Dialysis?
What is Dialysis?
Dialysis, also known as Hemodialysis, Haemodialysis or Renal Replacement Therapy, is a procedure that is used to treat advanced kidney failure.
Dialysis can help patients maintain an active life despite kidneys that are failing.
The Greek word “Dialysis” means loosening or splitting, in other words removing excess water and toxins from the blood.
Dialysis is used in people with Acute Kidney Injury as a temporary measure, and also for people with Stage 5 Chronic Kidney disease, sometimes known as End Stage Renal Disease or End Stage Kidney Disease.
Dialysis is also commonly used when people are waiting for a Kidney Transplant.
In Australia, dialysis procedures are covered by Medicare.
What are the different types of Dialysis?
There are several different types of dialysis that remove wastes and fluid from the blood in different ways.
Hemodialysis, the most common type of dialysis, works by circulating the blood through an external filter outside the body.
A machine called a hemodialyzer removes waste, acting like an artificial kidney.
Once waste is filtered, it is then returned to the body with the help of a dialysis machine.
Before you can have dialysis, Dr Gujadhur will refer you to a vascular surgeon to create an entrance point to your blood vessels.
- Typically this can be with an Arteriovenous (AV) Fistula which is made by surgically connecting an artery and a vein. When an artery is connected to a vein, it grows thicker and wider, making it easy to place needles.
- This is generally the preferred option because it provides the optimal blood flow for dialysis, lasts longer than other points of access and is less likely to get infected or cause blood clots than other access ports.
- Option two is through a Looped Tube AV Graft. Whilst AV fistula is generally the “gold standard” access point, it takes time for the fistula to mature – sometimes four months, and some patients with ESRD may not be able to wait that long before treatment begins. Other patients may not be able to have a fistula created if veins are small or weak and up to one third of fistules do not develop properly, which makes the Looped Tube AV graft a better option. The main downsides for the graft are a higher risk of clots or infection.
- The third option is with a Vascular Access Catheter in a large vein of the neck. The catheter option is generally an option for short term use (Acute Injury) while both AV options are designed for long-term treatments.
- AV fistula patients will begin treatments eight to twelve weeks after surgery, while those who receive grafts will begin treatment within days or one or two weeks.
The second main type of dialysis is Peritoneal Dialysis, which involves surgery to implant a catheter into the abdomen.
- During your regular dialysis sessions, a special fluid that draws out waste will flow through to the Peritoneum (a membrane in the abdomen).
- The waste is then drained from the abdomen.
- This process takes several hours and needs to be repeated multiple times a day, however the fluid exchange can be done while sleeping or awake.
Other treatments in the PD category include:
- Continuous Ambulatory Peritoneal Dialysis or CAPD must be performed when you are awake, needs to be performed several times a day and doesn’t require a machine.
- Automated Peritoneal Dialysis (APD) which uses a machine to cycle fluid out of the abdomen generally once daily while you sleep.
A third short term dialysis process, generally for people with Acute Kidney Injury is Continuous Renal Replacement Therapy (CRRT), also known as Hemofiltration. This is performed in an Intensive Care setting and a machine passes blood through tubing, removing waste, fluid and toxins.
- The blood is then returned to the body with replacement fluids and this procedure is performed sometimes 12-24 hours every day for several days.
How often do I need dialysis and how long does each session take?
- Hemodialysis treatment needs to be performed three times a week, generally for 3 to 5 hours each time.
- The procedure is generally performed in a hospital or dialysis centre. After extended treatments your doctor may feel that you are ready for dialysis at home, which is more often the case for people who require longer term treatment.
- Whilst you are having treatment you can watch TV, read or if in a centre or hospital talk to your neighbours.
Which type of dialysis is best for me? PD v Home Hemodialysis V In Centre?
Every patient is different and the type of dialysis you choose is something that will be discussed carefully with Dr Gujadhur and your treating team.
There may be medical, social or other reasons why one type of treatment is not ideal for you.
- In a nutshell, PD patients have more flexibility and it’s easier to travel, no machine or needles are required and there may be less dietary and fluid restrictions.
- The downsides of PD mean there are no days off, a catheter may affect body image, swimming is limited and there is greater potential for weight gain due to sugar in the dialysis fluid.
- The pros of Home Hemodialysis are that studies show home dialysis 5-7 times a week has improved outcomes in terms of long term survival, the treatment can be done in the comfort of home with no need to travel, and there is a greater sense of “control” over your illness.
- The downsides are that a dialysis partner must be present during treatments (which may mean time off work); a space at home needs to be dedicated to the machine and there are no medical professionals at home to monitor treatment (although you can call the centre).
- The benefits of In-Centre Hemodialysis include the reassurance of medical staff performing all aspects of the treatment; and developing relationships with other patients who understand the journey you are on.
- The disadvantages of In Centre dialysis are thrice weekly travel, less privacy; loved ones can’t be with you during treatment, and the times are scheduled by the centre so there’s less flexibility.
What are the side effects of Dialysis Treatment?
Whilst dialysis can prolong life for many, some side effects may occur.
While most of these can be managed with your treating team it’s important to speak to your doctor about any of the following:
- Blood pressure changes. Dialysis can cause a drop in blood pressure (Hypotension) especially if there is diabetes involved. Raised blood pressure (Hypertension) may also be a side effect.
- Abdominal cramps, nausea, vomiting and muscle cramps are also side effects of dialysis.
- Itching and sleep problems often due to Restless Legs are common side effects.
- Fluid overload is a serious side effect. Since fluid removal is required during the procedures, 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).
- Other more serious side effects include inflammation of the membrane of the heart (Pericarditis), high potassium that can impede heart function, and an infection at the access site.
- Depression and mood changes, such as irritability, sadness and loss of interest in things people normally enjoy are not uncommon during dialysis, but can be well managed with medications, exercise and psychotherapy.
Outside of the actual treatment what else should I do?
If you require dialysis, it’s important to stick to the treatment protocol, eat a low salt diet, keep drinking to a minimum, implement fluid restriction protocols and not smoke.
Dialysis is a serious responsibility and you will work together with Dr Gujadhur and a multidisciplinary team of nurses, dietitians and your GP so you do not have to shoulder this responsibility alone. Quite often dialysis can be done at home.