Dialysis

Hemodialysis

In hemodialysis, a machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately. Hemodialysis is the most common way to treat advanced kidney failure. The procedure can help you carry on an active life despite failing kidneys.
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Hemodialysis requires you to follow a strict treatment schedule, take medications regularly and, usually, make changes in your diet.

Hemodialysis is a serious responsibility, but you don't have to shoulder it alone. You'll work closely with your health care team, including a kidney specialist and other professionals with experience managing hemodialysis. You may be able to do hemodialysis at home.

Peritoneal (per-ih-toe-NEE-ul) dialysis is another way to remove waste products from your blood when your kidneys can no longer do the job adequately. During peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) fill in for your kidneys, with the help of a cleansing fluid that flows into and out of the peritoneal space.

How You Prepare Yourself

Preparation for hemodialysis starts several weeks to months before your first procedure. To allow for easy access to your bloodstream, a surgeon will create a vascular access. The access provides a mechanism for a small amount of blood to be safely removed from your circulation and then returned to you in order for the hemodialysis process to work. The surgical access needs time to heal before you begin hemodialysis treatments.

There are three types of accesses
Arteriovenous (AV) fistula

A surgically created AV fistula is a connection between an artery and a vein, usually in the arm you use less often. This is the preferred type of access because of effectiveness and safety.

AV graft

If your blood vessels are too small to form an AV fistula, the surgeon may instead create a path between an artery and a vein using a flexible, synthetic tube called a graft.

Central venous catheter

If you need emergency hemodialysis, a plastic tube (catheter) may be inserted into a large vein in your neck or near your groin. The catheter is temporary.

It's extremely important to take care of your access to reduce the possibility of infection and other complications. Follow your health care team's instructions about caring for your access.

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Risks

Most people who require hemodialysis have a variety of health problems. Hemodialysis prolongs life for many people, but life expectancy for people who need it is still less than that of the general population.

While hemodialysis treatment can be efficient at replacing some of the kidney's lost functions, you may experience some of the related conditions listed below, although not everyone experiences all of these issues. Your dialysis team can help you deal with them.

A drop in blood pressure is a common side effect of hemodialysis, particularly if you have diabetes. Low blood pressure may be accompanied by shortness of breath, abdominal cramps, muscle cramps, nausea or vomiting.

Although the cause is not clear, muscle cramps during hemodialysis are common. Sometimes the cramps can be eased by adjusting the hemodialysis prescription. Adjusting fluid and sodium intake between hemodialysis treatments may also help prevent symptoms during treatments.

Many people who undergo hemodialysis have itchy skin, which is often worse during or just after the procedure.

People receiving hemodialysis often have trouble sleeping, sometimes because of breaks in breathing during sleep (sleep apnea) or because of aching, uncomfortable or restless legs.

Not having enough red blood cells in your blood (anemia) is a common complication of kidney failure and hemodialysis. Failing kidneys reduce production of a hormone called erythropoietin (uh-rith-roe-POI-uh-tin), which stimulates formation of red blood cells. Diet restrictions, poor absorption of iron, frequent blood tests, or removal of iron and vitamins by hemodialysis also can contribute to anemia.

If your damaged kidneys are no longer able to process vitamin D, which helps you absorb calcium, your bones may weaken. In addition, overproduction of parathyroid hormone — a common complication of kidney failure — can release calcium from your bones.

If you consume too much salt or drink too much fluid, your high blood pressure is likely to get worse and lead to heart problems or strokes.

Since fluid is removed from your body during hemodialysis, drinking more fluids than recommended between hemodialysis treatments may cause life-threatening complications, such as heart failure or fluid accumulation in your lungs (pulmonary edema).

Insufficient hemodialysis can lead to inflammation of the membrane surrounding the heart, which can interfere with your heart's ability to pump blood to the rest of your body.

Potassium is a mineral that is normally removed from the body by the kidneys. If you eat more potassium than recommended, your potassium level may become too high. In severe cases, too much potassium can cause your heart to stop.

Potentially dangerous complications — such as infection, narrowing or ballooning of the blood vessel wall (aneurysm), or blockage — can impact the quality of your hemodialysis. Follow your dialysis team's instructions on how to check for changes in your access that may indicate a problem.

Dialysis-related amyloidosis develops when proteins in blood are deposited on joints and tendons, causing pain, stiffness and fluid in the joints. The condition is more common in people who have undergone hemodialysis for more than five years.

Changes in mood are common in people with kidney failure. If you experience depression or anxiety after starting hemodialysis, talk with your health care team about effective treatment options.

What you can expect from us

You can receive hemodialysis in a dialysis center, at home or in a hospital. Frequency of treatment varies, depending on your situation:
  • In-center hemodialysis

    Many people get hemodialysis three times a week in sessions of three to five hours each.

  • Daily hemodialysis

    This involves more-frequent, but shorter sessions — usually performed at home six or seven days a week for about two to three hours each time.

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Simpler hemodialysis machines have made home hemodialysis less cumbersome, so with special training and someone to help you, you may be able to do hemodialysis at home. You may even be able to do the procedure at night while you sleep.

There are dialysis centers located throughout the United States and in some other countries, so you can travel to many areas and still receive your hemodialysis on schedule. Your dialysis team can help you make appointments at other locations, or you can contact the dialysis center at your destination directly. Plan ahead to make sure space is available and proper arrangements can be made.

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The Procedure

During treatments, you sit or recline in a chair while your blood flows through the dialyzer — a filter that acts as an artificial kidney to clean your blood. You can use the time to watch TV or a movie, read, nap, or perhaps talk to your "neighbors" at the center. If you receive hemodialysis at night, you can sleep during the procedure.

Preparation

Your weight, blood pressure, pulse and temperature are checked. The skin covering your access site — the point where blood leaves and then re-enters your body during treatment — is cleansed.

Starting

During hemodialysis, two needles are inserted into your arm through the access and taped in place to remain secure. Each needle is attached to a flexible plastic tube that connects to a dialyzer. Through one tube, the dialyzer filters your blood a few ounces at a time, allowing wastes and extra fluids to pass from your blood into a cleansing fluid called dialysate. The filtered blood returns to your body through the second tube.

Symptoms

You may experience nausea and abdominal cramps as excess fluid is pulled from your body — especially if you have hemodialysis only three times a week rather than more often. If you're uncomfortable during the procedure, ask your care team about minimizing side effects by such measures as adjusting the speed of your hemodialysis, your medication or your hemodialysis fluids.

Monitoring

Because blood pressure and heart rate can fluctuate as excess fluid is drawn from your body, your blood pressure and heart rate will be checked several times during each treatment.

Finishing

When hemodialysis is completed, the needles are removed from your access and a pressure dressing is applied to the site to prevent bleeding. Your weight may be recorded again. Then you're free to go about your usual activities until your next session.

Preparation

Your weight, blood pressure, pulse and temperature are checked. The skin covering your access site — the point where blood leaves and then re-enters your body during treatment — is cleansed.

Results

Hemodialysis is performed to manage the kidney failure cases, till there is a need for kidney transplant. In certain cases, the patients might have to get the hemodialysis procedure done for the rest of their lives.

In-center hemodialysis or home dialysis are the two available options to the patients and are commonly conducted. Patients can go for either of the procedures and can benefit from the procedures in the following ways.

01

Patients can go for either of the procedures and can benefit from the procedures in the following ways.

  • Improved and better quality of life
  • Less and decreased symptoms like breathlessness, headache, and less abdominal cramps.
  • Increased well-being of the patient
  • Improved ability to concentrate, sleep and appetite.
  • High energy levels
02

The doctor also prescribes certain tests to the patient, in first few weeks of the treatment, in order to check the efficacy of hemodialysis treatment, as mentioned below.

  • The weigh and blood pressure of the patient is monitored closely.
  • Blood tests to evaluate the urea reduction ratio (URR)
  • Increased well-being of the patient
  • Improved ability to concentrate, sleep and appetite.
  • High energy levels
03

The patient can improve the results of hemodialysis by following certain precautions as mentioned below.

  • Eating a healthy and nutritious diet e.g. phosphorus and low sodium diet.
  • Taking the medicines on time and as prescribed.
  • Try to keep a check on the blood pressure
  • Prevent building up of phosphorus in the blood
  • Medicines to increase the red blood cells and control the amount of some nutrients in the blood.
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