DEPARTMENT OF NEPHROLOGY

CENTURY HOSPITAL

CENTURY HOSPITAL

DIALYSIS


Dialysis is the process of removing waste and excess water from the blood and is used primarily to provide an artificial replacement for lost kidney function in people with renal failure. Dialysis is regarded as a life sustaining measure until a renal transplant (Kidney transplant) can be performed, or sometimes as the only supportive measure in those for whom a transplant would be inappropriate.


When is dialysis needed?


Dialysis is needed when one has end stage kidney failure or CKD V, usually by that time loss of about 85 to 90 percent of kidney function is seen and have a GFR of lessthan 15 and if patient has severe symptoms caused by kidney disease, such as shortness of breath, fatigue, muscle cramps, nausea or vomiting or biochemical abnormalities like very high urea, creatinine, potassium or acidosis.


What does dialysis do?


When kidneys fail, dialysis keeps body in balance by:



  • Removing toxic wastes and extra water from the blood

  • Maintaining a safe level of certain chemicals in the blood, such as potassium, sodium and bicarbonate

  • Helping to control blood pressure


Is kidney failure permanent?


Usually yes, but not always. The chances that the kidneys will get better depend on what caused kidney failure. Kidney failure is divided into two general categories, acute and chronic. Acute (or sudden) kidney failure is often temporary. Some kinds of acute kidney failure get better after treatment. In some cases of acute kidney failure, dialysis may only be needed for a short time until the kidneys get better. In chronic kidney failure, the kidneys normally do not heal and may require lifelong dialysis or they can get transplanted.


Where is dialysis done?


Dialysis can be done in a hospital (hemodialysis) in the dialysis unit. Patients usually have hemodialysis three times a week. It takes about 4 hours each time.


Sometimes, dialysis can be done at home (peritoneal Dialysis).


How is Dialysis Done?


In hemodialysis, an artificial kidney (hemodialyser) is used to remove waste and extra chemicals and fluid from blood. Before the first dialysis treatment, an access is surgically created to get blood from the body into the hemodialyser and is returned to the body. This is typically a quick operation and will allow patient to return home the same day.


Sometimes, an access is made by joining an artery to a vein under your skin to make a bigger blood vessel called a fistula.



However, if your blood vessels are not adequate for a fistula, a PTFE tube is used to join an artery and a vein under your skin. This is called a graft.


Occasionally, an access is made by means of a narrow plastic tube, called a catheter, which is inserted into a large vein in your neck. . It is most commonly used as a temporary access when someone needs dialysis immediately or when they are waiting for a fistula/graft to mature. This type of access may be temporary, but is sometimes used for long-term treatment.



TAKING CARE OF YOUR GRAFT OR FISTULA


Avoid all pressure on the access site. If the graft or fistula clots, you may need a new one.



  • Do not allow anyone to take a blood pressure reading on the same arm with the access.

  • Do not wear tight clothing around the access site or on the arm.

  • Avoid placing pressure on the arm with the access while you sleep.

  • Avoid placing pressure on the arm when you are lifting heavy items.

  • Do not allow any blood to be drawn from the arm.

  • Do not use creams or lotions over the access site.


Do not miss or skip any dialysis sessions. Make sure time is maintained as the dialysis units are busy with regular schedules.


Risks


Dialysis carries several risks, although many can be avoided through proper procedure and careful use of equipment. Risks associated with dialysis include:



  • Bleeding at the access site

  • Low blood pressure

  • Irregular heartbeat

  • Infection

  • Nausea and vomiting

  • Air bubbles in the blood

  • Cardiac Arrests


WHAT IS HEMODIALYSIS?


In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a partially permeable membrane. The dialyzer is composed of thousands of tiny synthetic hollow fibers. The fiber wall acts as the semi permeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions. The cleansed blood is then returned via the circuit back to the body. Ultra filtration occurs by increasing the hydrostatic pressure across the dialyzer membrane. This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dial sate, and allows the removal of several liters of excess fluid during a typical 4 hour treatment. It is usually done thrice weekly.



Hemodialysis requires a strict treatment schedule, regular medications and usually, changes in the diet.


A dialysis nurse can train patients to do home dialysis. Patients do not have to buy a machine. Supplies can be delivered. Both the patient and any caregivers must learn to:



  • Handle the equipment

  • Place the needle into the access site

  • Monitor the machine and blood pressure during treatment

  • Keep records

  • Clean the machine

  • Order supplies