Diagnostics

Dialysis

What is dialysis?

Dialysis is a process that removes waste products, excess fluids, and toxins from the blood when the kidneys are unable to perform these functions effectively. It helps maintain a safe balance of electrolytes and fluid levels in the body.

Dialysis performs vital functions that the kidneys usually handle to maintain the body’s balance, including:

  • Removing waste and excess fluids from the body to prevent their accumulation.
  • Regulating safe levels of essential minerals in the blood, such as potassium, sodium, calcium, and bicarbonate.
  • Assisting in the regulation of blood pressure.

When is dialysis recommended by doctors?

Dialysis is typically recommended for individuals with end-stage kidney disease or advanced kidney dysfunction, where the kidneys have lost a significant portion of their function and can no longer effectively filter waste products and excess fluids from the body. Patients who experience severe symptoms such as fatigue, fluid retention, high blood pressure, electrolyte imbalances, and other complications due to kidney failure may require dialysis to support their kidney function and maintain overall health.

Who performs dialysis?

Trained healthcare professionals, including nephrologists (kidney specialists), dialysis nurses, and dialysis technicians, usually perform dialysis.  Dialysis is usually performed in specialized healthcare facilities such as dialysis centers or dialysis units within hospitals. Additionally, there are home-based dialysis options like peritoneal dialysis, where patients can receive training and perform dialysis treatments at home under proper guidance and support from doctors.

What are the types of dialysis?

There are two methods to get dialysis:

  • Hemodialysis
  • Peritoneal dialysis.

What is hemodialysis, and how is it performed?

Hemodialysis involves a machine that draws blood from the body, filters it through an artificial kidney called a dialyzer, and then returns the cleaned blood back to the body. This process typically takes 3 to 5 hours and is usually done thrice weekly at a hospital or dialysis center. Some people may need it more frequently based on their specific needs.  

 Before hemodialysis

Before starting hemodialysis, a minor surgical procedure is performed to create easier access to the bloodstream. This involves:

  • Arteriovenous fistula (AV fistula): A surgical connection between an artery and vein in the arm to create an enlarged access point for dialysis.
  • Arteriovenous graft (AV graft): If the artery and vein are not suitable for direct connection, a soft, hollow tube (graft) is used to link them, creating an enlarged access point for dialysis.
  • In urgent cases, a temporary catheter may be placed in a vein in the neck, chest, or leg to facilitate dialysis access.

The doctor will provide instructions on how to prevent infections in the fistula or graft, and if the patient chooses home hemodialysis, they will guide them through the process.

During hemodialysis

During hemodialysis, the dialysis machine

  • Draws blood from a needle in the arm.
  • Circulates the blood through the dialyzer filter, where waste is removed into a cleansing solution containing water, salt, and other additives.
  • Returns the filtered blood to the body through a separate needle in the arm.
  • Monitors blood pressure to regulate the speed of blood flow in and out of the body.


Some patients may experience low blood pressure during or immediately after hemodialysis, which can result in dizziness, lightheadedness, and fainting. The patient may feel nauseous or get headaches or muscle cramps. Patients with hemodialysis access sites, such as arteriovenous fistulas or grafts, are at risk of developing infections at the site of access. These infections can lead to serious complications if not promptly treated. It is crucial to promptly inform the doctor if any of these symptoms occur.

What is peritoneal dialysis, and how is it performed?

Peritoneal dialysis utilizes tiny blood vessels in the abdominal lining (peritoneum) to filter blood with the assistance of a dialysis solution—a cleansing liquid containing water, salt, and other additives.

This dialysis takes place at home and can be performed in two ways:

  • Automated peritoneal dialysis involves the use of a machine known as a cycler.
  • Continuous ambulatory peritoneal dialysis (CAPD) is done manually.


Before peritoneal dialysis

A minor surgical procedure is conducted approximately three weeks before beginning peritoneal dialysis. A soft, thin tube (catheter) is inserted through the belly and into the peritoneum during this procedure. The catheter remains in place permanently to facilitate peritoneal dialysis. A doctor will provide instructions on how to perform peritoneal dialysis at home and how to prevent infections at the catheter site.

During peritoneal dialysis

During peritoneal dialysis, the patient is to follow below-mentioned steps:

  • Connect the catheter to one branch of a Y-shaped tube. This tube connects to a bag containing dialysis solution. The solution flows through the tube and catheter into the peritoneal cavity.
  • After approximately 10 minutes, when the bag is empty, disconnect the tube and catheter.
  • Cap off the catheter.
  • Continue regular activities while the dialysis solution in the peritoneal cavity absorbs waste and extra fluids from your body, which takes about 60 to 90 minutes.
  • Remove the cap from the catheter and use the other branch of the Y-shaped tube to drain the fluid into a clean, empty bag.
  • Repeat these steps up to four times a day, and during the night, the patient may sleep with the solution in their stomach.


Some people prefer to perform peritoneal dialysis at night using automated peritoneal dialysis, where a machine called a cycler pumps the fluid in and out of the body while the patient sleeps.

After the dialysis, the presence of liquid in the belly during peritoneal dialysis may make the patient feel bloated or full.  Although this sensation might be uncomfortable, the treatment itself is not painful.

Peritonitis is a severe and common complication of peritoneal dialysis. It happens when infectious agents enter the peritoneal cavity through the dialysis catheter, causing symptoms like abdominal pain, cloudy dialysis fluid, and fever. The exit site of the catheter can also become infected, showing signs of redness, swelling, and tenderness. Long-term use of peritoneal dialysis may weaken the abdominal muscles, potentially leading to hernias, especially around the catheter exit site. It is essential to doctor promptly if any of these symptoms occur.

Dialysis is a vital and life-saving treatment for kidney failure or end-stage renal disease, allowing patients to continue their lives until they receive a kidney transplant.

References

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