Dialysis

Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly. It often involves diverting blood to a machine to be cleaned.
Normally, the kidneys filter the blood, removing harmful waste products and excess fluid and turning these into urine to be passed out of the body. In case the kidneys are not functioning properly as in case of Chronic Kidney Disease, the kidneys may not be able to clean the blood properly. Waste products and fluid build up to dangerous levels in body. If Left untreated, this can cause a number of unpleasant symptoms and eventually be fatal.

Dialysis facts

• Kidney dialysis is a procedure that is a substitute for many of the normal functions of the kidneys.
• Dialysis allows patients with kidney failure a chance to live productive lives.
• There are two types of dialysis: hemodialysis and peritoneal dialysis.
• Each type of dialysis has advantages and disadvantages. Patients can often choose the type of long term dialysis that best matches their needs.

What does the patient do during dialysis?

Treatment for hemodialysis usually takes place in a hemodialysis unit. This is a special building that is equipped with machines that perform the dialysis treatment. Special equipment adds the proper materials to purified water for the dialysis machines. The dialysis unit is also the place where patients can receive dietary counseling and help with social needs.

Patients generally go to the dialysis unit three times a week for treatment. For example, the schedule is either Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday.
Before treatment, patients weigh themselves so that excess fluid accumulated since the last dialysis session can be measured. Patients then go to assigned chairs / beds. The area of the graft or fistula (the connection between the artery and vein), is cleaned thoroughly. Two needles are then inserted into the graft or fistula. One takes the blood to the machine where it is cleaned. The other needle allows blood that is returning to the patient to go back into the patient’s body.
Treatments last from 2 to 4 hours. During this time, the dialysis staff checks the patient’s blood pressure frequently and adjusts the dialysis machine to ensure that the proper amount of fluid is being removed from the patients body.
Patients can read, watch television, sleep, or do other work during treatment. On occasion, patients who are very motivated may be able to perform dialysis themselves at home in a process called home hemodialysis.

Types

There are two main types of dialysis: haemodialysis and peritoneal dialysis.

1. Haemodialysis

Hemodialysis is the most common type of dialysis and the one most people are aware of. It uses an artificial kidney, known as a hemodialyzer, to remove waste and chemicals from blood. To get the blood to flow to the artificial kidney, doctors surgically create a vascular access, or an entrance point, into the blood vessels. This vascular access will allow a larger amount of blood to flow through the body during hemodialysis treatment. Therefore more blood can be filtered and purified.

The two type of vascular access designed for long-term dialysis treatments are an arteriovenous (AV) fistula, which connects an artery and a vein and an AV graft, which is a looped tube. For short-term use, a catheter may be inserted into the large vein in your neck.

Hemodialysis treatments usually last three to five hours. The treatment is typically needed three times per week. However, hemodialysis treatment can also be done in shorter, more frequent sessions.

Most hemodialysis treatments are done at a hospital or dialysis center. The length of treatment depends on the body size and the amount of waste in the body.

The external machine used for dialysis is called as the dialysis machine and the filter used in the machine is called as the hemodialyzer and the fluid used during dialysis is called as the dialysate.

2. Peritoneal dialysis

Peritoneal dialysis uses the inside lining of the abdomen (the peritoneum) as the filter, rather than a machine. Like the kidneys, the peritoneum contains thousands of tiny blood vessels, making it a useful filtering device.

Before treatment starts, an incision is made near the belly button and a thin tube called a catheter is inserted through the incision and into the space inside the abdomen (the peritoneal cavity). This is left in place permanently.

Fluid is pumped into the peritoneal cavity through the catheter. As blood passes through the blood vessels lining the peritoneal cavity, waste products and excess fluid are drawn out of the blood and into the dialysis fluid. The used fluid is drained into a bag a few hours later and replaced with fresh fluid.

There are numerous different types of peritoneal dialysis, but the main ones are continuous ambulatory peritoneal dialysis and continuous cycler-assisted peritoneal dialysis. In continuous ambulatory peritoneal dialysis, your abdomen is filled and drained multiple times each day. Continuous cycler-assisted peritoneal dialysis, however, uses a machine to cycle the fluid in and out of your abdomen. It’s usually done at night while you sleep.

Peritoneal dialysis can be done at home. The patient is trained on how to perform the steps of the treatment.

Advantages & Disadvantages

The two techniques are equally effective for most people, but each has its own advantages and drawbacks. For example:
Haemodialysis:
Advantage: The patient will have four treatment-free days a week.
Disadvantages:
a) The treatment sessions last longer,
b) Patient needs to visit the hospital each time,
c) The diet and fluid intake are restricted and
d) The patient has to plan his/her life around these sessions.

Peritoneal dialysis:
Advantage: – It can be done quite easily at home and can sometimes be done while sleep also.
Disadvantages:
a) It needs to be done every day,
b) Infection -Peritonitis,
c) Reduction in protein levels,
d) Malnutrition and
e) Weight gain and
f) Abdominal muscle weakness.