Many patients arrive at their first session with the same question: "What is actually going to happen during these 4 hours?". Rather than answering in abstract medical terms, we have written this concrete, step-by-step walkthrough, just as you will experience it at the Clinique ESSAADA in Sidi Bel Abbès.
If you are preparing for your very first session, you can also read our dedicated guide to the 1st session — it complements this article with the documents to bring and the preparations to make beforehand.
Before the session — getting ready is simple
Come dressed comfortably. Opt for a top with wide or removable sleeves: the team needs easy access to your arm (on the side of the fistula or catheter). A light meal 2 hours before your appointment slot is recommended. Avoid very sugary or very salty drinks in the hours beforehand.
Bring with you:
- Your Chifa card and your CNAS or CASNOS certificate
- Your most recent blood test results if you are coming from another centre
- A book, a pair of headphones, your charged phone — you will have 4 hours to fill
You are welcome to come accompanied. A dedicated waiting lounge is provided for your loved ones, with coffee and tea served.
Step 1 — Welcome and checks (15 minutes)
On your arrival, our reception desk checks your file and directs you to the referring nurse who will look after you during the session.
The first clinical step: weighing. You are weighed before every session, and the difference from your "dry weight" (your target weight after dialysis) is calculated precisely. This measurement determines the amount of water to be removed from the blood by ultrafiltration during the session.
Next comes the blood pressure reading, your temperature, and sometimes a quick blood test if your nephrologist has prescribed a one-off check. Altogether this takes 10 to 15 minutes.
Step 2 — Getting you settled (10 minutes)
You are settled onto a comfortable 3-position bed, with a blanket if you wish. You can choose your position: lying flat, semi-reclined to read, or sitting up to watch a screen.
The nurse then prepares the vascular access. There are two scenarios:
- You have an arteriovenous fistula (FAV): two needles are inserted — one to send the blood to the dialyser (the "arterial needle"), the other to return it once filtered (the "venous needle"). The puncture takes less than 10 seconds. If it is painful for you, an anaesthetic cream can be applied an hour before the session — mention it to the doctor.
- You have a central catheter (often temporary, while waiting for a fistula to mature): no puncture. The team disinfects the connectors, removes the caps and connects the lines directly.
Step 3 — Starting up and stabilising (the first 10-15 minutes)
Once you are connected to the generator, the machine starts up gradually. It begins with a low blood flow (around 150 ml/minute), then rises gently up to a therapeutic flow (300 to 400 ml/minute). This gradual build-up prevents drops in blood pressure or feelings of dizziness.
During the first 15 minutes, your nurse stays close by, monitoring your blood pressure, your heart rate and your comfort. At ESSAADA, a nephrologist is present on site throughout the entire duration of the sessions — no on-call phone arrangement, a genuine physical presence just a few metres from your station.
Step 4 — During the session (about 3 hrs 30)
This is when you will be "cruising". The blood flows continuously to the dialyser (the artificial kidney, a hollow-fibre filter), passes through a semi-permeable membrane where waste products such as urea and creatinine are removed, and returns purified to your circulation. The excess water built up between two sessions is gradually drawn off.
What to do for 3 hrs 30? Many patients sleep, read, watch films or series (headphones recommended out of respect for the shared calm). Others answer their emails, call their loved ones, or simply enjoy a moment of rest.
A nurse comes round every 15 minutes to check:
- Your blood pressure (often gradually falling, which is normal)
- That the blood circuit is running smoothly
- Your level of comfort
If at any point you feel unwell, get a cramp, feel a drop in energy, shivers or any kind of discomfort, ring the bell. The team responds immediately: slowing the machine down, adjusting the ultrafiltration, warming you up, offering something to drink. These incidents are manageable, and they are managed.
A coffee is served to you
At roughly the halfway point of the session, a coffee is offered. Water and drinks remain available throughout the session. If you have any particular dietary restrictions, let the team know at the start of the session.
Step 5 — End of the session (15 minutes)
When the prescribed dialysis time is reached, the machine slows down gradually, just as it did at the start. The nurse returns the blood remaining in the lines to your circulation, then:
- Removes the needles (or disconnects the catheter)
- Presses on the puncture sites for a few minutes to prevent any bleeding
- Applies a compression dressing that you will keep on for 2 to 4 hours
Step 6 — Post-session check and leaving (10 minutes)
A further weighing: we check that your "dry weight" has indeed been reached. A further blood pressure check: we make sure you are stable before you leave. If all is well — which is the case in the vast majority of sessions — you can go home.
Your next appointment is confirmed (most patients come 3 times a week as prescribed). A session sheet is added to your file and, on request, a report is sent to your treating nephrologist in France or at another centre in Algeria.
What you will feel after your first session
Tiredness is normal for the first 2-3 sessions: your body is getting used to the rhythm. Many patients describe a feeling of "being cleansed from the inside" the first few times. This feeling fades with the following sessions, and your energy returns quickly.
Some patients report a slight drop in blood pressure in the hours that follow — rest, hydrate sensibly (in line with your nephrologist's instructions), and eat normally according to your diet.
The concrete points to keep in mind
- 4 hours on average per session, of which ~3 hrs 30 is actual dialysis
- 3 daily slots at ESSAADA: morning (05:00-09:00), daytime (09:30-13:30), evening (14:00-19:00)
- A nephrologist on site at every session — no on-call phone arrangement
- Full CNAS / CASNOS coverage on a direct-billing basis — no payment up front
A first session that puts you at ease
If you feel apprehensive — that is normal, almost all of our patients have felt it. Our role is to make this journey as simple and as humane as possible. You are never alone during a session: a nurse comes round every 15 minutes, a doctor is just a few steps away, and a call bell is within reach.
For any question before your visit, read our FAQ or get in touch — our team replies within 24 to 48 working hours.