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Dialysis

Dialysis is a procedure that involves removing waste products and fluid from the blood that are normally eliminated by the kidneys. Dialysis procedures have been performed since the mid 1940's and have been available as a routine treatment option since 1960. There are two ways dialysis can be performed:

• Hemodialysis - fluid and wastes can be removed via access to a vein
• Peritoneal dialysis - fluid and wastes can be removed via access to the abdominal cavity

Dialysis is required when 85-90 percent of kidney function is lost. Patients with acute renal failure may only require dialysis for a short period of time. However, persons with end stage renal disease will need to have dialysis treatments indefinitely, unless a kidney transplant is an option. While it does some of the work that the kidneys are no longer able to perform, dialysis is not a cure for end-stage renal disease. Dialysis, however, does serve the following important functions:

• Removes waste, salt and extra water to prevent them from building up in the body
• Keeps a safe level of certain salts and chemicals in your blood, such as potassium, sodium and bicarbonate
• Helps to control blood pressure

Hemodialysis

In hemodialysis, a machine called a hemodialyzer is used to remove waste, extra chemicals, and fluid from the blood. Access to the blood vessels is made either by the creation of an ateriovenous (AV) fistula (a surgical procedure that connects an artery to a vein in the forearm) or the insertion of a soft plastic tube (graft) to connect an artery and a vein under the skin of the forearm. Occasionally, an access is made by means of a catheter inserted into a large vein in the neck. This type of access is usually temporary, but is sometimes used for long-term treatment.

For each treatment, a needle is inserted into the access and is connected by tubing to a large hemodialysis machine which drains the blood, bathes it in a special dialysate solution which removes waste substances and fluid, then returns it to your bloodstream. Hemodialysis is usually performed three times a week and each session lasts four to five hours. During treatment you can read, write, sleep, talk, or watch TV.

Hemodialysis can be performed in a hospital-based dialysis unit, a dialysis center in the community, or even at home. When performed at home, hemodialysis is done with the help of an assistant, often a family member or friend. If you choose to do home hemodialysis, you and your assistant will have to receive special training. The frequency and duration of each treatment session depends upon:

• The amount of kidney function remaining
• The amount of fluid gained since the last treatment
• The size and weight of the individual
• The type of dialyzer used (a type of hemodialysis called high-flux dialysis may take less time)

Possible complications of hemodialysis include muscle cramps and hypotension (sudden drop in blood pressure). Hypotension may cause you to feel dizzy or weak, or sick to your stomach. Side effects can be minimized by following the proper diet and taking medications as prescribed by your physician. There are also different dialysis techniques that the nephrologist (kidney doctor) can implement to help reduce side effects, such as hypotension.

Peritoneal Dialysis