Kidney dialysis is a life-saving treatment for individuals with end-stage kidney disease or acute kidney injury whose kidneys are severely impaired or have lost their ability to filter blood effectively. The process is also known as renal replacement therapy.
Indications for Kidney Dialysis
Kidney dialysis is recommended for individuals with severe kidney dysfunction or complete kidney failure , i.e., unable to perform their essential functions adequately.
The primary indications that require kidney dialysis include:
End-Stage Kidney Disease (ESKD): When the kidneys have lost more than 85-90% of their function, resulting in the inability to maintain;
Proper fluid balance
Electrolyte levels
Waste removal
Acute Kidney Injury (AKI): In cases of sudden and severe kidney damage, such as due to infections, toxins, or surgery, where the kidneys lose their filtration ability temporarily.
Uremia and Symptomatic Kidney Failure: When waste products, toxins, and excess fluids build up in the blood, leading to symptoms like;
Nausea
Vomiting
Fatigue
Confusion
Fluid overload
Hyperkalemia (High Blood Potassium): Elevated potassium levels in the blood can lead to life-threatening heart rhythm abnormalities. Dialysis can quickly lower potassium levels.
Severe Fluid Retention: When the body is unable to effectively remove excess fluid, leading to edema, shortness of breath, and high blood pressure.
Metabolic Acidosis: Kidney failure can cause an imbalance in the body’s acid-base balance.
Intoxication or Poisoning: In cases of severe drug overdose or exposure to toxic substances.
Severe Hypertension (High Blood Pressure): Uncontrolled high blood pressure can lead to damage to the blood vessels and organs.
Pericarditis or Cardiac Tamponade: In some instances, kidney failure can lead to inflammation around the heart ( pericarditis) or fluid accumulation around the heart (cardiac tamponade).
Types of kidney Dialysis Procedure
The two main types of kidney dialysis are:
Hemodialysis: In this procedure, blood is drawn out of the body, filtered through a machine (dialyzer), and then returned to the body. The dialyzer removes waste products, excess fluids, and toxins from the blood, mimicking the function of healthy kidneys.
Peritoneal Dialysis: This type uses the lining of the abdomen (the peritoneum) as a natural filter. A special dialysis fluid is introduced into the abdominal cavity, where it absorbs waste and excess fluids. After a set period, the fluid is drained out, taking the waste with it. This process can be done manually or with a machine (automated peritoneal dialysis).
Steps Involved in Kidney Dialysis Procedure
Hemodialysis Dialysis Procedure
Access Placement: A vascular access is created, usually in the form of an arteriovenous (AV) fistula, AV graft, or central venous catheter. This access allows blood to be taken out of the body and returned after it has been filtered.
Preparation and Connection:
You’ll be seated in a comfortable chair or lie on a bed.
The dialysis machine is prepared with sterile dialysis fluid (dialysate).
The access site is cleaned and connected to the dialysis machine via tubing.
Blood Filtration:
Blood is pumped from your body into the dialysis machine, where it passes through a special filter called a dialyzer or artificial kidney.
Inside the dialyzer, the blood is exposed to the dialysate, which helps remove waste and excess fluids.
Waste Removal:
The dialyzer removes waste products and excess fluids from the blood.
The cleaned blood is returned to your body through the same access site.
Monitoring: During the procedure, your blood pressure, heart rate, and other vital signs are monitored regularly.
Duration: Hemodialysis sessions typically last around 3 to 4 hours and are usually performed three times a week.
Peritoneal Dialysis Procedure
Catheter Placement: A peritoneal dialysis catheter is inserted into your abdomen, usually through a small surgical incision.
Filling the Abdomen:
Dialysis fluid (dialysate) is introduced into the peritoneal cavity through the catheter.
The dialysate stays in the abdomen for a set dwell time.
Exchange Phases:
The dialysate in the abdomen absorbs waste and excess fluids from your bloodstream during the dwell phase.
After the dwell time, the fluid is drained out of the abdomen and discarded (drain phase).
Repeat Cycles: The exchange cycle is repeated multiple times during the day and night using an automated device (cycler) or manual bags.
Monitoring: Your weight, blood pressure, and other parameters may be monitored to ensure proper fluid balance.
Duration: Peritoneal dialysis can be done daily, and the frequency of exchanges depends on the specific type of peritoneal dialysis and your prescribed schedule.
Who will Treat for Kidney Dialysis Procedure?
Several healthcare specialists are involved in the kidney dialysis procedure. The interdisciplinary nature of kidney care ensures that patients receive comprehensive and tailored treatment. The specialists involved in kidney dialysis care include:
Nephrologist
Dialysis Nurse
Dialysis Technician
Nephrology Dietitian
Social Worker (Gives counseling & helps with financial concerns)
Nephrology Pharmacist
Vascular Surgeon or Interventional Radiologist
Transplant Surgeon
Physical Therapist
Psychologist or Mental Health Specialist
Primary Care Physician
How to Prepare for the Kidney Dialysis Process?
Preparing for kidney dialysis involves several steps to ensure a smooth and safe experience.
Education and Consultation: Discuss dialysis with your nephrologist to understand the procedure, benefits, and challenges.
Choose a Dialysis Center: If undergoing hemodialysis, select a convenient center. For peritoneal dialysis, ensure you have the necessary supplies at home.
Scheduling and Routine: Plan dialysis sessions as prescribed—hemodialysis is usually multiple times a week, while peritoneal dialysis offers flexibility.
Medication Management: Follow your prescribed medications, and consult your nephrologist for any necessary adjustments.
Fluid Management: Monitor fluid intake as per your dialysis type to prevent overhydration or dehydration.
Access Care (Hemodialysis): Keep the vascular access site (fistula or graft) clean and protected.
Create a Comfortable Space (Peritoneal Dialysis): If you’re undergoing peritoneal dialysis at home, prepare a clean and organized space where you’ll perform the dialysis exchanges. Have all necessary supplies within easy reach.
Dress Comfortably: Wear loose and comfortable clothing to your dialysis sessions. If you’re receiving hemodialysis, this will make it easier to access your dialysis site.
Arrange Transportation (Hemodialysis): Plan transport if visiting a dialysis center, especially if assistance is needed post-treatment.
Emotional Preparation: Connect with support groups, family, or friends to help cope with dialysis adjustments.
Recovery After the Kidney Dialysis Procedure
There are some aspects to consider to ensure your well-being and a smooth transition after each dialysis session. The nature of kidney dialysis recovery can vary between hemodialysis and peritoneal dialysis.
Hemodialysis Recovery
Post-Dialysis Fatigue: It’s common to feel tired after a hemodialysis session. It is due to the physical stress of the procedure and the fluid and electrolyte changes that occur during dialysis.
Hydration: After hemodialysis, you might be advised to drink fluids to maintain proper hydration. However, it’s important not to over hydrate, as this can lead to fluid overload.
Dietary Considerations: Be mindful of your diet after dialysis. Depending on your treatment, you might have dietary restrictions related to potassium, phosphorus, sodium, and fluid intake.
Monitoring Blood Pressure: Your blood pressure might be lower after dialysis. Be cautious when standing up to avoid dizzinessor lightheadedness.
Peritoneal Dialysis Recovery
Catheter Care: To prevent infection, maintain proper hygiene around the catheter exit site and clean the area as instructed by your healthcare provider.
Dwell Time and Activity: During the dwell time, you must be careful with physical activities to avoid displacing the catheter or causing discomfort.
Fluid Balance: Monitor your fluid intake and output, as maintaining a proper fluid balance is essential in peritoneal dialysis.
Dietary Guidelines: Similar to hemodialysis, follow any dietary restrictions provided by your healthcare team to manage electrolyte levels and fluid balance.
Infection Prevention: Be vigilant about any signs of infection around the catheter site, and follow your healthcare provider’s instructions for catheter care.
General Tips for Both Dialysis Types
Rest and Recovery: Allow yourself time to rest and recover after each dialysis session, especially if you feel fatigued.
Medication Management: Continue taking prescribed medications as directed by your healthcare provider.
Communicate with Your Healthcare Team: If you experience any unusual symptoms or have concerns about your recovery, don’t hesitate to contact your healthcare team.
Follow-Up Appointments: Attend all follow-up appointments with your nephrologist or healthcare provider to discuss your progress, any concerns, and potential adjustments to your treatment plan.
Lifestyle Changes After Kidney Dialysis
Undergoing kidney dialysis requires certain lifestyle adjustments to ensure your overall well-being, manage your condition, and make the most of your treatment. Here are some essential lifestyle changes to consider after kidney dialysis:
Dietary Modifications: Follow a kidney-friendly diet prescribed by your nephrologist or a registered dietitian.
Blood Pressure Control: Maintain healthy blood pressure levels through medication, dietary adjustments, and lifestyle changes.
Physical Activity: Engage in regular, moderate physical activity as advised by your healthcare provider.
Smoking Cessation and Alcohol Moderation: Quitting smoking and moderating alcohol consumption are both important for your health.
Maintain Proper Hygiene: Keep the dialysis access site clean to prevent infections. Follow proper hand hygiene and care instructions for peritoneal dialysis.
Care for Vascular Access (Hemodialysis): If you have an arteriovenous fistula (AVF) or graft (AVG), follow proper care guidelines to maintain their function and prevent complications.
Benefits of Kidney Dialysis
Waste Removal: Dialysis helps to remove waste products such as urea, excess fluids, and toxins from the blood, which the kidneys can no longer filter. This helps to maintain a safe balance of essential substances like potassium, sodium, and bicarbonate in the body.
Blood Pressure Regulation: Dialysis helps manage blood pressure by removing excess fluid, which can often rise dangerously in individuals with kidney failure.
Electrolyte Balance: Dialysis helps maintain a proper balance of electrolytes, such as sodium, potassium, and calcium, which are crucial for muscle function and overall health.
Life-Saving Procedure: For individuals with ESRD, dialysis is often the only treatment option that can extend life while waiting for a kidney transplant.
Improved Quality of Life: Regular dialysis treatments help individuals feel better by reducing symptoms of kidney failure, such as fatigue, swelling, and shortness of breath.
Risks of Kidney Dialysis
Infection: Dialysis increases the risk of infections, especially when accessing the blood vessels or peritoneum. Hemodialysis involves a needle inserted into the bloodstream, while peritoneal dialysis uses a catheter that may lead to peritonitis (infection of the abdominal cavity).
Low Blood Pressure: One of the risks of hemodialysis is a drop in blood pressure, which can cause dizziness, fainting, and other cardiovascular complications. This is especially true if too much fluid is removed during a session.
Blood Clots: Hemodialysis involves blood flow through a dialysis machine, and there is a small risk of blood clots forming in the bloodlines or dialysis access point, which could lead to complications or require additional treatment.
Anemia: Since dialysis removes red blood cells along with waste products, patients may develop anemia (low red blood cell count), which can lead to fatigue, weakness, and other symptoms.
Bone Mineral Disorder: Dialysis can lead to imbalances in calcium and phosphate levels, resulting in bone mineral disorders. This can increase the risk of fractures and other bone-related issues.
Fluid Imbalance: Despite efforts to regulate fluid levels, patients may experience fluid overload or dehydration, both of which can cause complications such as swelling, difficulty breathing, or cardiovascular issues.
Dialysis Disequilibrium Syndrome: This is a rare but serious condition that occurs when the removal of toxins from the blood is too rapid, causing swelling in the brain, confusion, and seizures.
