Dialysis

What is dialysis?

Dialysis is a treatment for people whose kidneys are failing. When you have kidney failure, your kidneys don’t filter blood the way they should. As a result, wastes and toxins build up in your bloodstream. Dialysis does the work of your kidneys, removing waste products and excess fluid from the blood.

Who needs dialysis?

People who have kidney failure, or end-stage renal disease (ESRD), may need dialysis. Injuries and conditions like high blood pressure, diabetes and lupus can damage kidneys, leading to kidney disease..

There are five stages of kidney disease. In stage 5 kidney disease, healthcare providers consider you to be in end-stage renal disease (ESRD) or kidney failure. At this point, kidneys are carrying out around 10% to 15% of their normal function. You may need dialysis or a kidney transplant to stay alive. Some people undergo dialysis while waiting for a transplant.

What do the kidneys do?

Your kidneys are part of your urinary system. These two bean-shaped organs sit below your ribcage on each side of your spine. They clean toxins from your blood, returning filtered, nutrient-rich blood to the bloodstream.

The waste and extra water make urine, which moves from the kidneys into the bladder. Your kidneys also help regulate Your blood pressure.

What are the types of dialysis?

There are two ways to get dialysis:

• Hemodialysis.

• Peritoneal dialysis.

Hemodialysis

What is hemodialysis?

With hemodialysis, a machine removes blood from your body, filters it through a dialyzer (artificial kidney) and returns the cleaned blood to your body. This 3- to 5-hour process may take place in a hospital or a dialysis center three times a week.

You can also do hemodialysis at home. You may need at-home treatments four to seven times per week for fewer hours each session. You may choose to do home hemodialysis at night while you sleep.

What happens before hemodialysis?

Preparation for hemodialysis starts several weeks to months before your first procedure. To allow for easy access to your bloodstream, a surgeon will create a vascular access. The access provides a mechanism for a small amount of blood to be safely removed from your circulation and then returned to you in order for the hemodialysis process to work. The surgical access needs time to heal before you begin hemodialysis treatments.

There are three types of accesses:

• Arteriovenous (AV) fistula. A surgically created AV fistula is a connection between an artery and a vein, usually in the arm you use less often. This is the preferred type of access because of effectiveness and safety.

• AV graft. If your blood vessels are too small to form an AV fistula, the surgeon may instead create a path between an artery and a vein using a flexible, synthetic tube called a graft.

• Central venous catheter. If you need emergency hemodialysis, a plastic tube (catheter) may be inserted into a large vein in your neck. The catheter is temporary.

It’s extremely important to take care of your access site to reduce the possibility of infection and other complications. Follow your health care team’s instructions about caring for your access site.

What happens during hemodialysis?

During hemodialysis, the dialysis machine:

• Removes blood from a needle in your arm.

• Circulates the blood through the dialyzer filter, which moves waste into a dialysis solution. This cleansing liquid contains water, salt and other additives.

• Returns filtered blood to your body through a different needle in your arm.

• Monitors your blood pressure to adjust how fast blood flows in and out of your body.

What happens after hemodialysis?

Some people experience low blood pressure during or immediately after hemodialysis. You may feel nauseous, dizzy or faint.

Other side effects of hemodialysis include:

• Chest pain or back pain.

• Headaches.

• Itchy skin.

• Muscle cramps.

• Restless legs syndrome.

What are the Potential Risks and Complications of Hemodialysis?

Most people who require hemodialysis have a variety of health problems. Hemodialysis prolongs life for many people, but life expectancy for people who need it is still less than that of the general population.

While hemodialysis treatment can be efficient at replacing some lost kidney function, you may experience some of the related conditions listed below, although not everyone experiences all of these issues. Your dialysis team can help you deal with them.

• Low blood pressure (hypotension). A drop in blood pressure is a common side effect of hemodialysis. Low blood pressure may be accompanied by shortness of breath, abdominal cramps, muscle cramps, nausea or vomiting.

• Muscle cramps. Although the cause is not clear, muscle cramps during hemodialysis are common. Sometimes the cramps can be eased by adjusting the hemodialysis prescription. Adjusting fluid and sodium intake between hemodialysis treatments also may help prevent symptoms during treatments.

• Itching. Many people who undergo hemodialysis have itchy skin, which is often worse during or just after the procedure.

• Sleep problems. People receiving hemodialysis often have trouble sleeping, sometimes because of breaks in breathing during sleep (sleep apnea) or because of aching, uncomfortable or restless legs.

• Anemia. Not having enough red blood cells in your blood (anemia) is a common complication of kidney failure and hemodialysis. Failing kidneys reduce production of a hormone called erythropoietin (uh-rith-roe-POI-uh-tin), which stimulates formation of red blood cells. Diet restrictions, poor absorption of iron, frequent blood tests, or removal of iron and vitamins by hemodialysis also can contribute to anemia.

• Bone diseases. If your damaged kidneys are no longer able to process vitamin D, which helps you absorb calcium, your bones may weaken. In addition, overproduction of parathyroid hormone — a common complication of kidney failure — can release calcium from your bones. Hemodialysis may make these conditions worse by removing too much or too little calcium.

• High blood pressure (hypertension). If you consume too much salt or drink too much fluid, your high blood pressure is likely to get worse and lead to heart problems or strokes.

• Fluid overload. Since fluid is removed from your body during hemodialysis, drinking more fluids than recommended between hemodialysis treatments may cause life-threatening complications, such as heart failure or fluid accumulation in your lungs (pulmonary edema).

• Inflammation of the membrane surrounding the heart (pericarditis). Insufficient hemodialysis can lead to inflammation of the membrane surrounding your heart, which can interfere with your heart’s ability to pump blood to the rest of your body.

• High potassium levels (hyperkalemia) or low potassium levels (hypokalemia). Hemodialysis removes extra potassium, which is a mineral that is normally removed from your body by your kidneys. If too much or too little potassium is removed during dialysis, your heart may beat irregularly or stop.

• Access site complications. Potentially dangerous complications ― such as infection, narrowing or ballooning of the blood vessel wall (aneurysm), or blockage ― can impact the quality of your hemodialysis. Follow your dialysis team’s instructions on how to check for changes in your access site that may indicate a problem.

• Amyloidosis. Dialysis-related amyloidosis (am-uh-loi-DO-sis) develops when proteins in blood are deposited on joints and tendons, causing pain, stiffness and fluid in the joints. The condition is more common in people who have undergone hemodialysis for several years.

• Depression. Changes in mood are common in people with kidney failure. If you experience depression or anxiety after starting hemodialysis, talk with your health care team about effective treatment options.

How much does dialysis cost?

All types of dialysis are expensive, but, for most patients, the federal government now pays 80 percent of all dialysis charges, while private insurance or state medical assistance pays the rest.

Peritoneal Dialysis

What is peritoneal dialysis?

With peritoneal dialysis, tiny blood vessels inside the abdominal lining (peritoneum) filter blood through the aid of a dialysis solution. This solution is a type of cleansing liquid that contains water, salt and other additives.

Peritoneal dialysis takes place at home. There are two ways to do this treatment:

• Automated peritoneal dialysis uses a machine called a cycler.

• Continuous ambulatory peritoneal dialysis (CAPD) takes place manually.

What happens before peritoneal dialysis?

About three weeks before you start peritoneal dialysis, you’ll have a minor surgical procedure. A surgeon inserts a soft, thin tube (catheter) through your belly and into the peritoneum. This catheter stays in place permanently.

A healthcare provider will teach you how to perform peritoneal dialysis at home and prevent infections at the catheter site.

What happens during peritoneal dialysis?

During peritoneal dialysis, you:

• Connect the catheter to one branch of a Y-shaped tube. This tube connects to a bag that has dialysis solution. The solution flows through the tube and catheter into the peritoneal cavity.

• Disconnect the tube and catheter after about 10 minutes, when the bag is empty.

• Cap off the catheter.

• Go about your usual activities while the dialysis solution inside the peritoneal cavity absorbs waste and extra fluids from the body. This process can take 60 to 90 minutes.

• Remove the cap from the catheter and use the other branch of the Y-shaped tube to drain the fluid into a clean, empty bag.

• Repeat these steps up to four times a day. You sleep with the solution in your stomach all night.

Some people prefer to do peritoneal dialysis at night. With automated peritoneal dialysis, a machine called a cycler pumps the fluid in and out of the body while you sleep.

What happens after peritoneal dialysis?

The liquid in your belly can make you feel bloated or full. It might feel uncomfortable, but the treatment isn’t painful. Your stomach may stick out more than usual when it’s filled with fluid.

What are the potential risks or complications of peritoneal dialysis?

• Skin infections around the catheter.

• Peritonitis: an infection that occurs when bacteria get inside the abdomen through the catheter. You may experience fever, abdominal pain, nausea and vomiting.

• Hernia: using the abdominal catheter and pumping your belly full of fluid can  weaken abdominal muscles over time. You may develop a hernia. This condition occurs when an organ like the small intestine pokes through the abdominal muscles. You may feel a bulge near the belly button or in the groin area between the abdomen and upper thigh. Your doctor can repair a hernia with surgery

• Weight gain: during peritoneal dialysis, your body absorbs dextrose, a sugar, from the dialysis solution. Over time, this extra sugar can lead to weight gain.

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