Dialysis is a life-saving procedure for kidney failure patients. When the kidneys are unable to do so, it aids in the removal of waste materials and extra fluid from the circulation.
Dialysis can also help regulate blood pressure and balance minerals in the blood.
In this blog post, we will explain how each type of dialysis works, what to expect during the procedure, and what are the possible side effects.
Types of dialysis
There are two main types of dialysis: Hemodialysis and Peritoneal dialysis. Each type has its advantages and disadvantages, requiring a different procedure and preparation.
The most popular form of dialysis is Hemodialysis. It filters the blood outside the body using a device known as a dialyzer. The dialyzer functions as an artificial kidney, clearing the blood from waste and extra fluid before reintroducing it to the body.
Before starting Hemodialysis, you will need a minor surgery to create a vascular access site. This is an opening into one of your blood vessels, usually in your arm, that allows easy and fast flow of blood to and from the dialyzer.
There are three types of vascular access sites:
Arteriovenous fistula (AV fistula): A surgeon connects an artery and a vein in your arm. This creates a larger and stronger blood vessel that can withstand repeated needle insertions.
Arteriovenous graft (AV graft): If your blood vessels are too small or weak to create an AV fistula, a surgeon will use a graft (a soft, hollow tube) to connect an artery and a vein in your arm. A graft is more prone to infection and clotting than a fistula, so it needs more care and monitoring.
Central venous catheter (CVC): If you need Hemodialysis urgently or temporarily, a surgeon will insert a catheter (a long, thin tube) into a large vein in your neck, chest, or groin. A CVC is not suitable for long-term use because it has a high risk of infection and blockage.
How can hemodialysis be done?
Hemodialysis can be done at a dialysis center or at home. If you choose to do it at a dialysis center, you will have a trained nurse or technician to help you with the procedure. You will typically have three sessions per week, each lasting about four hours.
If you choose to do it at home, you will need special training and equipment, and you will have more flexibility in scheduling your sessions. You may need more frequent but shorter sessions, or longer sessions at night while you sleep.
During Hemodialysis, you will be connected to the dialyzer by two tubes: one that carries your blood from the access site to the dialyzer, and another that returns the filtered blood to your body.
The dialyzer contains thousands of tiny fibers that act as filters. As your blood passes through these fibers, waste products and excess fluid are removed by a solution called dialysate that flows in the opposite direction. The dialysate is then drained away along with the waste products and excess fluid.
Peritoneal dialysis is another type of dialysis that uses your own body as a filter. It uses the lining of your abdomen (belly) or peritoneum as a membrane to filter the blood inside your body.
The peritoneum has many tiny blood vessels that allow waste products and excess fluid to pass through it into a solution called dialysate that fills your abdominal cavity.
Before starting peritoneal dialysis, you will need a minor surgery to place a catheter (a soft tube) in your belly. The catheter will allow you to fill and drain your abdominal cavity with dialysate. The catheter will stay in place permanently unless you stop peritoneal dialysis or develop complications.
Peritoneal dialysis can be done at home or at work. You will need special training and equipment to perform the procedure safely and effectively. There are two main types of peritoneal dialysis:
Continuous ambulatory peritoneal dialysis (CAPD)
This is the most common type of peritoneal dialysis. You will need to perform four exchanges per day, each lasting about 30 minutes.
An exchange is when you drain out the used dialysate from your belly and replace it with fresh dialysate. You can do this manually using gravity bags or with the help of a device called a cycler. Between exchanges, you can carry on with your normal activities while the dialysate stays in your belly for several hours.
Continuous cycling peritoneal dialysis (CCPD)
This type of peritoneal dialysis uses a cycler machine to perform the exchanges automatically while you sleep. You will need to connect your catheter to the cycler before going to bed and disconnect it in the morning.
The cycler will perform three to five exchanges during the night, each lasting about an hour. You may also need to perform one exchange during the day to keep some dialysate in your belly.
Both types of dialysis can help you live longer and improve your quality of life if you have kidney failure. However, dialysis is not a cure for kidney disease and cannot do everything healthy kidneys can.
You will still need to follow a special diet, take medications, and monitor your blood pressure and other health indicators. You will also need regular check-ups with your healthcare provider and dialysis team.
The effectiveness of dialysis depends on several factors, such as:
- How much kidney function you have left.
- How well you follow your dialysis schedule and instructions.
- How well you take care of your access site or catheter.
- How well you manage your fluid intake and output.
- How well you control your blood sugar and blood pressure levels.
- How well you cope with the emotional and social aspects of dialysis.
Both types of dialysis come with side effects. It can also be hard to tell for sure whether a symptom is because of dialysis or the kidney failure that is also affecting the body.
Some of the most common side effects that people report include:
Low blood pressure
This can happen when too much fluid is removed from the blood during dialysis. It can cause dizziness, nausea, fatigue, and fainting. To prevent low blood pressure, you should limit your fluid intake between dialysis sessions, avoid salty foods, and report any weight changes to your dialysis team.
This can happen when there is an imbalance of electrolytes (minerals) in the blood due to dialysis. It can cause painful spasms in the legs, feet or hands. To prevent muscle cramps, you should follow your prescribed diet, avoid alcohol and caffeine, and stretch before and after dialysis.
This can happen if bacteria enter the bloodstream through the access site or catheter, or if the peritoneum gets inflamed due to peritoneal dialysis. It can cause fever, chills, redness, swelling, pain, or pus at the access site or catheter exit site.
Anaemia can cause weakness, fatigue, shortness of breath and pale skin. Anemia can be caused by kidney failure or by blood loss during Hemodialysis.
This can happen when waste products build up in the skin due to kidney failure or inadequate dialysis. It can cause dryness, flaking, rash or bleeding.
To relieve itchy skin, you should avoid hot showers or baths, use mild soap and moisturizer, wear loose-fitting clothes made of cotton or silk, and avoid scratching.
Dialysis can be costly, particularly if you don’t have enough coverage or health insurance. You should find out how much each type of dialysis costs, what is covered by your insurance plan or government program (such as Medicare or Medicaid), and what are the out-of-pocket expenses that you have to pay.
Dialysis can limit your ability to travel for work or leisure. You should plan ahead if you want to travel while on dialysis. You should find out where you can get dialysis at your destination (if possible), how much it will cost, what are the requirements for insurance or medical records, and how it will affect your schedule and routine.
Dialysis can affect your nutritional needs and appetite. You should follow a special diet that your healthcare provider or dietitian prescribes. You should limit your sodium (salt), potassium, phosphorus, protein, and fluid intake to prevent dialysis complications.
Dialysis can affect how some medications work in your body. You should tell your healthcare provider and dialysis team about all your medications, including prescription drugs, over-the-counter drugs, supplements and herbal.
When to see a doctor
Before starting dialysis, you should ask your healthcare provider and dialysis team some questions to help you make an informed decision and prepare for the treatment. Some of these questions are:
- What are the pros and cons of each type of dialysis for me?
- How will dialysis affect my quality of life and daily activities?
- How often and how long will I need dialysis?
- Where will I get dialysis and who will help me with it?
- How will I know if dialysis is working well for me?
Dialysis is a treatment that can help you live longer and better if you have kidney failure. However, it is not a cure for kidney disease, and it comes with some challenges and risks.
You should weigh the benefits and drawbacks of each type of dialysis and discuss with your healthcare provider and dialysis team about the best option for you.
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