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Dialysis

Listed below is the step by step procedure of dialysis:

1. What is Dialysis?
2. Why is Dialysis Required?
3. Pre-operative Preparation
4. Day Before Surgery
5. Procedure Day
6. Methods/Techniques of Dialysis
7. Post Procedure
8. Risks and Complications
9. FAQs

What is Dialysis?

A process in which removal of toxic wastes and excessive fluids from the human body is carried out in conditions where kidneys are not able to function in proper manner is known as dialysis. 

Kidneys are a pair of organs, situated at either side of the spine. In normal conditions, kidneys carry out the functions of removing waste materials from the body and these waste materials get out of the body through urination.

Dialysis performs the most important function of kidneys, which is to excrete all wastes outside the body. Therefore this process is also known as renal replacement therapy.

Why is Dialysis Required?

When kidneys of the patients stop working properly and are not able to filter the waste materials from the body, waste materials start getting accumulated in the body. This is very dangerous and can cause severe complications. When kidneys get damaged to severe extent and there is kidney failure, dialysis is the preferred approach. Because of kidney failure, blood does not get filtered properly which causes serious side effects. When kidney diseases are left untreated, they lead to severe complications and eventually cause kidney failure. Dialysis process helps in removing unwanted materials and fluid before failure of kidneys takes place in severe kidney damage patients.

Pre-dialysis Procedure

Once it is decided to undergo dialysis procedure, surgeon schedules everything related to the process. Preoperative tests need to be carried out for proper patient health check up. It helps in understanding the conditions of kidneys.

An anesthesiologist needs to study health details of the patient undergoing dialysis process. Given below is the list of tests required to be performed prior to the dialysis process.

• Chest X-ray
• EKG to check heart rhythm
• Blood tests
• Vein mapping in noninvasive way for veins to be used for hemodialysis process.

Patients need to inform the surgeon about any previous surgery they underwent. If any pacemaker is inserted, this needs to be reported as well. Since such information is of great importance from the point of interference in dialysis process, patients need to be aware about it.

It is sometimes dangerous to become pregnant while on dialysis treatment for the health of mother and baby. Successful pregnancy is possible while females are on dialysis, but there needs to be continuous close monitoring at a dialysis unit. In such cases, frequent and long duration of treatment sessions are required. It is recommended that female patients undergoing dialysis need to discuss the plan of pregnancy with their doctors. This helps in avoiding complications.

Day Before Dialysis

A day before dialysis, all records of tests and medication history of the patients need to be organized and kept handy. This helps during the dialysis process and reduces chances of complications during and post surgery. All instructions regarding eating and drinking restrictions are given by the surgeon to the patients to avoid complications during surgery. If not followed, there can be obstruction or delay in the dialysis process.

Procedure Day

Few hours before surgery, patients need to follow eating and drinking restrictions as mentioned earlier. When the patient arrives at the hospital, he or she will be given a gown to wear. Personal belongings, such as jewelry, contact lenses and other valuables need to be kept away before surgery. It is advised not to bring valuables at the hospital if possible.

Basic testing, such as temperature, body weight, breathing rate, pulse and blood pressure of the patient needs to be checked by the nurse prior to surgery. The blood is collected from the arm of the patients and checked for kidney functioning as well as for knowing red and white blood cell count. A consent form needs to be signed prior to the surgery by the patients. This gives an authority to perform the operative process to the surgeon.

An intravenous (IV) line is initiated in the arm of the patient for the provision of medications and other necessary fluids during and after the dialysis process. The provision of fluid helps the patient by preventing them from dehydration. This is why patients can find these IV lines after waking up post-dialysis process. Family and close relatives remain with the patient for moral support in most of the cases. This helps in making the patient more comfortable.

Testing for suitability for anesthesia is carried out by an anesthesiologist for avoiding complications.

Rhythm of heart is monitored prior to the dialysis to prevent the heart complications. A subcutaneous injection of heparin ( a blood thinning agent) needs to be given to the patients for prevention of blood clots in the legs during dialysis process. This injection is also given after the completion of surgery for the same purpose. During the entire process of dialysis, monitoring of breathing rate, heart rate and blood pressure is carried out by the the anesthesiologist.

A dose of antibiotics is given to these patients by intravenous route for preventions of incision related infections.

After anesthesia, patients will be subjected to dialysis process by the surgeon.

Methods/Techniques of Dialysis

Two main types of dialysis are there.

1. Hemodialysis: It involves diversion of blood to an external instrument while it is getting filtered prior to its return into the body.
2. Peritoneal dialysis: This method involves pumping of dialysis fluid into the abdominal space for getting waste materials discarded from the blood traveling through vessels.

Hemodialysis

In most of the patients, three sessions of hemodialysis in a week are carried out. Each session can be of four hours approximately. This process is carried out in the hospital, or at home when patients are trained to carry out dialysis on their own.

Insertion of two thin needles is carried out into AV fistula and taped in place. Removal of blood is carried out slowly with the help of one needle and transferred to a dialysis machine called dialyzer.

This dialysis machine consists of a special kind of liquid called dialysate and a series of membranes which work as a filter. These membranes help in filtration of waste materials from the blood of the patients. Later, these materials travel into the dialysate fluid.

This used dialysate fluid is removed out of dialysis machine and filtered blood gets traveled back into the body with the help of another needle. The process of hemodialysis is not painful in general. Some patients feel dizziness and sickness and can experience muscular cramps while going through hemodialysis. Rapid changes in blood fluid levels during hemolysis treatments lead to such muscular cramps. On completion of dialysis treatment, removal of needles is done and for prevention of bleeding, plaster is applied at the site of needle insertion. Patients can go home soon after completion of dialysis. Hospitalization is based on the overall health of the patients.

Peritoneal Dialysis

Two main types of peritoneal dialysis are used for carrying out dialysis process.

1. Continuous ambulatory peritoneal dialysis (CAPD): In this type of dialysis, the blood of the patients is filtered many times in a day.
2. Automated peritoneal dialysis (APD): In this dialysis type, filtration of the blood is carried out during the night while patient is sleeping.

Both types of peritoneal dialysis can be carried out at home when patients are trained to perform dialysis on their own.

Continuous Ambulatory Peritoneal Dialysis (CAPD)

In CAPD, a special equipment for performing dialysis is used. This equipment consists of a bag with dialysate fluid, an empty bag for collection of waste products and a series of tubings and clips for making both bags secure. This can be done by connecting these bags to a catheter.

During CAPD process, a bag of dialysate fluid is connected with the catheter in the abdomen of the patients. This helps in getting fluid into the peritoneal cavity and stay there for few hours. Waste materials and excess body fluids are removed out of the blood through the peritoneal cavity lining while the dialysate fluid is left in the peritoneal cavity.

After few hours, old fluid gets drained into the bag kept for waste collection. New fluid is passed to the peritoneal cavity of the patients for replacing with old one and allowed to stay there until the next treatment session. The process of fluid exchange is less painful and for completion, approximately 30-40 minutes are required. Though there is less pain involved, initial discomfort can be experienced by the patients. During sessions of dialysis, disconnection of bags is carried out. The catheter ends need to be sealed properly.

Automated Peritoneal Dialysis (APD)

A bag attached with the automated peritoneal dialysis machine (APD) is filled with dialysate fluid before patient goes to the sleep. When patient is in sleep, various fluid exchanges are carried out by APD machine automatically. This process takes 8-10 hours in general. After completion of the treatment, some amount of dialysate fluid remains in the abdomen of the patient. This fluid gets drained in next session of the treatment. If patient needs to go to the toilet, there can be an interruption in the process of fluid exchange during the night. In some cases, there is a concern about danger associated with the power cut during an APD. It is considered safe even if the patients miss exchange of fluid worth of one night since treatment gets resumed within 24 hours. For technical emergency issues, patients can contact their medical team. It is advised to report unusual problems as soon as possible to avoid further risks and complications.

Post Procedure

For patients undergoing dialysis, diet and fluid restrictions are required to be followed. The quantity of fluids patients can drink is restricted since dialysis machine is not able to remove excess fluid worth of two to three days. Build up of excess fluid in the blood, lungs and other tissues may lead to severe complications. Based on the size and weight of the patients, amount of fluid intake is decided by the doctors. In most of the patients, 1000-1500ml of fluid per day is allowed. Diet of these patients needs to be carefully planned since consumption of minerals can increase the risk of mineral accumulation into the body. Patients are referred to the dietitian for better diet planning suitable while undergoing the dialysis process. It varies from patient to patient. Avoidance of potassium and phosphorus containing foods is recommended for these patients. Reduction of salt intake is also advised to avoid complications.

Risks and Complications

There are risks and side effects of hemodialysis as well as of peritoneal dialysis. Given below are the side effects of dialysis process.

Patients can feel exhausted and tired all the time as a side effect of long term dialysis. Most of the times, fatigue is caused as a result of loss of kidney functioning, dietary restrictions of dialysis process and overall stress while going through the process of kidney failure. Patient needs to inform the surgeon about their energy levels based on fatigue experience. Surgeon can recommend diet with high energy and exercise can be recommended.

Low-to-moderate exercise can be suggested based on overall health of the patient after dialysis.

Side Effects for Hemodialysis

• Sepsis

  Patients undergoing hemodialysis process are more prone to develop sepsis blood poisoning. Bacteria enter at this stage into the body of these patients and spread throughout the body. This leads to multiple organ failure. Dizziness and high temperature are the warning signs of sepsis. Upon noticing any such symptoms along with other unusual symptoms, patients need to inform dialysis surgeon. Timely treatment helps in reducing severity of complications. Once sepsis is developed, antibiotic therapy is recommended.

• Low Blood Pressure

  Hypotension or low blood pressure is a commonly observed side effect of hemodialysis process. It occurs as a result of reduction in the levels of fluid while dialysis process is going on. As a result of low blood pressure, nausea and dizziness can be experienced by the patients. For persistent symptoms, patients need to consult with the surgeons. It can help in early recovery process.

• Muscle Cramps

  Muscle cramps can be experienced by the patients undergoing dialysis process; especially in the lower legs. This occurs as a result of reaction of muscles to the loss of fluids happened in the dialysis process. In case where extremely painful muscle cramps are experienced by the patients, timely reporting to the surgeon is very essential.

• Itching of the Skin

  Itchy skin can be experienced by the patients undergoing dialysis process. It happens due to build up of minerals during sessions of dialysis in the body of the patients. Doctors can recommend moisturizing and smoothening creams for getting relief from itching.

• Fluid Overload

  As a result of kidney dialysis, there can be fluid overdose in patients. To avoid this, patients need to consume a fixed quantity of fluid.

• Other Side Effects

  There are some other side effects of hemodialysis process. These are listed herewith.

  1. Dryness of mouth
  2. Anxiety
  3. Insomnia (difficulties in sleeping)
  4. Loss of sex drive
  5. Erectile dysfunction

Side Effects For Peritoneal Dialysis

• Hernia

  Patients going through peritoneal dialysis are more prone to get affected by hernia. This happens due to holding of fluid in the peritoneal cavity for longer time. As a result of this, strain on the muscles of abdomen gets increased. Appearance of lump is a prime sign of hernia development in the body. This lump can be painless and can be detected only after detailed check-up. This condition of hernia needs to be treated by surgical process. A synthetic mesh can be used for strengthening of abdominal wall.

• Weight Gain

  Sugar molecules are present in the fluid used while performing peritoneal dialysis. Some of these get absorbed in the body during the process of dialysis. This causes increase in calorie intake of the patients. Weight gain occurs due to ignorance of daily calorie consumption. For patients with a concern of weight gain, doctors can suggest diet and exercise plan.

  Patients need to avoid fad diets which claim to reduce weight. Extreme dieting can upset the chemistry of body and may lead to various disorders.

• Peritonitis

  Peritonitis is a bacterial infection of peritoneum. This occurs as a side effect of peritoneal dialysis process. It can happen when equipment used for dialysis is not in clean condition. Bactria present on the dialysis equipment spread to the peritoneum of the patients and it gets infected. It is advised to keep the dialysis equipment clean and hygienic to avoid developing infections. Antibiotic treatment needs to be used for peritonitis. In patients with recurrence of such infections, dialysis needs to be switched to hemodialysis process.

FAQs

1. Can patients travel while they are on dialysis?

   A. It is possible to travel while patients are under dialysis treatment, provided they ensure that they have enough dialysis medication and access to dialysis. With proper precautions, patients can travel without any issues.

2. How long hemodialysis treatment can work?

   A. For how long hemodialysis treatment can work is decided based on various factors. These factors are listed below.

   • Working capacity of kidneys of the patients
   • Quantity of waste material in the body of the patients
   • Type of artificial kidney used
   • Amount of fluid weight gain by the patient during treatment
3. Is it true that failure of kidneys is permanent? Is dialysis only option for it?

   A. In most of the cases, kidney failure is permanent but this is not the case always. Acute kidney failure gets treated well in most of the patients and dialysis is required for some time only. Once kidneys get recovered, no dialysis is required in most of the patients. In case of chronic kidney failure or end stage kidney failure, there are no possibilities of kidney recovery and dialysis is the only option of treatment. This needs to be done for rest of the life of the patient. In extremely severe conditions, kidney replacement with donor's kidney needs to be carried out.

4. Is process of kidney dialysis uncomfortable?

   A. Yes, in some patients, discomfort is experienced due to the process of kidney dialysis compared to other. The process of dialysis as such is painless still there can discomfort as a result of needle insertion in some cases. Drop in the blood pressure, stomach upset, headache, cramps and vomiting can be experienced by some patients, With frequent sessions of the treatment, these symptoms disappear and recovery become faster.

5. What is the required frequency of the dialysis treatment?

   A. Dialysis needs to be carried out three times a week in general.

6. What is success rate of the dialysis?

   A. Success rate of the dialysis is based on the extent of kidney damage and overall health of the patients. Unless patients are advised to undergo a kidney transplant process, they need to be treated with the dialysis process for kidney failure. Expectancy of life is decided as per the medical conditions and treatment received by the patients. Average patient can survive for 5 to 10 years after dialysis. There are many examples of patients who have survived for more than 20 years. Patients need to follow healthy lifestyle while on dialysis. This helps in increasing their quality of life.

7. What is the impact of dialysis on having children?

   A. It is possible for male patients on dialysis to be fathers successfully. But in female patients, there is a lot of pregnancy stress on the body. Kidney failure and pregnancy together can be troublesome for the health of both; the baby and pregnant woman. Also it can worsen the kidney disease. Patients need to discuss with the dialysis surgeon prior to pregnancy planning. This helps in preventing complications associated with pregnancy.