaching patients and families to do peritoneal dialysis or home hemodialysis
- Supervision: overseeing patient care technicians and coordinating with nephrologists, dietitians and social workers
The stages of chronic kidney disease
Chronic kidney disease (CKD) is measured using the glomerular filtration rate (GFR), an estimate of how well the kidneys filter blood. Doctors and nurses use these stages, based on KDIGO guidelines, to describe how advanced kidney disease is:
| Stage | GFR (mL/min/1.73 m²) | What it means |
|---|---|---|
| Stage 1 | 90 or higher | Normal filtering, but with signs of kidney damage |
| Stage 2 | 60 to 89 | Mildly decreased function |
| Stage 3a | 45 to 59 | Mild to moderately decreased function |
| Stage 3b | 30 to 44 | Moderately to severely decreased function |
| Stage 4 | 15 to 29 | Severely decreased function; planning for dialysis or transplant often begins |
| Stage 5 | Less than 15 | Kidney failure; dialysis or a transplant is usually needed |
The most common causes of kidney failure in the United States are diabetes and high blood pressure.
This guide is educational. Talk with a health care provider about your own kidney health and lab results.
Hemodialysis vs peritoneal dialysis
| Hemodialysis (HD) | Peritoneal dialysis (PD) | |
|---|---|---|
| How it works | Blood is pumped through a machine with a filter (dialyzer) and returned to the body | Dialysis fluid is placed in the belly through a catheter, and the lining of the abdomen (peritoneum) acts as the filter |
| Access | Fistula, graft or central venous catheter | PD catheter in the abdomen |
| Typical schedule | In-center: usually three times a week for about 3 to 4 hours | Daily at home, either several manual exchanges (CAPD) or overnight with a cycler machine (APD) |
| Where | Dialysis center, hospital or at home | Usually at home |
| Key nursing concerns | Low blood pressure, access problems, bleeding and fluid shifts | Peritonitis (watch for cloudy fluid and belly pain), catheter exit-site care and fluid balance |
In the ICU, critically ill patients may receive continuous renal replacement therapy (CRRT), a slower, 24-hour form of dialysis that is gentler on unstable blood pressure.
Dialysis access: fistulas, grafts and catheters
Hemodialysis needs a reliable way to move large amounts of blood in and out of the body. This is called vascular access, and caring for it is one of the most important parts of a dialysis nurse's job.
- AV fistula: a surgeon connects an artery directly to a vein, usually in the arm. Over several weeks, the vein grows larger and stronger so it can handle dialysis needles. Fistulas generally last longest and have the lowest infection risk, so they are usually the preferred access.
- AV graft: a soft synthetic tube connects an artery and a vein. Grafts can often be used sooner than fistulas but have a higher risk of clotting and infection.
- Central venous catheter: a tube placed in a large vein, usually in the neck or chest. A tunneled catheter, often called a permcath, runs under the skin to lower infection risk. Catheters can be used right away but have the highest risk of infection, so they are usually a temporary bridge.
How to check a fistula or graft
Nurses and patients check access every day by:
- Feeling for the thrill: a buzzing or vibrating sensation over the access
- Listening for the bruit: a whooshing sound heard with a stethoscope
A missing thrill or bruit can mean the access has clotted and needs urgent attention. Patients are taught to avoid blood pressure checks, blood draws, IVs, tight sleeves and sleeping on the access arm.
Common dialysis complications
- Low blood pressure (intradialytic hypotension): the most common complication during hemodialysis, often from removing fluid too quickly
- Muscle cramps during or after treatment
- High potassium (hyperkalemia): dangerous for the heart, especially after missed treatments (see our telemetry nurse guide for heart rhythm changes)
- Fluid overload: swelling and shortness of breath when patients gain too much fluid between treatments
- Access problems: clotting, narrowing, bleeding or infection
- Dialysis disequilibrium syndrome: headache, nausea, confusion or, rarely, seizures, most often in new patients whose waste levels drop too quickly
- Infections, especially with catheters, and peritonitis with PD
- Anemia and bone disease, which develop with long-term kidney failure
Dialysis teams also measure adequacy, how well each treatment is clearing waste, often with a calculation called Kt/V.
Where do dialysis nurses work?
- Outpatient dialysis centers, the most common setting
- Hospitals, including inpatient dialysis units and ICUs (for acute dialysis and CRRT)
- Home dialysis programs, training and supporting patients on PD and home hemodialysis (see our home health nurse guide)
- Nephrology clinics caring for patients with earlier stages of CKD
- Transplant centers
- Acute dialysis services that travel to different hospitals
- Travel nursing, since dialysis nurses are in high demand (see our travel nurse guide)
Dialysis nurse vs dialysis tech
| Dialysis nurse (RN) | Dialysis tech (PCT) | |
|---|---|---|
| Education | Nursing degree and RN license | Training program and, in most states, a dialysis technician certification |
| Main duties | Assessments, medications, care planning, catheter care, education and supervising care | Setting up machines, cannulating fistulas and grafts, monitoring treatment and vital signs |
| Common certifications | CNN, CDN | CCHT and other technician credentials |
Dialysis nurses and techs work side by side, and many dialysis nurses started their careers as techs.
How to become a dialysis nurse
- Earn a nursing degree (ADN or BSN) and pass the NCLEX-RN.
- Get clinical experience. Many dialysis companies hire new graduates and provide dialysis training. Others prefer a year of med-surg or ICU experience first.
- Get BLS certified, and ACLS if required.
- Complete dialysis training, which usually lasts several weeks to a few months.
- Earn the CDN or CNN once you meet the experience requirements.
CNN and CDN certification
The Nephrology Nursing Certification Commission (NNCC) offers the main certifications for dialysis and nephrology nurses:
- CDN (Certified Dialysis Nurse): focused on dialysis nursing. Eligibility generally requires a current RN license plus a set amount of recent dialysis nursing experience and continuing education.
- CNN (Certified Nephrology Nurse): covers the full scope of nephrology nursing. Eligibility generally requires a current RN license, a bachelor's degree in nursing, nephrology nursing experience and continuing education in nephrology.
Check NNCC for current hour and education requirements. The American Nephrology Nurses Association (ANNA) is the main professional organization for the specialty.
How much do dialysis nurses make?
The U.S. Bureau of Labor Statistics does not publish a separate salary for dialysis nurses, because it groups them with all registered nurses. The median annual wage for registered nurses was $97,550 in May 2025, according to the BLS.
Dialysis nurse pay depends on location, employer, setting (outpatient, acute hospital or home program), experience, certification and on-call duties. Acute and travel dialysis nurses often earn more because of call and flexibility requirements.
What is it like to be a dialysis nurse?
- Early mornings: many outpatient dialysis centers open very early, sometimes before 5 a.m., and some run Saturday shifts.
- No night shifts at most outpatient centers, though acute and on-call roles are different.
- Long-term relationships: nurses see the same patients several times a week for years, getting to know them and their families well.
- Fast-paced turnover: centers run several shifts of patients a day, with careful timing between them.
- Technical skills: machines, water treatment, access cannulation and lab trends.
- Emotional moments: nurses celebrate transplant calls and also support patients with serious illness and end-of-life decisions.
A short history of dialysis
- 1943: Dutch physician Willem Kolff builds one of the first working artificial kidney machines during World War II.
- 1960: Belding Scribner in Seattle develops a reusable access shunt, making long-term, repeated dialysis possible for chronic kidney failure.
- 1966: surgeons describe the arteriovenous fistula, still the preferred dialysis access today.
- 1969: the organization that becomes the American Nephrology Nurses Association is founded.
- 1972: Congress extends Medicare coverage to people with end-stage kidney disease, making dialysis available to far more Americans.
- Today: hundreds of thousands of Americans rely on dialysis, and home dialysis options continue to grow.
When is Nephrology Nurses Week?
Nephrology Nurses Week is celebrated each September, led by ANNA. It is a great time to thank the nurses who care for kidney patients, along with the techs, dietitians and social workers on the dialysis team. National Nurses Week (May 6 to 12) and World Kidney Day in March are other great times to celebrate.
Nephrology Nurses Week ideas
- Have patients sign a thank-you banner for the unit.
- Bring breakfast for the early-morning shift.
- Sponsor CNN or CDN exam fees or ANNA memberships.
- Celebrate transplant anniversaries of former patients.
- Recognize the techs, dietitians and social workers who make dialysis possible.
Gifts for dialysis nurses
A detailed mandala design for the nurses who keep kidneys running. Perfect for Nephrology Nurses Week. $29.99
Shop now →
For the coffee that powers early-morning setups and back-to-back treatment shifts. $15.99
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For lab trends, patient notes and CNN or CDN studying. $17.99
Shop now →Dialysis nurse humor
- "Filtering blood and drama." (Now a sticker.)
- "Did you really only drink 'a little water' this weekend? The scale disagrees."
- "Feel the thrill. Hear the bruit. Love the fistula."
- "Our day starts before the sun and the coffee."
- "Potassium is my nemesis. Bananas are on notice."
- "I don't just see my patients. I see them three times a week, for years."
Frequently asked questions
What does a dialysis nurse do?
Dialysis nurses care for patients with kidney failure. They assess patients before and during treatment, manage dialysis machines and vascular access, give medications, watch for complications, monitor labs and teach patients about diet, fluids, access care and home dialysis.
What are the stages of chronic kidney disease?
CKD has five stages based on GFR: stage 1 (90 or higher with kidney damage), stage 2 (60 to 89), stage 3a (45 to 59), stage 3b (30 to 44), stage 4 (15 to 29) and stage 5 (less than 15, kidney failure).
What is the difference between hemodialysis and peritoneal dialysis?
Hemodialysis filters blood through a machine and is usually done three times a week in a dialysis center. Peritoneal dialysis uses the lining of the abdomen as a filter and is usually done daily at home.
What is the thrill and bruit of a fistula?
The thrill is the buzzing vibration you feel over a working fistula or graft, and the bruit is the whooshing sound you hear with a stethoscope. A missing thrill or bruit can mean the access has clotted.
What is a permcath?
A permcath is a tunneled central venous catheter used for hemodialysis. It runs under the skin into a large vein in the neck or chest. It can be used right away but has a higher infection risk than a fistula or graft.
What certification do dialysis nurses need?
The main certifications are the CDN (Certified Dialysis Nurse) and the CNN (Certified Nephrology Nurse) from the Nephrology Nursing Certification Commission. Requirements include an RN license, nephrology experience and continuing education.
How much do dialysis nurses make?
BLS does not report dialysis nurse pay separately. Registered nurses overall earned a median of $97,550 in May 2025. Pay varies by setting, location, experience, certification and on-call duties.
Can new grads become dialysis nurses?
Yes. Many dialysis companies hire new graduate nurses and provide dialysis training, though some employers prefer prior acute care experience.
Exploring other specialties? See our full guide to nurse specialties and the types of nurses.
Celebrate the dialysis nurses in your life
For Nephrology Nurses Week, a new CNN or the nurse who sees you three times a week.
Shop the Dialysis Collection →Sources
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Registered Nurses
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Kidney Failure and Dialysis
- Kidney Disease: Improving Global Outcomes (KDIGO), CKD Classification
- National Kidney Foundation, KDOQI Vascular Access Guidelines
- Nephrology Nursing Certification Commission (NNCC), CNN and CDN Certification
- American Nephrology Nurses Association (ANNA)