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dialysis

Dialysis

Dialysis is a treatment which is needed when your kidneys can no longer take care of your body's needs. When the kidneys are healthy, they clean the blood. They also generate hormones that keep your bones stronger and blood healthier. When your kidneys stop functioning / fail, a treatment is needed to replace the work of the kidneys used to do, called dialysis in case you don’t have kidney transplant.

When is dialysis needed?

Dialysis is needed when you develop kidney failure of end stage -- usually by the time about 85 to 90 percent of your kidney functions are lost.

What does dialysis do?

When your kidneys fail, dialysis help to maintain the balance in the body by:

  • Removing salt, waste and extra water to prevent them from generating in the body.
  • Maintaining a safe level of important chemicals in your blood, such as potassium, sodium and bicarbonate.
  • Maintain and control blood pressure.

Is kidney failure permanent?

Some kinds of acute kidney failure can get better after treatment. In some cases, dialysis is the only needed for a short period of time in terms of acute kidney failure. Dialysis is needed for the rest of the life in the case of chronic or end stage kidney failure when our kidney cannot get better.

Are there different types of dialysis?

There are two types of dialysis - hemodialysis and peritoneal dialysis. Both types helps in filtration of blood to remove harmful wastes, extra salt, and water from the body.

What is hemodialysis?

In hemodialysis, an artificial kidney (hemodialyzer) is used for the removal of the waste and extra chemicals and fluid from your blood. An access (entrance) into the blood vessels is done by the doctor to get your blood into the artificial kidney. A minor surgery to your arm or leg is done to achieve this. Sometimes, a bigger blood vessel called a fistula is created by joining an artery to a vein under your skin. However, if your blood vessels are not adequate and big enough for a fistula, the doctor create a graft by using a soft plastic tube to join an artery and a vein under your skin.

Another way is to make an access by means of a narrow plastic tube, called a catheter, which is inserted into a large vein in your neck.

How long do hemodialysis treatments last?

The time needed for your dialysis depends on:

  • How proper your kidneys work.
  • Fluid weight gained by you between treatments.
  • Waste accumulation in your body.
  • How old you are.

What is peritoneal dialysis and how does it work?

The blood is cleaned inside the body in this type of dialysis. The access is achieved by a small surgery by placing a plastic tube called a catheter into the abdomen. The abdominal area (called the peritoneal cavity) is slowly filled with dialysate through the catheter during this treatment. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate.

What are the different kinds of peritoneal dialysis and how do they work?

There are several kinds of peritoneal dialysis but two major ones are:

1- Continuous Ambulatory Peritoneal Dialysis (CAPD)
2- Automated Peritoneal Dialysis (APD).

Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. You do this yourself, usually four or five times a day at home and/or at work. You put a bag of dialysate (about two quarts) into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange. You use a new bag of dialysate each time you do an exchange. While the dialysate is in your peritoneal cavity, you can go about your usual activities at work, at school or at home.

Risks of Dialysis

Hemodialysis :

  • Risks associated with placement of temporal vascular access (catheters).
  • Bleeding
  • Injury to neighboring structures such as artery, plura (cover of lungs) (causing accumulation of air in the cavity outside the lungs).
  • Infection
  • Accidental removal of catheter
  • Technical failure e.g. Blockage of catheter Permanent catheter :
  • Technical failure e.g. Poor quality artery or vein, Infection, Bleeding Complications from hemodialysis :
  • Fall of blood pressure
  • Cramps
  • Fever
  • Irregular heart beat
  • Other rarer complications include destruction of red blood cells (hemolysis) or lowering of oxygen in blood.

Peritoneal dialysis :

  • Technical failure (displacement of catheter or block of catheter).
  • Infections
  • Procedure risks :
  • poor drainage
  • Leck of fluid into chest or outside the peritoneal cavity infection

Alternative Procedures

Alternative to dialysis is Renal Transplant which may be advised to a patient depending upon various medical and other factors. At times the usual hemodialysis procedure may be substituted by another procedure which is carried out round the clock (CRRT) continuous renal replacement therapy.

Endourology