Quick Facts About Kidney Dialysis

• Type of Procedure: Non-surgical, medical procedure.
• Duration: Each dialysis session typically takes about 3 to 5 hours. It's usually done 3 times a week (for hemodialysis). Peritoneal dialysis is done more frequently, but can be done at home.
• Anesthesia Used: No anesthesia is needed for dialysis. (However, minor anesthesia may be used if a catheter is being placed.)
• Recovery Time: No major recovery time after each session, but patients may feel tired. Most people resume normal activities within a few hours after dialysis.

Types of Kidney Dialysis Procedure

The two main types of kidney dialysis are:

• Hemodialysis: In this procedure, blood is drawn out of the body, filtered through a machine (dialyzer), and then returned to the body. The dialyzer removes waste products, excess fluids, and toxins from the blood, mimicking the function of healthy kidneys.
• Peritoneal Dialysis: This type uses the lining of the abdomen (the peritoneum) as a natural filter. A special dialysis fluid is introduced into the abdominal cavity, where it absorbs waste and excess fluids. After a set period, the fluid is drained out, taking the waste with it. This process can be done manually or with a machine (automated peritoneal dialysis).

Indications for Kidney Dialysis

Kidney dialysis is recommended for individuals with severe kidney dysfunction or complete kidney failure, i.e., unable to perform their essential functions adequately.

The primary indications that require kidney dialysis include:

• End-Stage Kidney Disease (ESKD): When the kidneys have lost more than 85-90% of their function, resulting in the inability to maintain;
• Proper fluid balance
• Electrolyte levels
• Waste removal
• Acute Kidney Injury (AKI): In cases of sudden and severe kidney damage, such as due to infections, toxins, or surgery, the kidneys lose their filtration ability temporarily.
• Uremia and Symptomatic Kidney Failure: When waste products, toxins, and excess fluids build up in the blood, leading to symptoms like;
• Nausea
• Vomiting
• Fatigue
• Confusion
• Fluid overload
• Hyperkalemia (High Blood Potassium): Very high potassium can cause dangerous heart rhythm problems. Dialysis can quickly remove the extra potassium.
• Severe Fluid Retention: When the body holds onto too much fluid, causing swelling, shortness of breath, and high blood pressure.
• Metabolic Acidosis: Kidney failure can cause too much acid to build up in the body, making dialysis necessary to restore balance.
• Poisoning or Overdose: In serious cases of drug overdose or poisoning, dialysis helps remove harmful substances from the blood.
• Severe Hypertension (High Blood Pressure): Uncontrolled high blood pressure can lead to damage to the blood vessels and organs.
• Pericarditis or Cardiac Tamponade(Heart Complications): Kidney failure can sometimes cause inflammation around the heart ( pericarditis) or fluid accumulation around the heart (cardiac tamponade).

Benefits of Kidney Dialysis

Dialysis helps people with kidney failure live healthier and longer lives. It supports the body by doing the important work that damaged kidneys can no longer handle.

• Removes waste and toxins: Dialysis cleans the blood by removing waste, extra fluids, and toxins that the kidneys can no longer filter. It also helps keep important substances like potassium and sodium in balance.
• Blood Pressure Regulation: Dialysis helps manage blood pressure by removing excess fluid, which can often rise dangerously in individuals with kidney failure.
• Electrolyte Balance: Dialysis helps maintain a proper balance of electrolytes, such as sodium, potassium, and calcium, which are crucial for muscle function and overall health.
• Life-Saving Procedure: For people with end-stage kidney disease (ESRD), dialysis is often the only way to stay alive while waiting for a kidney transplant.
• Improved Quality of Life: Regular dialysis treatments help individuals feel better by reducing symptoms of kidney failure, such as fatigue, swelling, and shortness of breath.

How to Prepare for the Kidney Dialysis Process?

Preparing for kidney dialysis involves several steps to ensure a smooth and safe experience.

• Consultation: Discuss dialysis with your nephrologist to understand the procedure, benefits, and challenges.
• Choose a Dialysis Center: If undergoing hemodialysis, select a convenient center. For peritoneal dialysis, ensure you have the necessary supplies at home.
• Scheduling and Routine: Plan dialysis sessions as prescribed; hemodialysis is usually multiple times a week, while peritoneal dialysis offers flexibility.
• Medication Management: Follow your prescribed medications, and consult your nephrologist for any necessary adjustments.
• Fluid Management: Monitor fluid intake as per your dialysis type to prevent overhydration or dehydration.
• Access Care (Hemodialysis): Keep the vascular access site (fistula or graft) clean and protected.
• Create a Comfortable Space (Peritoneal Dialysis): If you're undergoing peritoneal dialysis at home, prepare a clean and organized space where you'll perform the dialysis exchanges. Have all necessary supplies within easy reach.
• Dress Comfortably: Wear loose and comfortable clothing to your dialysis sessions. If you're receiving hemodialysis, this will make it easier to access your dialysis site.
• Arrange Transportation (Hemodialysis): Plan transport if visiting a dialysis center, especially if assistance is needed post-treatment.
• Emotional Preparation: Connect with support groups, family, or friends to help cope with dialysis adjustments.

Steps Involved in Kidney Dialysis Procedure

Hemodialysis Dialysis Procedure

1. Access Placement: A vascular access is created, usually in an arteriovenous (AV) fistula, AV graft, or central venous catheter. This access allows blood to be taken out of the body and returned after filtering it.

2. Preparation and Connection:

• You'll be seated in a comfortable chair or lie on a bed.
• The dialysis machine is prepared with sterile dialysis fluid (dialysate).
• The access site is cleaned and connected to the dialysis machine via tubing.

3. Blood Filtration:

• Blood is pumped from your body into the dialysis machine, passing through a special filter called a dialyzer or artificial kidney.
• The blood is exposed to the dialysate inside the dialyzer, which helps remove waste and excess fluids.

4. Waste Removal:

• The dialyzer removes waste products and excess fluids from the blood.
• The cleaned blood is returned to your body through the same access site.
• Monitoring: During the procedure, your blood pressure, heart rate, and other vital signs are monitored regularly.
• Duration: Hemodialysis sessions typically last around 3 to 4 hours and are usually performed thrice weekly.

Peritoneal Dialysis Procedure

1. Catheter Placement: A peritoneal dialysis catheter is inserted into your abdomen, usually through a small surgical incision.

2. Filling the Abdomen:

• Dialysis fluid (dialysate) is introduced into the peritoneal cavity through the catheter.
• The dialysate stays in the abdomen for a set dwell time.

3. Exchange Phases:

• The dialysate in the abdomen absorbs waste and excess fluids from your bloodstream during the dwell phase.
• After the dwell time, the fluid is drained out of the abdomen and discarded (drain phase).
• Repeat Cycles: The exchange cycle is repeated multiple times daily and at night using an automated device (cycler) or manual bags.
• Monitoring: Your weight, blood pressure, and other parameters may be monitored to ensure proper fluid balance.
• Duration: Peritoneal dialysis can be done daily, and the frequency of exchanges depends on the specific type of peritoneal dialysis and your prescribed schedule.

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Specialists to Perform Kidney Dialysis Procedure

Several healthcare specialists are involved in kidney dialysis care. The teamwork among different experts ensures that patients receive complete and personalized treatment.

The specialists involved in kidney dialysis care are;

• Nephrologist
• Dialysis Nurse
• Dialysis Technician
• Nephrology Dietitian
• Social Worker (Gives counseling & helps with financial concerns)
• Nephrology Pharmacist
• Vascular Surgeon or Interventional Radiologist
• Transplant Surgeon
• Physical Therapist
• Psychologist or Mental Health Specialist
• Primary Care Physician

Risks and Complications of Kidney Dialysis

While dialysis is a life-saving treatment, it can sometimes lead to certain side effects and complications. Knowing these risks can help patients watch for symptoms and seek care early.

• Infection: Dialysis can raise the risk of infections. In hemodialysis, needles go into your bloodstream, and in peritoneal dialysis, a tube (catheter) is placed in your belly, which can sometimes cause an infection called peritonitis.
• Low Blood Pressure: During hemodialysis, blood pressure can drop if too much fluid is removed. This can make you feel dizzy, faint, or cause heart problems.
• Blood Clots: Blood flowing through the dialysis machine can sometimes form clots, which can block the blood flow and may need extra treatment.
• Anemia: Dialysis can lower the number of red blood cells in your body, causing anemia. This can make you feel tired, weak, and short of breath.
• Bone Mineral Disorder: Dialysis can lead to calcium and phosphate level imbalances, resulting in bone mineral disorders. This can increase the risk of fractures and other bone-related issues.
• Fluid Imbalance: Removing the right amount of fluid can be hard. Too much fluid can cause swelling and breathing problems, while too little can lead to dehydration.
• Dialysis Disequilibrium Syndrome: This is a rare but serious condition that occurs when the removal of toxins from the blood is too rapid, causing swelling in the brain, confusion, and seizures.

Recovery After the Kidney Dialysis Procedure

There are some aspects to consider to ensure your well-being and a smooth transition after each dialysis session. The nature of kidney dialysis recovery can vary between hemodialysis and peritoneal dialysis.

Hemodialysis Recovery

• Post-Dialysis Fatigue: It's common to feel tired after a hemodialysis session. It is due to the physical stress of the procedure and the fluid and electrolyte changes that occur during dialysis.
• Hydration: After hemodialysis, you might be advised to drink fluids to maintain proper hydration. However, it's important not to overhydrate, as this can lead to fluid overload.
• Dietary Considerations: Be mindful of your diet after dialysis. Depending on your treatment, you might have dietary restrictions related to potassium, phosphorus, sodium, and fluid intake.
• Monitoring Blood Pressure: Your blood pressure might be lower after dialysis. Be cautious when standing up to avoid dizziness or lightheadedness.

Peritoneal Dialysis Recovery

• Catheter Care: To prevent infection, maintain proper hygiene around the catheter exit site and clean the area as instructed by your healthcare provider.
• Dwell Time and Activity: During the dwell time, you must be careful with physical activities to avoid displacing the catheter or causing discomfort.
• Fluid Balance: Monitor your fluid intake and output, as maintaining a proper fluid balance is essential in peritoneal dialysis.
• Dietary Guidelines: Similar to hemodialysis, follow any dietary restrictions your healthcare team provides to manage electrolyte levels and fluid balance.
• Infection Prevention: Be vigilant about any signs of infection around the catheter site, and follow your healthcare provider's instructions for catheter care.

General Tips for Both Dialysis Types

• Rest and Recovery: Allow yourself time to rest and recover after each dialysis session, especially if you feel fatigued.
• Medication Management: Continue taking prescribed medications as directed by your healthcare provider.
• Communicate with Your Healthcare Team: If you experience any unusual symptoms or have concerns about your recovery, don't hesitate to contact your healthcare team.
• Follow-Up Appointments: Attend all follow-up appointments with your nephrologist or healthcare provider to discuss your progress, concerns, and potential adjustments to your treatment plan.

Lifestyle Changes After Kidney Dialysis

After starting kidney dialysis, you must make some changes to stay healthy and feel your best. Here are some important things to keep in mind:

• Dietary Modifications: Follow a kidney-friendly diet prescribed by your nephrologist or a registered dietitian.
• Blood Pressure Control: Maintain healthy blood pressure levels through medication, dietary adjustments, and lifestyle changes.
• Physical Activity: Engage in regular, moderate physical activity as your healthcare provider advises.
• Smoking Cessation and Alcohol Moderation: Quitting smoking and moderating alcohol consumption are both important for your health.
• Maintain Proper Hygiene: Keep the dialysis access site clean to prevent infections. Follow proper hand hygiene and care instructions for peritoneal dialysis.
• Care for Vascular Access (Hemodialysis): If you have an arteriovenous fistula (AVF) or graft (AVG), follow proper care guidelines to maintain its function and prevent complications.