Dialysis

Dialysis is a life-saving treatment for people whose kidneys can no longer effectively filter waste, toxins, and excess fluid from the blood. Understanding dialysis, how it works, and what to expect can help you feel more confident and prepared if you or a loved one needs this treatment.

What is Dialysis?

Dialysis is a medical procedure replicating some of the functions of the kidneys. When the kidneys cannot remove waste products, extra fluid, and toxins from the blood, dialysis helps. It also helps balance electrolytes, control blood pressure, and remove excess fluid, which can build up when kidney function is impaired.

While dialysis is not a cure for kidney disease, it can significantly improve the quality of life and extend survival in people with kidney failure.

When is Dialysis Needed?

Dialysis is typically recommended when kidney function declines to less than 10-15% of normal. This stage is known as end-stage kidney disease (ESKD) or kidney failure. However, dialysis may also be needed temporarily in cases of acute kidney injury (AKI), a sudden loss of kidney function due to illness, injury, or certain medications.

Your healthcare team will monitor your kidney function through tests such as:

• eGFR (Estimated Glomerular Filtration Rate): A measure of how well your kidneys filter blood.

• Creatinine and BUN (Blood Urea Nitrogen) levels: High levels indicate that waste products are building up in your blood.

Common symptoms that may indicate the need for dialysis include:

• Severe fatigue

• Swelling in the legs, ankles, and face (edema)

• Nausea and vomiting

• Shortness of breath

• Difficulty concentrating or confusion

Types of Dialysis

There are two main types of dialysis: hemodialysis and peritoneal dialysis. Each type has its benefits and challenges, and the right choice depends on your medical condition, lifestyle, and personal preferences.

1. Hemodialysis

Hemodialysis involves using a machine to filter blood outside the body. The blood is cleaned in a dialyzer (artificial kidney) and then returned to the body.

• How it works: A vascular access point (fistula, graft, or catheter) allows blood to flow out of your body and into the dialysis machine. The machine removes waste, toxins, and extra fluid from the blood before returning it to your body.

• Frequency: Typically, hemodialysis is performed thrice a week, lasting 3-5 hours each session. However, some patients may opt for more frequent or shorter sessions at home.

• Where it’s done:

  • In-center hemodialysis: Performed at a dialysis clinic by nurses and technicians

  • Home hemodialysis: Done at home by patient and their caregiver themselves after proper training and equipment, offering greater flexibility.

• Pros:

  • High efficiency in removing waste and fluid.

  • Mostly performed in a center by nurses and technicians.

  • Available in many healthcare facilities.

• Cons:

  • Requires regular visits to a dialysis center (if in-center).

  • It can cause fatigue, low blood pressure, and muscle cramps.

  • Risk of infection at the access site.

  • Dietary limitations as dialysis is done every other day

2. Peritoneal Dialysis (PD)

Peritoneal dialysis uses the lining of your abdomen (peritoneum) as a natural filter. A special fluid (dialysate) is introduced into your abdominal cavity to absorb waste and excess fluid.

• How it works: A catheter is surgically placed into your abdomen. Dialysate is introduced into the abdominal cavity, absorbing waste and toxins. After a few hours, the fluid is drained and replaced with fresh dialysate.

• Types of PD:

  • Continuous Ambulatory Peritoneal Dialysis (CAPD): Done manually 4-5 times daily.

  • Automated Peritoneal Dialysis (APD): Done at night using a machine while you sleep.

• Pros:

  • It can be done at home, offering more flexibility and independence.

  • No needles are required.

  • It is gentler on the body than hemodialysis.

• Cons:

  • Requires strict hygiene to prevent infection (peritonitis).

  • It may not suit everyone, especially those with prior abdominal surgery.

  • Hernias can occur requiring surgery .

Other Dialysis Options

In some cases, patients may be eligible for specialized dialysis options, such as:

1. Nocturnal Hemodialysis: A longer, slower form of hemodialysis done overnight while you sleep, either at home or in a center.

2. Daily Hemodialysis: Shorter, more frequent sessions that can improve quality of life and reduce side effects.

Living with Dialysis

Dialysis requires significant lifestyle adjustments, but with proper planning and support, many patients can continue to work, travel, and enjoy life.

Diet and Nutrition

Dialysis patients must follow a special diet to manage fluid intake and prevent complications. Key dietary considerations include:

• Limiting sodium, potassium, and phosphorus: These minerals can build up in the blood and cause problems.

• Controlling fluid intake: Too much fluid can lead to swelling and high blood pressure.

• Getting enough protein: Dialysis removes protein, so you may need to eat more high-quality protein sources.

Your healthcare team, including a dietitian, will help create a personalized meal plan.

Exercise and Activity

Staying active can help improve overall well-being and reduce some side effects of dialysis. Light activities like walking, stretching, or yoga can be beneficial, but always consult your doctor before starting a new exercise routine.

Emotional Health

Starting dialysis can be emotionally challenging. It’s normal to feel anxious or depressed. Seeking support from counselors, social workers, or support groups can help you cope with these feelings.

Potential Complications of Dialysis

1. Infections: Proper care of the access site is crucial to prevent infections.

2. Low Blood Pressure: Removing too much fluid during hemodialysis can cause low blood pressure, leading to dizziness and fatigue.

3. Muscle Cramps: Some patients experience cramps during hemodialysis.

4. Peritonitis: A potential complication of peritoneal dialysis caused by infection of the peritoneum.

5. Hernias: Increased abdominal pressure from peritoneal dialysis can lead to hernias.

Questions to Ask Your Healthcare Team

1. Which type of dialysis is best for me?

2. How will dialysis affect my daily life and activities?

3. What side effects should I expect, and how can I manage them?

4. How should I care for my dialysis access point?

5. Are there any support groups or resources available for dialysis patients?

6. Can I travel while on dialysis?

Takeaway

Dialysis is a crucial treatment for managing kidney failure and maintaining quality of life. While it requires lifestyle changes, many patients continue to lead fulfilling lives with proper care and support. Understanding your options and working closely with your healthcare team can help you make informed decisions and adapt to life on dialysis.

If you’re considering or starting dialysis, don’t hesitate to contact your healthcare providers for guidance and support.