The Dialysis Nurse manages the care of patients with end-stage renal disease (ESRD) or acute kidney injury requiring hemodialysis or peritoneal dialysis, reporting to the Dialysis Unit Manager or Clinical Supervisor. Dialysis nursing is structurally different from most hospital specialties because it operates on a recurring treatment model: the same patients come in three times a week, every week, for years. That longitudinal relationship creates both a deeper therapeutic bond and a unique clinical obligation to catch the small changes that signal a serious shift in a patient's condition. Success in this role looks like consistent access patency rates, complication rates below ESQIP benchmarks, and patient adherence to fluid and dietary restrictions that are tracked over time, not just one visit.
Conduct pre-treatment assessments including weight, blood pressure, access site inspection, and symptom review prior to initiating each dialysis session.
Initiate, monitor, and discontinue hemodialysis sessions, managing machine parameters including blood flow rate, dialysate composition, and ultrafiltration goals.
Cannulate arteriovenous fistulas and grafts using buttonhole or rope-ladder technique per unit protocol and patient access plan.
Manage peritoneal dialysis exchanges for PD patients, monitoring for signs of peritonitis, catheter malfunction, and inadequate clearance.
Assess and troubleshoot access complications including clotting, stenosis, and infection, notifying vascular access coordinators per escalation protocol.
Administer IV medications during dialysis including iron, erythropoiesis-stimulating agents (ESAs), and antibiotics per nephrologist orders.
Recognize and manage intradialytic complications including hypotension, cramping, access bleeding, and cardiac arrhythmias.
Review and respond to routine lab values (Kt/V, URR, hemoglobin, potassium, phosphorus) to identify trends requiring provider notification.
Educate patients on fluid and dietary restrictions, access care, and medication adherence between sessions in a way that accounts for their long-term treatment reality.
Complete ESRD Medical Evidence Report documentation and CMS regulatory requirements for dialysis facility compliance.
Coordinate home dialysis training and support for patients transitioning to home hemodialysis or peritoneal dialysis.
Participate in facility QA/QAPI programs, tracking treatment adequacy metrics and contributing to improvement initiatives.
Active, unrestricted RN license in the state of practice; ADN accepted with commitment to BSN progression.
Current BLS certification.
1-3 years of dialysis nursing experience (outpatient or inpatient) with demonstrated competency in hemodialysis machine operation and access cannulation.
Familiarity with ESRD patient population, chronic kidney disease staging, and renal replacement therapy modalities.
Experience interpreting dialysis adequacy labs (Kt/V, URR, BMP) and recognizing reportable trends.
Ability to independently manage 4-6 patients during a dialysis shift in an outpatient setting.
Knowledge of CMS Conditions for Coverage for dialysis facilities and ESQIP quality benchmarks.
CDN (Certified Dialysis Nurse) or CNN (Certified Nephrology Nurse) from NNCC or ANCC.
Experience with both hemodialysis and peritoneal dialysis modalities.
Home dialysis training experience (HHD or PD).
Acute dialysis experience in ICU or inpatient settings (CRRT familiarity a plus).
Experience in chronic kidney disease (CKD) education clinics serving pre-dialysis patients.
Hemodialysis machine setup, operation, and troubleshooting
AV fistula and graft cannulation (buttonhole and rope-ladder techniques)
Peritoneal dialysis exchange management and catheter care
Intradialytic complication recognition and response (hypotension, arrhythmia, access bleeding)
ESRD lab interpretation (Kt/V, URR, hemoglobin, phosphorus, potassium)
IV medication administration during dialysis (iron, ESAs, antibiotics)
CMS documentation and ESQIP compliance reporting
Long-term therapeutic relationship management with a chronic patient population
Motivational communication around fluid and dietary adherence
Cultural sensitivity in patient education for diverse ESRD populations
Efficient time management across multiple simultaneous patients
Empathy and boundary-setting within chronic care relationships
Dialysis nurses earn $76,000 to $98,000 annually across most U.S. markets, consistent with the national RN median of $86,070 (BLS, May 2023). Outpatient dialysis nurses at chain facilities (DaVita, Fresenius) often earn at the lower-to-mid end of this range; hospital-based inpatient dialysis and CRRT nurses command higher rates. CDN or CNN certification adds 6-10% to base compensation at most facilities. Source: U.S. Bureau of Labor Statistics, May 2023; PayScale, 2025.
San Francisco Bay Area, CA ($104,000 - $126,000)
Seattle, WA ($97,000 - $118,000)
New York Metro, NY ($95,000 - $114,000)
Boston, MA ($94,000 - $112,000)
Los Angeles, CA ($92,000 - $110,000)
Dialysis nursing positions typically include medical, dental, and vision insurance, 401(k) with employer matching, 3-4 weeks PTO, and CDN/CNN exam fee reimbursement. Large dialysis organizations offer structured orientation programs, clinical advancement pathways, and shift flexibility given the predictable schedule structure of outpatient dialysis. Tuition assistance is available at most major employers.
Cannot explain the difference between Kt/V and URR: These are the primary measures of dialysis adequacy. A nurse who cannot interpret them cannot meaningfully assess whether a patient's treatment is working.
No demonstrated cannulation experience or significant nervousness about accessing fistulas: AV access cannulation is a core daily skill. Extended discomfort with this procedure creates patient safety risk and slows unit throughput.
Has never managed intradialytic hypotension independently: This is the most common dialysis complication. Candidates who have only observed rather than managed it will need extensive one-on-one supervision.
No awareness of CMS Conditions for Coverage for dialysis facilities: Dialysis units are heavily regulated. Nurses who don't understand the compliance framework create documentation and survey risk for the organization.
Cannot describe how they would approach a patient who consistently violates fluid restrictions: Adherence education is a core dialysis nursing function. A punitive or avoidant approach to this scenario signals a misalignment with chronic care nursing principles.
Q What does a dialysis nurse do?
A A dialysis nurse manages hemodialysis and peritoneal dialysis treatments for patients with end-stage renal disease or acute kidney injury. They initiate and monitor dialysis sessions, cannulate vascular access sites, manage intradialytic complications, administer IV medications, and educate patients on adherence to fluid and dietary restrictions.
Q What qualifications do you need to be a dialysis nurse?
A You need an active RN license, current BLS, and 1-3 years of dialysis experience with demonstrated hemodialysis machine competency and access cannulation skills. ADN is accepted at most facilities. The CDN (Certified Dialysis Nurse) or CNN (Certified Nephrology Nurse) credentials from NNCC or ANCC are the recognized specialty certifications.
Q How much does a dialysis nurse make?
A Dialysis nurses earn $76,000 to $98,000 annually in most U.S. markets, consistent with the national RN median of $86,070 (BLS, May 2023). Hospital-based dialysis and inpatient CRRT nurses typically earn more than outpatient clinic nurses. CDN or CNN certification adds 6-10% to base compensation at most employers.
Q What skills are required for a dialysis nurse?
A Dialysis nurses need hemodialysis machine operation, AV fistula and graft cannulation, peritoneal dialysis management, intradialytic complication response, ESRD lab interpretation, and CMS compliance documentation. Interpersonally, they need strong motivational communication skills to support long-term patient adherence and therapeutic relationship management.
Q What is the career path for a dialysis nurse?
A Dialysis nurses advance to charge nurse, clinical coordinator, or home dialysis training specialist. With additional credentials, options include nephrology nurse practitioner (with MSN/APRN), dialysis unit manager, or regional clinical director at large dialysis organizations. Some move into kidney transplant coordination.
Q What are the biggest challenges facing dialysis nurses today?
A Staffing shortages in dialysis nursing are among the worst in any specialty, driven by the demanding ratio requirements and limited nursing school training in nephrology. ESRD prevalence continues to grow, adding volume without a parallel increase in trained nurses. Patient non-adherence to fluid and dietary restrictions remains a persistent and emotionally taxing clinical challenge.