Muljibhai Patel Urological Hospital
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DIALYSIS

What Is It ?

Healthy kidneys clean your blood and remove extra fluid in the form of urine. They also make substances that keep your body healthy. Dialysis replaces some of these functions when your kidneys no longer work.

What It's Used For

You need dialysis if your kidneys no longer remove enough wastes and fluid from your blood to keep you healthy. This usually happens when you have only 10 to 15 percent of your kidney function left. You may have symptoms such as nausea, vomiting, swelling and fatigue. However, even if you don't have these symptoms yet, you can still have a high level of wastes in your blood that may be toxic to your body. Your doctor is the best person to tell you when you should start dialysis.

How It's Done

There are two different types of dialysis - hemodialysis and peritoneal dialysis.

HEMODIALYSIS:

How does hemodialysis work?

In hemodialysis, a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood. To get your blood into the dialyzer, the doctor needs to make an access, or entrance, into your blood vessels. This is done with minor surgery, usually to your arm.

How does the dialyzer clean my blood?

The dialyzer, or filter, has two parts, one for your blood and one for a washing fluid called dialysate. A thin membrane separates these two parts. Blood cells, protein and other important things remain in your blood because they are too big to pass through the membrane. Smaller waste products in the blood, such as urea, creatinine, potassium and extra fluid pass through the membrane and are washed away.

Where is hemodialysis done?

Hemodialysis can be done in a hospital, in a dialysis center that is not part of a hospital or at home. You and your doctor will decide which place is best, based on your medical condition, and your wishes.

How long will each hemodialysis treatment last?

Hemodialysis treatments usually last about four hours, and they are done three times a week. Your doctor will give you a prescription that tells you how much treatment you need. Studies have shown that getting the right amount of dialysis improves your overall health, keeps you out of the hospital and enables you to live longer. Your dialysis care team will monitor your treatment with monthly lab tests to ensure you are getting the right amount of dialysis. One of the measures your dialysis care team may use is called urea reduction ratio (URR). Another measure is called Kt/V (pronounced kay tee over vee).

  • Your Kt/V should be at least 1.2 or
  • Your URR should be at least 65 percent.

Can I have hemodialysis at home?

Possibly, many patients have their hemodialysis treatments at home.

Can dialysis cure my kidney disease?

In some cases of sudden or acute kidney failure, dialysis may only be needed for a short time until the kidneys get better. However, when chronic kidney disease progresses to kidney failure over time, your kidneys do not get better and you will need dialysis for the rest of your life unless you are able to receive a kidney transplant.

Will I be uncomfortable on hemodialysis?

When you begin hemodialysis, the needles put in your fistula or graft may be uncomfortable. Most patients get used to this in time. Our dialysis care team will make sure you are as comfortable as possible during your treatment. Symptoms like cramps, headaches, nausea or dizziness are not common, but if you do have any of them, ask any of the team member if any of the following steps could help you:

  • Slow down your fluid removal, which could increase your dialysis time.
  • Check your high blood pressure medications.
  • Adjust your dry weight, or target weight. Cool the dialysate a little.
  • Use a special medication to help prevent low blood pressure during dialysis.

You can help yourself by following your diet and fluid allowances. The need to remove too much fluid during dialysis is one of the things that may make you feel uncomfortable during your treatment.

Is reuse of my dialyzer safe?

Yes, before you reuse your dialyzer, your dialysis center cleans it according to careful guidelines. If done properly, reuse is generally safe. Before each treatment, your dialyzer must be tested to make sure it is still working well. If your dialyzer no longer works well, it should be discarded and you should be given a new one. If you do not wish to reuse your dialyzer, you inform the center to provide you with a new dialyzer for each treatment.

Can I travel?

Yes. Before you travel, you must make an appointment for dialysis treatments at another center. The staff at center may be able to help you arrange this appointment.

Can I continue to work?

Yes. Many dialysis patients continue to work or return to work after they have gotten used to dialysis. If your job has a lot of physical labor (heavy lifting, digging, etc.), you may need to change your duties.

Hemodialysis Access:

How Your Access Works

A hemodialysis access, or vascular access, is a way to reach the blood for hemodialysis. The access allows blood to travel through soft tubes to the dialysis machine where it is cleaned as it passes through a special filter, called a dialyzer. An access is placed by a minor surgery. As a hemodialysis patient, your access is one of the following:

  • A fistula, an access made by joining an artery and vein in your arm.
  • A graft, an access made by using a piece of soft tube to join an artery and vein in your arm.
  • A catheter, a soft tube that is placed in a large vein, usually in your neck.

If your access is a fistula or graft, your nurse or technician will place two needles into the access at the beginning of each treatment. These needles are connected to soft tubes that go to the dialysis machine. Your blood goes to the machine through one of the tubes, gets cleaned in the dialyzer, and returns to you through the other tube. If your access is a catheter, it can be connected directly to the dialysis tubes without the use of needles.

A fistula should be considered the first choice for your access because it generally lasts longer and has fewer problems such as infections and clotting. However, some patients may not be able to receive a fistula because their blood vessels are not strong enough. A graft is considered the second choice for an access. Catheters are generally used as a temporary access, but sometimes they are permanent. Sometimes, it may be possible to switch to a fistula from another type of access. If you do not have a fistula, ask your dialysis care team if a switch would be possible for you.

Caring For Your Access

Whether your access is a fistula, graft or catheter, you should make sure to take good care of it. Your dialysis care team will teach you the steps of good access care. The chart below gives you some general tips about everyday access care and how to prevent problems.

Fistula or Graft

  • Wash with an antibacterial soap each day, and always before dialysis. Do not scratch your skin or pick scab.
  • Check for redness, a feeling of excess warmth or the beginning of a pimple on any area of your access.
  • Ask team to rotate the needles when you have your dialysis treatment.

Catheter

  • Keep catheter dressing clean and dry.
  • Make sure the area of the access is cleaned and the dressing is changed by your care team at each dialysis session.
  • Keep an emergency dressing kit at home in case you need to change your dressing between treatments.
  • Never open your catheter to the air.

PERITONEAL DIALYSIS:

What is peritoneal dialysis and how does it work?

  • A soft tube, called a catheter, is placed in your belly. This is done by minor surgery. This catheter makes it possible for you to easily connect to special tubing which allows two to three quarts of a cleansing fluid to flow into your belly. The cleansing fluid is called dialysate. It takes about 10 minutes for the dialysate to fill your belly. When the filling is done, the catheter is capped so that it doesn't leak.
  • What happens next is an amazing process. The lining of your belly (called the peritoneal membrane) acts as a natural filter. It lets the wastes and extra fluid in your blood pass through it into the cleansing fluid. At the same time, the lining of your belly holds back the important things your body needs, like red blood cells and nutrients.
  • To do its job, the dialysate must stay in your belly for at least 3-4 hours or more, depending on your body size and how much waste has to be removed. This time is called your dwell time. After your dwell time, you drain the cleansing fluid from your body into an empty bag. You discard the bag. You then repeat the in-and-out process a number of times during the day, using fresh dialysate. The process of exchanging bags of dialysate is called a bag exchange. PD can be done at home, at work, or while traveling.

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:
    Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD).
  • 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.

Continuous Cycling Peritoneal Dialysis (CCPD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night while you sleep.

How will I learn how to do peritoneal dialysis?

The training staff at dialysis center will teach you everything you need to know, including how to do exchanges, order supplies, clean your catheter, and guard against infection. Once you and the staff are comfortable with your ability to do PD alone, you can start doing your own treatments at home.

How will I know how much dialysis I need?

  • The amount of dialysis needed is different for everyone. It is based on many factors, including your weight, how much kidney function you still have, your overall health, and the results of your lab tests. Your doctor will give you a dialysis prescription that is designed just for you. Your prescription will tell you:
  • How many exchanges you need to make each day.
  • How long the dialysis fluid needs to stay in your belly (your dwell time).
  • What type and amount of dialysis fluid you need to use for each exchange.

Will my dialysis care team monitor my treatments?

Yes. Your dialysis care team will measure your treatments regularly with lab tests. This tells them if your treatment is removing enough wastes from your blood. The test that is used to check your “delivered dose” of dialysis is called Kt/Vurea

TIP

Getting the right amount of dialysis depends on how well you follow your prescription.
Make sure you:

  • Do all your prescribed exchanges.
  • Follow the prescribed amount of time (dwell time) you keep the dialysis fluid in your belly.
  • Use the full amount of dialysis fluid prescribed for you.
  • Prevent infections by doing your exchanges exactly as you were taught.
  • Take all your medications exactly as ordered by your doctor.
  • Follow your diet and fluid allowances.
  • Too much fluid in your body can cause swelling, shortness of breath and increased blood pressure.
  • Report any problems to your doctor or dialysis care team.
  • Never be afraid to tell your dialysis care team exactly how you do your exchanges.

This is the best way to check that you are doing them correctly. Your total Kt/V urea from the dialysis and your remaining kidney function should never be less than 1.7 per week.

How often should my treatments be measured?

Your delivered dose of dialysis should be measured every three - four months. This measurement should be done more often when:

  • You first start PD treatment
  • Your PD prescription is changed
  • Your dialysis care team feels it is needed
  • Your level of kidney function has gone down

To measure your delivered dose of dialysis, your dialysis care team may ask you to bring to the dialysis center all the dialysis bags you used over a 24-hour period, or just a sample from each of the used bags. You also may be asked to collect a 24-hour urine collection. Both the urine and the dialysate collections are important in measuring your total dose of dialysis.

Will I need to follow a special diet?

Yes. Getting the right nutrients and balancing fluids is as important to your health as getting the right amount of dialysis. The registered dietitian at your dialysis center will help you plan your diet to make sure you get the right amount of protein, calories and other important nutrients.

You may also need to:

  • Limit how much sodium (salt) you eat
  • Take nutritional supplements

TIP

Because your dialysis fluid contains sugar, you may have a tendency to gain weight. Your dietitian can help you plan your diet to get the right amount of calories and keep the right weight for you. If you have diabetes, your dosage of insulin or other medications may need to change.

What is peritonitis?

One thing you have to be very careful about in PD is peritonitis, an infection of the peritoneum
(the lining of the belly). Peritonitis happens when germs get into the peritoneal cavity through the catheter. It is treatable with antibiotics, but it's important to get it treated promptly. When doing an exchange:

  • Make sure the area where you do your exchange is clean.
  • Make sure you and anyone else in the room wears a surgical mask.
  • Do not allow children or pets into the room.
  • Close all doors and windows and turn off any ceiling fans or air conditioners.
  • Gather all your supplies before you start your exchange.
  • Scrub your hands for at least two minutes before each exchange, using a good soap.
  • Dry your hands with a disposable paper towel. Do not touch anything unrelated to your treatment, not even your skin or your hair. If you do touch something, wash your hands again before continuing.
  • Avoid coughing or sneezing on your sterile supplies. If this happens, you must start the process over with new supplies. Make sure you do your exchanges exactly as taught by your training program. Don’t try anything different without asking your dialysis care team about it.

What are the signs of peritonitis?

The main signs of peritonitis are:

  • A cloudy dialysis bag when you are draining out the used fluid
  • Unusual stomach pain, either mild or severe
  • Fever or chills

If you notice any of these signs, call your doctor or dialysis center right away. Getting prompt treatment for peritonitis is very important. If you do not get prompt treatment, the infection can get worse and you may have to go to the hospital. In addition, the infection may scar your peritoneal membrane, making PD less effective. In extreme cases, you may have to change to hemodialysis.

Are there any other infections I should watch for?

Infections can also occur at the place where the catheter leaves your skin, called your exit site. You should clean this area at least once a day with soap and water. You should also check your exit site and catheter every day. If problems occur, you can often catch them in the early stages. Signs of exit site infection are:

  • Pus at the exit site
  • Redness around the exit site
  • Swelling or bulging around the exit site
  • Tenderness or pain at the exit site

TIP

Taking good care of your catheter is also important to prevent infections and do well on PD. Here are some tips for routine catheter care:

  • Check your catheter every day for signs of cracking or pulling.
  • Do not wear tight clothes and belts around the exit site.
  • Wash your hands with soap and water for at least two minutes and dry them with a disposable paper towel before handling your catheter, and before and after an exchange is made.
  • Tape the catheter down to your skin.
  • Keep the catheter away from scissors or other sharp objects.
  • Cleanse the catheter thoroughly with a wash cloth and soap every day.
  • Keep a special dressing over the exit site if your dialysis care team tells you to do so.
  • Do not allow tugging or pulling of your catheter.

What if I have questions or problems?

Once you have learned all you need to know, your PD supplies will be delivered directly to your home and you will be ready to start your treatment. But you will never be on your own. You will visit dialysis center for regular checkups and lab tests. Your doctor and dialysis care team will check:

  • Your overall health and nutritional health
  • Any symptoms that indicate you may not be getting enough dialysis
  • How you are doing with your exchanges
  • The results of other important tests

In addition, your center will always be just a phone call away if you have any problems. You will be the primary person responsible for your own care. So be sure to call your doctor or dialysis care team if you notice any problems