Dialysis

Dialysis is a treatment that removes the toxic wastes from the body when the kidneys fail to do this on their own. There are 2 types of dialysis:

  • Hemodialysis. Blood is pumped from the body, through a filter (dialyzer). The blood is cleaned of waste products and returned to the body. Hemodialysis is performed in a dialysis center for 3 to 4 hours, 3 times a week. Dialysis is performed through an arteriovenous (AV) access, which provides access to the blood vessel. The main advantage of hemodialysis is that no training is required of the patient. Disadvantages include potential AV access failure and lack of freedom, as you must stay relatively near a dialysis center.

  • Peritoneal dialysis. The body's own lining (membrane) is used as a filter. A fluid drains in and out of the abdomen to get rid of the body's toxic wastes. Advantages are that it can be taught to the patient and can be done at home with careful technique. It allows more freedom and less discomfort. Disadvantages include potential inflammation inside the abdomen (peritonitis) and membrane failure.

PRE-DIALYSIS

How well your kidneys are working determines when you should start dialysis.

  • As your kidney function declines, your caregiver may make arrangements for you to get an AV access or dialysis catheter placed. Your caregiver can explain this to you.

  • You may be started on a medicine to help prevent low red blood cells (anemia). Erythropoietin (EPO) is a hormone that the kidneys produce, which helps the body make more red blood cells. Red blood cells carry oxygen to your body's cells. Having enough red blood cells is important to protect the heart and maintain energy. When your kidneys stop working, they no longer make this hormone.

  • Start early to control your blood pressure. High blood pressure damages your heart, kidneys, and vessels. You may be started on some medicines to lower your blood pressure.

  • It is important for patients to exercise as much as possible.

RISKS AND COMPLICATIONS

  • High pressure may develop in your AV access. This could mean that the vessel leading from your access is narrowed, and that a repair may be needed.

  • The AV access can become clotted. A small surgical procedure may be needed to remove the clot so that the access will work again.

  • Infection is common in dialysis patients. Keep your access site clean.

AFTER DIALYSIS

  • The better your dialysis, the more waste products are removed, and the better you feel. This is known as dialysis adequacy. This is measurable. Your caregiver will help you to know your lab values.

  • When your albumin level is low, it may mean that you are not adequately cleaned (dialyzed). Albumin is a protein in the blood that is a marker of nutrition. Your albumin levels may also be low due to peritoneal dialysis, which removes this protein. In this case, you may be asked to eat more protein rich foods.

  • Some dialyzers used in hemodialysis are better matched with you than others. Your caregiver can help determine the dialyzer that works best for you.

  • Heart attacks and vessel disease are common in kidney patients. Keep your cholesterol under control. Watch your salt and fluid intake. Exercise regularly or as directed.

FOR MORE INFORMATION

National Institute of Diabetes and Digestive and Kidney Diseases: www2.niddk.nih.gov

National Kidney Foundation: www.kidney.org