What is Hemodialysis?
Hemodialysis is a procedure used in cases of kidney failure, to remove waste products like creatinine, urea and excess fluids from the blood. It is a form of renal replacement therapy which may be performed as an outpatient procedure or an inpatient therapy if the patient is already admitted to the hospital.
What Happens When Your Kidneys Fail?
Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.
How Does Hemodialysis Work?
A dialysis machine and a dialyzer (which is a special filter) are used to clean the blood. Blood is obtained from a Hemodialysis access, which is connected to the blood vessels.
The dialyzer consists of two parts: One part is for the blood, and the other part is for a fluid that is known as dialysate. The dialysate is a washing fluid. The two parts are separated by a thin membrane. Components of the blood like protein and blood cells do not pass through the membrane. However, waste products in the blood like urea, creatinine, potassium and excess fluid pass through the membrane and get washed away.
What are the Different Kinds of Hemodialysis?
The type of Hemodialysis that the patient needs is determined by their doctor and mainly fall into the following two categories:
In-center Hemodialysis : This is conducted in a hospital or a dialysis center. It takes approximately three to five hours a day, and is usually done three times a week.
Home Hemodialysis : This is conducted at home if the patient is trained or has trained helpers and family members. It is done three times a week or on every alternate day. These sessions may be of varied lengths depending on the doctor’s advice. Some sessions may be six hours long, which may help the patient to feel better.
What is a Hemodialysis Access?
A Hemodialysis access is a site on the patient’s body that is created to enable the blood to flow in and out during the treatment. The type of access that is made depends on how urgently the Hemodialysis needs to be started and are:
Fistula : A fistula is a Hemodialysis access that is made by joining one artery to a vein in the lower arm. Repeated access can be made through a fistula for every dialysis session. The fistula may take many months to be formed. It will not clot easily like other dialysis access methods. It is a very effective and durable method of access for Hemodialysis. Complications that may be involved are infection and thrombosis, which is formation of a clot.
Graft : A graft is an access in which a synthetic tube is implanted under the skin of the patient’s arm. It may be used if the patient’s veins are very small. The tube is used as an artificial vein where the needle is placed to access blood during Hemodialysis. The graft which has been placed in the patient’s arm can be used after a week of its placement. Complications of clotting and infection are common, so a replacement graft may be required often. A common type of graft used for Hemodialysis is a polytetrafluoroethylene graft.
Venous Catheter : If the patient requires immediate Hemodialysis and if the patient does not have a permanent access, a temporary catheter tube may be placed in a vein located in the neck, chest or groin. It is not used as a permanent form of access for routine use because infection and clogging is a common problem in a venous catheter.
How Diet Can Help?
Eating the right foods can help improve your dialysis and your health. Your clinic has a dietitian to help you plan meals. Follow the dietitian's advice closely to get the most from your Hemodialysis treatments. Here are a few general guidelines.
How Can I Adjust to Changes?
Following a strict schedule is one of the biggest adjustments you must make when you start Hemodialysis treatments.
Most patients go to a dialysis center—three times a week for 3 to 5 or more hours each visit. For example, you may be on a Monday-Wednesday-Friday schedule or a Tuesday-Thursday-Saturday schedule.
You may be asked to choose a morning, afternoon, or evening shift, depending on availability and capacity at the dialysis unit. Your dialysis center will explain your options for scheduling regular treatments.
Even in the best situations, adjusting to the effects of kidney failure and the time you spend on dialysis can be difficult. Aside from the "lost time," you may have less energy. You may need to make changes in your work or home life, giving up some activities and responsibilities. Keeping the same schedule you kept when your kidneys were working can be very difficult now that your kidneys have failed. Accepting this new reality can be very hard on you and your family.