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Dialysis is a life-saving procedure aimed at mimicking the function of the kidney by removing waste products and excess fluid from the blood when this vital organ stops working properly. With chronic kidney disease (CKD) affecting approximately 10% of the global population, many progress to end-stage renal disease (ESRD), where Dialysis or Kidney Transplantation becomes essential. Most healthcare providers opt for Kidney Transplantation as it has better patient outcomes. This blog post discusses the types of dialysis and when you should undergo them.
Synopsis
When Is Dialysis Required?
Dialysis is generally advised when the kidneys lose around 85-90% of their function, or the glomerular filtration rate (GFR) is below 15 mL/min. When the kidneys reach such impairment, they cannot properly filter waste products and excess fluid in the blood, resulting in their concentration in the body. This stage is referred to as kidney failure or end-stage renal disease (ESRD).
Kidney Disease that Necessitates Dialysis
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Diabetes: Long-standing elevated blood sugar levels may lead to diabetic nephropathy, causing damage to blood vessels within the kidneys, and is the most common cause of kidney disease and dialysis.
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Hypertension: Elevated blood pressure may cause the kidneys to gradually become damaged. In many cases, this results in decreased blood flow to the kidneys, hindering them from filtering the blood.
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Systemic Lupus Erythematosus (SLE): Lupus can result in inflammation in the kidneys and a resulting condition named lupus nephritis; damage can affect kidney function, bringing about an essential requirement of dialysis.
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Acute Kidney Injury (AKI): Sudden or acute impairment of the kidney due to intense disease, severe trauma, or overdose of medicine can even bring about the acute failure of kidneys and, for some short time, permanent, requiring dialysis.
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Other: Some patients with CKD may be placed on dialysis while waiting for a kidney transplant because dialysis helps manage the symptoms and maintain health before the availability of a donor organ.
Key Signs and Symptoms Suggesting the Patient Requires Dialysis
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Fatigue
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Ammonia-smelling breath
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Loss of appetite
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Foamy urine
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Difficulty urinating or frequent urination
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Swelling of feet
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Itchiness
Types of Dialysis
There are two main types of dialysis:
Haemodialysis
Haemodialysis filters blood through a machine called a dialyser. The blood is filtered outside the body and then returned to the patient. It is a 3- to 5-hour procedure that may take place in a hospital or any dialysis centre thrice weekly.
Before the Haemodialysis Procedure
A minor surgical procedure would be needed to create some easy access to the bloodstream involving:
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Fistula or Graft Creation: Involves connecting an artery with a vein in the arm (AV fistula) or using a synthetic graft (AV graft), thereby allowing blood to flow into the dialysis equipment with adequate efficiency.
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Placement of catheter: Sometimes, dialysis access is done with a temporary catheter placed in the vein, usually in the neck or groin area.
During the Haemodialysis Process
The body's blood is drawn out through a catheter or AV fistula and passed through the dialyser machine for filtration. This filtered blood is returned to the body through another needle or catheter.
Blood pressure, heart rate, and other vital signs are monitored by the healthcare team.
After the Haemodialysis Procedure
Vital signs are carefully monitored after dialysis, as patients may experience dizziness or fatigue.
AV Fistula, AV graft, or catheter are looked for any signs of infection or bleeding.
- Peritoneal Dialysis:
This is a procedure where a patient's abdominal lining, or the peritoneum, serves as a filter to filter out waste products and excess fluids. A special fluid known as dialysate is introduced into the patient's peritoneal cavity and absorbs waste.
- Before Peritoneal Dialysis Procedure:
A catheter is implanted in the abdomen (peritoneal cavity) in a surgical procedure so that the dialysate can flow in and out of the body.
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During Peritoneal Dialysis:
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Infusion: Through the catheter, dialysis fluid is infused into the peritoneal cavity. The fluid contains dextrose or any other osmotic agent that will draw out waste and excess fluid from the blood.
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Dwell Time: The fluid is allowed to dwell in the peritoneal cavity for a set time to allow diffusion of the waste products and toxins across the peritoneal membrane.
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Drainage: The used dialysis fluid, which is filled with waste and excess fluid, is drained out and discarded.
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Types of Peritoneal Dialysis:
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Continuous Ambulatory Peritoneal Dialysis (CAPD): The manual exchanges are done 3-5 times a day and take approximately 30-40 minutes to complete.
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Automated Peritoneal Dialysis (APD): A machine does the exchange while the patient is sleeping overnight.
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- After Peritoneal Dialysis Procedure:
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Patients are monitored for signs of infection at the catheter site, such as redness and swelling.
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Proper hygiene is observed after each exchange to avoid infections such as peritonitis.
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Weight and blood pressure may be checked to ensure that the dialysis process has removed the right amount of fluid.
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Conclusion
Dialysis has a vital role in treating kidney failure. It serves as a life-saving supportive measure until the patient gets a transplant. If you or your loved one is suffering from any symptoms of renal dysfunction, consult with or expert Nephrologist, in Bhubaneswar, for detailed treatment and consultation.
FAQ's
Dialysis is advised for the following reasons:
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Removal of waste and toxins
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To maintain the electrolyte balance
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To regulate blood pressure
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Supportive treatment in patients with ESRD until a kidney transplant is done.
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Haemodialysis: Usually three times a week, with three to five hours spent in each session.
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Peritoneal Dialysis: May be performed daily, either manually (CAPD) or with a machine overnight (APD).
Dialysis is generally safe, but some common side effects may include:
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Fatigue
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Low Blood Pressure (Hypotension)
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Muscle Cramps
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Itching
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Infection
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Fatigue: Ensure adequate sleep with a regular diet.
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Low Blood Pressure: One shouldn't intake large meals or fluids during the time of treatment.
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Infections: Maintain strict infection precaution principles at access sites.
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Muscle cramps: Improve flow rate during haemodialysis.
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Dietary changes: Discuss nutritional balancing and decreasing side effects with a renal dietitian.
You can schedule an appointment at Manipal Hospitals, Bhubaneswar, by contacting us or visiting our website.
Visit: https://www.manipalhospitals.com/bhubaneswar/
Contact no: 06746666600
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