Kidney dialysis is a process for removing waste and excess water from the blood, and is used primarily as an artificial replacement for lost kidney function in people with renal failure.Dialysis may be used for those with an acute disturbance in kidney function (acute kidney injury, previously acute renal failure), or progressive but chronically worsening kidney function–a state known as chronic kidney disease stage 5 (previously chronic renal failure or end-stage renal disease). The latter form may develop over months or years, but in contrast to acute kidney injury is not usually reversible, and dialysis is regarded as a "holding measure" until a renal transplant can be performed, or sometimes as the only supportive measure in those for whom a transplant would be inappropriate.
There are two types of kidney dialysis available today:
- Hemodialysis
- Peritoneal Dialysis
Hemodialysis
Hemodialysis is a treatment for kidney failure. Normally, the kidneys work to filter the blood and remove waste and excess salt and water. Kidney failure, also called “end-stage renal disease,” is when the kidneys stop working completely.
Below video in YouTube provides a demonstration of how Hemodialysis is normally done.
With hemodialysis, a machine takes over the job of the kidneys. Blood is pumped from the body, filtered through a dialysis machine, and then returned to the body.
Where will I have hemodialysis? — Most people can choose between having hemodialysis at a dialysis center (in a hospital or clinic) or at home.
There are downsides and benefits to both options:
- If you have dialysis at a center, you will need to travel there and back. But doctors and nurses at the center can watch you closely during your dialysis.
- If you have dialysis at home, you or someone else will need to learn how to do it. You will also need special equipment and supplies. But people who do home dialysis often feel better and feel more independent and in control of their life. Also, some studies show that people who do home dialysis end up being healthier than those who get dialysis in a center.
How often will I have hemodialysis and how long does it take? — You will have hemodialysis at least 3 times a week. Your schedule will depend on where you have it:
- People who go to a center usually have dialysis 3 times a week. Each treatment usually takes 3 to 5 hours.
- People do home dialysis 3 to 7 times a week, but they have more choice with their schedule. Some people do dialysis during the day. Each treatment usually takes 3 to 4 hours. Other people do dialysis overnight while they sleep.
When will I start hemodialysis? — You and your doctor will decide the right time for you to start hemodialysis. It will depend partly on how well your kidneys work, your symptoms, and your overall health. Your doctor will do blood tests to check how well your kidneys are working.
Before you start hemodialysis, you need surgery to prepare your body. Your doctor will create an “access,” which is a way for the blood to leave and return to your body. There are 3 different types of access:
- AV fistula – This is the most common type of access.
- AV graft
- Central venous catheter
What happens during hemodialysis?
It depends on your access. If you have an AV fistula or AV graft, the doctor or nurse will put 2 needles into your arm, in your access. If you have a central venous catheter, he or she will connect the catheter tube to tubes from the dialysis machine.
During hemodialysis, blood leaves your body through the access. The blood travels through and is filtered by the dialysis machine. Then the blood returns to your body.
What problems can happen with hemodialysis? — People can have problems with their access. An access can get infected, get blocked, or stop working.
People can also have problems during dialysis treatments. These can include:
- Feeling lightheaded
- Trouble breathing
- Belly or muscle cramps
- Nausea or vomiting
Let your doctor or nurse know if you have any problems. Many of them can be treated.
Is there anything else I should do?
Yes. If you get dialysis on a regular basis, you will need to:
- Take care of your access – Wash your access with soap and warm water every day and before each dialysis treatment. Don’t scratch or pick at the area. Don’t let anyone use that arm to take blood or measure blood pressure.
- Check your access every day – When your access is working normally and blood is flowing through it, you can feel a vibration over the area. Let your doctor or nurse know if you don’t feel a vibration.
- Weigh yourself every day – When your kidneys don’t work, fluid collects in your body. Let your doctor or nurse know if you gain more weight than usual between dialysis treatments.
- Follow a special diet – You will need to limit the amount of fluids you eat and drink. You might also need to avoid foods with a lot of sodium, potassium, and phosphorus. These are minerals that can build up in your body if you have kidney problems.
Can I travel if I get dialysis? — Probably. If you do home dialysis, you might be able to take your machine with you. If you get dialysis in a center, you will need to find a dialysis center in the place that you want to visit.
Peritoneal Dialysis
Peritoneal dialysis is a procedure that involves piping a special fluid into the belly. This fluid collects waste and excess salt and water from the blood. Then the used fluid drains out of the belly. This is a procedure which can be done at home but it has to be done every day.
The below YouTube video provides a demo of how Peritoneal Dialysis works.
When will I start peritoneal dialysis?
You and your doctor will decide the right time for you to start. It will depend partly on how well your kidneys work, your symptoms, and your overall health. Your doctor will do blood tests to check how well your kidneys are working.
Preparation for Peritoneal Dialysis
Before you start peritoneal dialysis, you need surgery to create a way for the fluid to get in and out of your belly. The doctor will put a thin tube (called a “catheter”) in your belly. One end of the tube stays in your belly. The other end stays outside your body. It takes about 2 weeks for your body to heal with the tube in it before you can start dialysis.
You will also need to learn how to do peritoneal dialysis. A nurse will teach you (or a family member, if he or she will do it) how to set up and use the equipment.
How often will I do peritoneal dialysis and how long does it take?
Your schedule depends on the type of peritoneal dialysis you do. There are 2 types of peritoneal dialysis:
- Continuous ambulatory peritoneal dialysis (CAPD) – CAPD is done all day and night. People do the exchanges themselves. People usually do 3 to 5 exchanges during the day and do a dwell overnight. Each daytime exchange takes about 30 to 40 minutes.
- Continuous cycling peritoneal dialysis (CCPD) – For CCPD, a machine does the exchanges. CCPD is usually done overnight.
Most people can choose the type of peritoneal dialysis they have. Talk with your doctor about which type of peritoneal dialysis is best for you.
What problems can happen with peritoneal dialysis?
Problems that can happen with peritoneal dialysis include:
- An infection of the skin around the tube – An infection can cause the skin to become red, painful, or hard. Pus might also drain from the area. Treatment usually includes antibiotic medicines or creams.
- An infection inside the belly (called “peritonitis”) – Peritonitis can cause belly pain, fever, nausea, or diarrhea. It can also cause the used fluid to look cloudy. Treatment usually includes antibiotics that go into the belly with the dialysis fluid.
- A hernia – A hernia is when a belly muscle becomes weak. It causes an area of the belly to bulge out. It usually doesn’t hurt. A hernia is treated with surgery.
Call your doctor or nurse if:
- The skin around your tube gets red, painful, or hard, or pus drains from it.
- You have belly pain, fever, or the used dialysis fluid looks cloudy.
- A part of your belly bulges out.
- Is there anything else I should do?
Yes, you will need to:
- Weigh yourself every day – You need to use your weight to figure out each day’s dialysis treatment
- Take care of the skin around your tube – Every 1 to 2 days, wash the area carefully, pat it dry, and put an antibiotic cream on it. Keep the area covered with gauze and tape. Tell your doctor or nurse if you injure the area or if the tube moves out of place.
- Follow a special diet – You might need to limit the amount of fluids you drink and eat. You might also need to avoid foods with a lot of sodium, potassium, and phosphorous. These are minerals that can build up in your body if you have kidney problems.
