Dialysis: Procedure and Types toxic material

September 17, 2021
Background 
The kidneys are located on either side of your spine, just below your ribs. They are vital for removing toxic waste material and extra fluid from your body in the form of urine. They make sure that your body has the right fluid and electrolyte balance, that your blood is clean, and that your blood pressure is controlled. Additionally, they produce hormones to keep your bones strong and to keep your red blood cell count in a normal range. 
Conditions like obesity, high blood pressure, and diabetes can impact your kidney function and can lead to chronic kidney disease. In this condition, the kidney is unable to remove excess water and toxic material from the body efficiently. 

What is dialysis?
Dialysis is a procedure used to filter waste material, extra fluid, electrolytes, etc., from your blood using a machine or your abdominal lining. 

Types of Dialysis

There are two types of dialysis:

Haemodialysis: 
In haemodialysis, you are connected to a hemodialyzer (also called an artificial kidney), which removes extra fluids and toxic waste substances from your blood. Vascular access is created so that blood from your body flows continuously into the dialysis machine and back to your body. Vascular access can be established using:
  • An arteriovenous (AV) fistula:  Your artery is connected to your vein in the arm region surgically. This method provides good blood flow and is the preferred form of access for long-term haemodialysis. 
  • An AV graft, much like AV fistula, is a plastic tube that connects an artery to a vein in certain circumstances when the patient’s blood vessels are not strong enough to create an AV fistula. This can also be used for long-term haemodialysis. 
  • A venous catheter is usually placed into a vein in your neck, chest, or groin, and is used for short-term haemodialysis as this type of access carries a high risk of infection.
After establishing vascular access, your doctor will insert two needles (called arterial needle and venous needle) into the vascular access. One needle is used to carry blood from the body to the dialyzer (a filter that filters your blood), while the other brings back the filtered blood to your body.
You can get haemodialysis done at the comfort of your home or a dialysis centre. In either case, you will be monitored by a well-experienced health care worker. Haemodialysis at a dialysis centre is most commonly done thrice a week and each session lasts for 3 - 5 hours long. When done at home, it is usually 3 - 6 times a week and each session last for 3 - 10 hours. 

Advantages: 
Haemodialysis allows you to lead a normal and active life 
It controls your blood pressure and maintains the proper balance of fluid and electrolytes (for example: potassium and sodium). 
No workload for the patient. The patient must come to the centre for dialysis

Possible side-effects:
Some patients may experience one or more of the following side effects after undergoing dialysis. These may include:
  • Low blood pressure
  • Muscle cramps
  • Itching
  • Nausea and vomiting
  • Headache
  • Restless leg syndrome i.e., you will have an uncontrollable urge to move your legs 
  • Swelling, bleeding, or infection at the blood access site

Less commonly:
  • Pain in your chest or back
  • Confusion 
  • Blurry vision
  • Seizures
  • Patients are monitored very closely for complications on haemodialysis and the prescription can be adjusted to minimize these.

Peritoneal dialysis

In peritoneal dialysis, the lining of your abdomen (also called the peritoneal membrane) is used to filter your blood. There are 2 types of peritoneal dialysis, namely:
  • Continuous Ambulatory Peritoneal Dialysis (CAPD): A catheter is surgically placed inside your abdomen. A special fluid called the dialysate is infused into your abdominal cavity (also called the peritoneal cavity) through the catheter.  This fluid bathes the blood vessels of the abdominal cavity and draws waste products and excess water out of these blood vessels. This abdominal fluid is then drained out into a bag and is discarded. This procedure must be done 3 - 5 times/day, and since it does not involve any machines, you can do your regular activities while undergoing CAPD. 
  • Continuous Cycling Peritoneal Dialysis (CCPD): This requires a special machine called a cycler, which fills and removes dialysate from your body. The procedure can be done overnight usually every night.

Advantages:
  • Compared with haemodialysis, CAPD offers greater flexibility. You can go to work or travel more easily.
  • Fewer dietary restrictions
  • Easier to tolerate for patient with certain heart conditions than haemodialysis

Possible side effects: 
  • Infection at the point of entry of the catheter into the abdomen, or in the lining of your abdomen
  • Weight gain
  • Holding fluid for long periods may strain your abdomen muscles and cause a hernia. 

Frequently Asked Questions

What are the signs and symptoms of kidney failure or chronic kidney disease?
  • The signs and symptoms of kidney failure or chronic kidney disease may include:
  • Nausea, or vomiting
  • Swelling or oedema around your ankles and legs
  • Fatigue
  • Dry and itchy skin
  • Frequent urination

When do I need dialysis?
Over time, when your kidneys lose their ability to function effectively, electrolytes such as phosphorus, potassium, and acids; waste by-products of metabolism, and fluid begin to build up in your blood which can lead to life-threatening complications. At this stage, based on your overall health, and the severity of your symptoms, your doctor will recommend dialysis or kidney transplantation. Kidney transplantation is considered the better option for most patients.  Those patients who are not considered candidates for transplant or who do not have donors for transplant are maintained on dialysis.

Can dialysis cure my kidney disease?
No. Dialysis can only perform the work of your kidneys and does not necessarily cure your kidney disease. Until you can find a suitable match for kidney donation, dialysis will help you to lead a normal and comfortable life. 

How long can I live on dialysis?
Based on your overall health conditions, you can survive for about 5-10 years on dialysis. Some have gone to live up to 20 years and even 30 years on dialysis.  

Can I lead a normal life after dialysis?
Yes. You can lead a normal life and do your everyday activities after dialysis. 

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