Hemodialysis

Overview

Hemodialysis is done when your body needs to filter the waste, salts, and fluid from the blood. The function is ideally performed by the kidneys, but when the kidneys don’t function adequately the waste and the toxins build up in the blood. 

The process of hemodialysis is used to treat advanced stages of kidney failure and helps to control blood pressure levels and maintain the balance of electrolytes like potassium, sodium, and calcium in the body and is started before the kidneys stop functioning totally to avoid complications. The treatment is not a cure for kidney failure but it does enable a person to live a better life.

During the treatment the person strictly needs to adhere to the treatment schedule, ensure that they take their medications on time, and modify their diet as per the doctor’s instructions. The person undergoing hemodialysis is required to closely work with the healthcare team.

When Does A Person Require Dialysis

There are five stages of kidney disease, and the doctor considers hemodialysis in the end stage when the kidneys function only 10 to 15 % of their capacity. Hemodialysis is done to keep the kidney alive.

The doctor considers the following factors before starting hemodialysis for a person:

• The overall health condition of the person.
• How their kidney is functioning.
• Does the person have any severe symptoms?
• How is the quality of life of the person?
• What does the person prefer?

The symptoms of kidney failure include:

• Nausea.
• Vomiting.
• Swelling in the body.
• Tiredness.

If the person shows the above symptoms, the doctor relies on the estimated glomerular filtration rate(eGFR) to check what is the level of kidney functioning. The test includes checking the blood creatinine along with the age, gender, etc of the person. The test results assist the doctor in formulating the treatment and if the person requires hemodialysis or not.

What Are The Causes Of Kidney Failure

• If a person has diabetes.
• If they have high levels of blood pressure.
• There is inflammation in their kidneys called glomerulonephritis.
• If the person is suffering from polycystic kidney disease which means, there are cysts in the kidney.
• If the person has any inherited kidney diseases.
• If there is a prolonged intake of nonsteroidal anti-inflammatory drugs or other medicines that cause harm to the kidneys.
• A person’s kidneys may stop functioning after a severe ailment like a complicated surgery or a heart attack.

People with chronic kidney disease may choose maximum conservative management or palliative care which involves the management of complications like fluid overload, hypertension, and anemia. Some people may also be advised a kidney transplant depending on their condition. However, they may require dialysis till they find a donor.

The Procedure Details Of Hemodialysis

Hemodialysis involves the use of a machine that removes the waste from a person’s body and runs it through a filter called a dialyzer which works like an artificial kidney. The filtered blood is then put back into the body. The entire process takes around three to five hours and may be required three times a week.

Hemodialysis can be done at home too but the frequency of the treatment increases.

Before hemodialysis, the doctor is required to make a minor incision to access the bloodstream in the body. There are two types of incisions made:

Arteriovenous fistula (AV fistula) involves the surgeon connecting an artery and vein in the person’s arm.

Arteriovenous graft (AV graft) includes the doctor using a graft that is a tube to connect the artery to the vein. This is required when the artery or the vein is too short.

Both procedures include enlarging the artery and the vein which makes dialysis easier due to the quicker flow of blood. However, if the dialysis needs to happen very quickly then a catheter is placed in the vein of the neck, chest, or leg of the person for temporary access.

During the process, the dialysis machine takes blood from the person’s arm with the help of a needle. The blood is sent to the dialyzer which filters the waste and puts it into a dialysis solution. This fluid acts as a cleanser and contains water, salts, and other additives. The filtered blood is then sent back to the body with the help of a different needle through the arm of the person.

Throughout the process, the machine monitors the blood flow and the pressure of the person.

After hemodialysis, some people may experience low blood pressure levels that cause nausea and dizziness.

The procedure may also cause chest or back pain, headaches, itching on the skin, cramps in the muscles, and restless leg syndrome in some people.

What Are The Risks Involved In Hemodialysis

• During the AV fistula or graft procedure, some people get an infection at the site where the incision is made. They may also develop a blockage due to blood clots caused by scarring of tissues leading to slow blood flow.
• Sometimes the dialysis needle can come out of the arm of the person during the procedure and can lead to blood loss.
• People may experience disrupted sleep after the procedure.
• Hemodialysis can worsen bone disease by removing excessive calcium or too little calcium from the person’s body and can also contribute to anemia.
• If too much potassium is removed from a person’s body during hemodialysis, the person’s heart can beat irregularly or stop functioning.
• Fluid is removed from the body during the procedure and if a person consumes more fluid than recommended, it can lead to failure of the heart or fluid buildup in the lungs.
• Inadequate hemodialysis can cause inflammation in the membrane of the heart that interferes with the heart’s ability to pump blood to the body.
• Amyloidosis occurs when the protein in the blood is deposited on the joints and tendons. The condition can be a result of prolonged hemodialysis.

The doctor must be contacted in case of the following symptoms:

• Difficulty while passing urine.
• Dizziness, and fainting.
• If the person feels unusually thirsty.
• Fever or leakage of fluid or redness and swelling at the site where the catheter is placed.
• Severe pain in the abdomen.
• Bulging in the abdomen or groin.

Conclusion

Hemodialysis is an effective treatment for people in the end stage of kidney disease and enables the person to keep the kidney alive and provide quality life to a person. The procedure can assist a person while they wait for a kidney transplant. There are different types of dialysis available depending on the condition of the person and the procedure can be conducted at home too. Before any treatment the doctor should be consulted, and their instructions should be followed carefully.