Understanding Dialysis: What You Need to Know Before Starting

What is Dialysis?

Before talking about dialysis, you must know a bit about the functioning of the kidneys. Kidneys filter out wastes from the body and maintain a balance between salts, minerals, electrolytes, etc. in the body. When your renal functions become compromised, it leads to a constant build-up of wastes inside the body. A person with severely damaged kidneys will have a huge build-up of waste inside his/her body. This is where dialysis assumes importance. In dialysis, instead of our kidneys doing the filtering job, a machine filters out wastes and toxins from the blood and returns the filtered blood to the body of the patient.

Dialysis Process in Some Detail

Dialysis has two types:

• Hemodialysis
• Peritoneal dialysis

What is Hemodialysis?

In hemodialysis, your blood is extracted and passed through a dialyzer (artificial kidney) for the purpose of filtration. Dialyzer returns this filtered blood to the body. This process takes 3-5 hours and you may have to undergo hemodialysis 2-3 times a week, depending on the functioning of the kidneys.

What happens before hemodialysis?

A minor surgical procedure is carried out so that there is an easy access to your bloodstream. You may have to undergo:

• Arteriovenous fistula (AV fistula): In this medical procedure, a surgeon creates a connection between an artery and a vein in your arm.
• Arteriovenous graft (AV graft): In case the artery and the vein are too short to have a meaningful connection, the surgeon utilizes a graft (which is a form of soft, hollow tube) to connect them.

These surgical procedures are used to enlarge the connected artery and vein, resulting in a smooth dialysis process.

While you go through hemodialysis, the dialysis machine:

• Extracts your blood through a needle.
• Circulates the blood in the machine, where blood is cleaned with the help of a cleansing liquid.
• Returns cleaned blood to your body through a different needle.
• Regulates your blood pressure all this while avoiding the occurrence of any potential side effects.

Potential Side Effects of Hemodialysis:

• Low blood pressure post dialysis
• Chest or back pain
• Headaches
• Itchy skin
• Muscle cramps
• Restless legs syndrome

What is Peritoneal Dialysis?

In Peritoneal dialysis, tiny blood vessels present in the abdominal lining (peritoneum) are given the job of filtering blood with the help of a dialysis solution. This dialysis solution has water, salt, and other additives, and it performs the role of a dialysis solution. Peritoneal dialysis takes place at home. Two ways through which this dialysis is done at home are:

• Automated peritoneal dialysis
• Continuous ambulatory peritoneal dialysis (CAPD)

Prep Before Peritoneal Dialysis

Patients have to undergo a minor surgical operation before this dialysis. A soft, thin tube (also known as a catheter) is inserted through the belly of the patient and into his/her peritoneum. Your doctor will teach you the entire process and precautionary measures. The biggest benefit of this type of dialysis is that it is less inconvenient than hemodialysis. During peritoneal dialysis:

• The catheter placed in the patient’s belly is attached to one arm of a Y-shaped tube. A connection is made between this tube and the bag containing the dialysis solution. The solution travels through the tube and catheter and enters the peritoneal cavity.
• After around 10 minutes, when the bag is empty, disconnect the tube and place a cap on the catheter.
• You can do your usual activities while the dialysis solution filters the blood in the meantime. This process may last for 1-1.5 hours.
• Once the process is done, remove the cap from the catheter and empty the fluid into a clean, empty bag.
• Depending on the severity of your disease, you may be required to undergo this process at least 3-4 times a day.

Bloating is one of the major side effects of this type of dialysis

When is Dialysis Needed?

If you have an End-Stage Renal Disease (ESRD) or if your kidney functioning has seen massive deterioration, i.e. your eGFR is 15 mL/min/1.73 m2 or less, you need to take the services of dialysis.

Things to Know before Undergoing Dialysis

• Your doctor will check for vital signs such as blood pressure, heartbeat, etc. before recommending dialysis. Keep your latest medical reports with you.
• Dialysis is not painful, however, needles used in hemodialysis may cause pain.
• Dialysis does not guarantee a longer life span. It is just a medical procedure to filter blood via machines.
• You will need to adhere to the diet regulations prescribed by your doctor. To concretize this point further, you need to consume a low-salt diet and you may also need to moderate the consumption of animal protein. 

Conclusion

Dialysis is the standard procedure for people with acute renal damage. You must consult with your doctor if you require this procedure or not. Your doctor will be able to assess the pros and cons of dialysis for you and offer you the best possible solution.