Dialysis is a lifesaving medical treatment that takes over the essential job of filtering waste and excess fluids from your blood when your kidneys are no longer functioning properly. This article dives into the different types of dialysis, the treatment process itself, the benefits it provides, and what recovery looks like for patients.
What is dialysis?
Dialysis is a medical intervention that acts as a lifeline for individuals whose kidneys are no longer functioning adequately. These bean-shaped organs play a critical role in filtering waste products and excess fluid from the blood, which are then eliminated through urine. When kidney failure sets in, this filtration process falters, leading to a buildup of toxins and fluids in the bloodstream. Dialysis steps in to perform the essential function of cleansing the blood, mimicking the work of healthy kidneys.
Who needs dialysis?
Kidney failure, also known as end-stage renal disease (ESRD), occurs when the kidneys lose their ability to effectively filter waste and fluids from the blood. This can be caused by various factors like high blood pressure, diabetes, lupus, or even unknown reasons. While some kidney problems are temporary and improve with recovery, others develop into chronic conditions. There are five stages of kidney disease, with stage 5 being the most severe (ESRD). At this critical stage, where kidneys function at only 10-15% capacity, dialysis or a kidney transplant becomes necessary for survival. Dialysis can also serve as a bridge treatment for some patients waiting for a transplant.
What do the kidneys do?
Tucked beneath your rib cage on either side of your spine, lie two bean-shaped marvels known as your kidneys. These vital organs are part of your urinary system and act as a filtration unit for your blood. They meticulously remove toxins and waste products, keeping your blood clean and nutrient-rich. The leftover waste and excess water are cleverly transformed into urine, which then travels from your kidneys to your bladder for elimination. Moreover, your kidneys play a crucial role in maintaining healthy blood pressure, ensuring optimal blood flow throughout your body.
What are the types of dialysis?
There are two ways to get dialysis:
- Hemodialysis
- Peritoneal dialysis
Procedure Details
What is hemodialysis?
Hemodialysis offers a lifeline for those with failing kidneys. This process involves a machine that acts as an artificial kidney, or dialyzer. Blood is extracted from the body, meticulously filtered by the dialyzer to remove waste products, and then returned clean to the bloodstream. Hemodialysis is typically performed in a hospital or dialysis center three times a week, lasting 3 to 5 hours each session. However, home hemodialysis is another option, allowing for greater flexibility. With home hemodialysis, treatments may be done more frequently (4-7 times a week) but for shorter durations. This option even allows for nighttime treatments while you sleep.
What happens before hemodialysis?
Hemodialysis requires some preparation to ensure smooth access to your bloodstream. A minor surgical procedure will create a permanent access point, typically an arteriovenous fistula (AV fistula). This involves connecting an artery and vein in your arm, making them larger and easier to use for dialysis. Alternatively, an arteriovenous graft (AV graft) might be used if the natural vessels are unsuitable. This graft is a soft, hollow tube that bridges the artery and vein. Both AV fistulas and grafts allow for faster blood flow during dialysis. In urgent cases where immediate dialysis is necessary, a temporary access point may be created by placing a catheter, a thin tube, into a vein in your neck, chest, or leg. To prevent infections in any of these access points, you’ll receive training from your healthcare provider. Additionally, if you choose home hemodialysis, they will also provide instruction on performing the treatment yourself.
What happens during hemodialysis?
Hemodialysis transforms your blood’s journey during treatment.
Extraction:
Blood is extracted from your body through a needle placed in your arm.
Filtration:
This extracted blood then travels through a special filter within the dialyzer. The dialyzer acts as an artificial kidney, using a cleansing solution (containing water, salt, and other additives) to draw out waste products from your blood.
Return:
Once cleansed, the filtered blood is returned safely back into your body through a different needle in your arm.
Monitoring:
Throughout the process, the dialysis machine closely monitors your blood pressure, allowing for adjustments to the speed at which blood flows in and out of your body.
What happens after hemodialysis?
While hemodialysis offers a vital service, it can sometimes come with temporary side effects. Some people experience low blood pressure during or after the procedure, which can lead to feelings of nausea, dizziness, or even fainting. Other potential side effects include chest pain, back pain, headaches, itchy skin, muscle cramps, and even restless legs syndrome.
What is peritoneal dialysis?
Peritoneal dialysis offers an alternative approach to blood filtration, conveniently performed at home. It utilizes the tiny blood vessels within your abdominal lining, called the peritoneum, as a natural filter. A special cleansing solution, similar to the one used in hemodialysis (containing water, salt, and other additives), plays a key role in this process. Peritoneal dialysis comes in two main methods:
- Automated peritoneal dialysis: This method utilizes a machine called a cycler to automate the process of filling and draining the cleansing solution from your abdomen.
- Continuous ambulatory peritoneal dialysis (CAPD): This method involves manual exchanges of the dialysis solution throughout the day.
What happens before peritoneal dialysis?
Peritoneal dialysis requires some preparation for at-home treatment. Roughly three weeks beforehand, a minor surgery will be performed. During this procedure, a surgeon inserts a soft, thin tube (catheter) through your abdomen and into the peritoneum, the lining of your abdominal cavity. This catheter will remain permanently in place to facilitate dialysis exchanges. To ensure a smooth and safe experience, a healthcare provider will meticulously train you on performing peritoneal dialysis at home, including proper techniques to prevent infections around the catheter site.
What happens during peritoneal dialysis?
Peritoneal dialysis allows you to manage your treatment at home. Here’s a breakdown of the process:
- Filling:
A Y-shaped tube is used to connect the catheter to a bag containing dialysis solution. This solution flows through the tube and catheter into your peritoneal cavity. After about 10 minutes, once the bag is empty, the connection is removed, and the catheter is capped.
- Dwelling:
While capped, the catheter allows the dialysis solution to work its magic for 60 to 90 minutes, absorbing waste and excess fluids from your body within the peritoneal cavity.
- Draining:
After the dwell time, the cap is removed, and the other branch of the Y-shaped tube is used to drain the used solution into a separate empty bag.
- Repeating:
These steps (filling, dwelling, and draining) are typically repeated up to four times a day. For overnight, some people choose to keep the solution in their abdomen while they sleep.
- Automation Option:
For those who prefer nighttime treatment, automated peritoneal dialysis offers an alternative. A machine called a cycler automates the process of pumping the dialysis solution in and out of your body while you sleep.
What happens after peritoneal dialysis?
Peritoneal dialysis may come with a sensation of fullness or bloating in your abdomen due to the presence of dialysis solution. While this might feel uncomfortable, it’s important to remember that the treatment itself is painless. You may also notice your stomach appearing more prominent than usual when filled with the solution.
What are the potential risks or complications of hemodialysis?
Even though hemodialysis is a lifesaver, there can be occasional complications with the access point (AV fistula or graft). These can include infections, issues with blood flow, or blockages caused by scar tissue or blood clots. In rare instances, the needles used during dialysis might dislodge from your arm, or a tube might disconnect from the machine. Thankfully, there are safeguards in place. A blood leak detection system is designed to alert you or the medical staff to such problems, prompting the machine to shut down temporarily until the issue is resolved. This system plays a crucial role in preventing blood loss.
What are the potential risks or complications of peritoneal dialysis?
Peritoneal dialysis, while performed at home, also comes with potential complications. One concern is infection, particularly around the catheter insertion site. More seriously, peritonitis, a bacterial infection within the abdomen, can occur if bacteria enter through the catheter. This can cause fever, abdominal pain, nausea, and vomiting.
The process of using the catheter and filling your abdomen with fluid can weaken your abdominal muscles over time, potentially leading to a hernia. A hernia occurs when an organ like the small intestine pushes through the weakened muscles, creating a bulge near the belly button or groin. Hernias can be surgically repaired by your doctor.
Another potential side effect is weight gain. The dialysis solution contains dextrose, a sugar, which your body absorbs during treatment. Over time, this extra sugar intake can contribute to weight gain.
Recovery and Outlook
What’s the outlook (prognosis) for someone on dialysis?
Dialysis offers a lifeline for those with kidney failure, and the longevity it provides can vary depending on individual circumstances. Generally, people on dialysis can live for 10 to 20 years. However, several factors influence this outlook, including your age, overall health, the underlying cause of kidney failure, and any other health conditions you may have. Fortunately, a kidney transplant can offer a permanent solution. Once a transplanted kidney starts functioning effectively, you can discontinue dialysis treatment.
Will I have activity restrictions while I’m on dialysis?
Dialysis doesn’t have to hold you back from living a full life. Many people on dialysis manage active lifestyles, balancing work, family, and even travel. For those traveling, healthcare providers can help arrange dialysis treatments at centers near your destination. If you’re on self-dialysis (either method), you can bring dialysis solution bags and your portable home dialysis machine (if applicable) with you.
Peritoneal dialysis may require some adjustments to your exercise routine, as a full abdomen might limit certain physical activities. However, exercise is generally encouraged for people on dialysis. It’s always best to consult your healthcare provider before starting any specific activities or sports to ensure they’re suitable for you.
When to see a doctor
Difficulty urinating
Dizziness, fainting, unusual thirst (dehydration), or other signs of low blood pressure
Nausea and vomiting
Signs of infection, including fever, oozing, or redness at the AV fistula or catheter site
Severe abdominal pain
An unusual bulge in your abdomen or groin, which could be a hernia
