Dialysis (Hemodialysis) | ڈایالسز/ہیموڈایالسز

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Dialysis (Hemodialysis)

Healthy kidneys clean blood by removing waste, toxic substances and excess water that is passed in the form of urine. Dialysis is required when the kidneys are no longer able to filter out toxic waste, salts and excess fluids from the blood. Dialysis can be performed in two ways:

  • Hemodialysis commonly referred as dialysis
  • Peritoneal dialysis

This leaflet focuses on hemodialysis

Dialysis (hemodialysis) is most commonly used method to treat chronic kidney conditions that has resulted in complete or partial renal failure. In most patients, kidney function deteriorates gradually. Those patients who have 10-15% of kidney function remaining than the normal kidneys require regular dialysis. Due to reduced kidney function, toxic waste (urea, creatinine, potassium etc.) builds-up in the body and start to effect other body organs. Dialysis is done through a machine, mostly in a hospital or dialysis center; however portable dialysis machines are available, which can be used by patients at home. Dialysis machine removes the toxic waste and excess water and therefore works as a substitute to some kidney functions.

Usually one dialysis session takes about 4 hours and most patients require 2-3 dialysis in a week.  This procedure is done on a strict schedule and the patient must attend all appointments to suitably manage the condition.  Dialysis allows advanced kidney failure patients to have a more active life.

This procedure is done for kidney failure patients, but not everyone in kidney failure requires dialysis.  The doctor will measure the kidney function with a blood test called estimated glomerular filtration rate. This test will help the doctor to determine if the patient is a candidate for dialysis and when it should be suitable to start.

Many medical conditions can cause the kidneys to fail, but the most common causes include:

  • Diabetes
  • Kidney inflammation
  • Polycystic kidney disease
  • High blood pressure
  • Blood vessel inflammation
  • Kidney stones
  • Recurrent Kidney infection

Dialysis is performed through a dialysis machine, which contains a special filter called dialyzer (or artificial kidney). The patient blood flows into the machine through an access point. The access point is created before dialysis through a minor surgery to allow the proper flow of the blood into the machine. Access point could be one of the following type:

1. Fistula (made by joining an artery and vein in the arm)

2. Graft – (made by using a soft tube to connect an artery and vein, usually in the arm)

3. Central venous catheter – (Soft tube is inserted in the large vein, near the neck or chest)

Fistula and graft require several weeks to mature and be able to use for dialysis. Until fistula or graft are not completely healed, central venous catheter is used for dialysis in patients who need it urgently.

When the patient is connected to the machine, the blood flows into the machine and pass through the dialyzer. The dialyzer allows the toxic waste and excess fluid to wash out while keeping the blood cells and important proteins in the blood.

During the procedure, the patient should get comfortable and the process for dialysis is as follows:

  • Preparation: This involves cleansing the skin on the access site and checking the pulse, temperature and blood pressure.
  • Starting: Patient is hooked up to the dialysis machine and dialysis begins.
    Monitoring: Throughout dialysis, someone will check the heart rate and blood pressure.
  • Finishing: Everything is removed and a pressure dressing goes onto the access site.

Each dialysis in hospital takes about 3-5 hours to complete. Most patients require 3 dialysis in a week. 

Patient may receive dialysis at home, in a hospital or in a dialysis center. If dialysis is done in a hospital or center, Patient needs to go three times per week and each session lasts approximately three to five hours. Home dialysis takes about two to three hours, but require dialysis at least six days per week.

Most people who are candidates for dialysis have other medical issues and this results in an increased risk for problems during dialysis. Not everyone will have problems as they go through dialysis, but patients should know the potential risks, so that they can be recognized and treated quickly.

The possible risks of dialysis include:

  • Low blood pressure
  • Skin dryness and Itching
  • Anemia
  • Muscle cramps
  • Sleep problems
  • Bone diseases
  • High blood pressure
  • Pericarditis
  • Access site complications
  • Depression
  • Fluid overload
  • High potassium levels
  • Amyloidosis

The goal of dialysis is to improve quality of life of the patient.

To ensure dialysis is going according to plan, patient will have testing about once a month. This includes blood tests to measure the blood counts, blood chemistry, total urea clearance and urea reduction ratio. The doctor will also keep an eye on the access site to ensure adequate blood flow.

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