Dialysis

Jai Ganesh · Today 00:08:25

Dialysis

Gist

Dialysis is a life-sustaining medical treatment that filters waste, excess water, and toxins from the blood when kidneys fail. It acts as an artificial kidney to manage end-stage renal disease or acute kidney injury. The two main types are hemodialysis (an external machine) and peritoneal dialysis (using the abdominal lining), usually required 3–7 times a week.

Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly. It often involves diverting blood to a machine to be cleaned.

Normally, the kidneys filter the blood, removing harmful waste products and excess fluid and turning these into urine to be passed out of the body.

Summary

Kidney dialysis[a] is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. Along with kidney transplantation, it is a type of renal replacement therapy.

Dialysis may need to be initiated when there is a sudden rapid loss of kidney function, known as acute kidney injury (previously called acute renal failure), or when a gradual decline in kidney function, chronic kidney failure, reaches stage 5. Stage 5 chronic renal failure is reached when the glomerular filtration rate is less than 15% of the normal, creatinine clearance is less than 10 mL per minute, and uremia is present.

Dialysis is used as a temporary measure in either acute kidney injury or in those awaiting kidney transplant and as a permanent measure in those for whom a transplant is not indicated or not possible.

In West European countries, Australia, Canada, the United Kingdom, and the United States, dialysis is paid for by the government for those who are eligible. The first successful dialysis was performed in 1943.

Details

Dialysis is a treatment for people whose kidneys are failing. There are two types of dialysis: hemodialysis and peritoneal dialysis. Both types perform the normal duties of your failing kidneys by filtering waste and excess fluid from your blood.

Overview:

What is dialysis?

Dialysis is a treatment for people whose kidneys aren’t working. When you have kidney failure, your kidneys don’t filter blood the way they should. As a result, wastes and toxins build up in your bloodstream. Common wastes include nitrogen waste (urea), muscle waste (creatinine) and acids. They usually leave your body when you pee. Dialysis does the work of your kidneys by removing waste products and excess fluids from your blood.

Why do people have to get dialysis?

People who have late-stage kidney disease, end-stage kidney disease (ESKD) or kidney failure may need kidney dialysis. The following diseases and conditions can damage your kidneys, leading to kidney disease:

* High blood pressure
* Diabetes
* Lupus

Some people develop kidney problems for unknown reasons. Kidney failure can be a long-term condition, or it can come on suddenly (acute) after a severe illness or injury. Acute kidney failure may recover.

There are five stages of kidney disease. In stage 5 kidney disease, healthcare providers consider you to be in kidney failure. At this point, your kidneys only function at less than 15% of their normal rate. You may need dialysis or a kidney transplant to stay alive. Some people undergo dialysis while waiting for a transplant.

Is going on dialysis serious?

Yes, going on dialysis is serious. If you need dialysis and choose not to start or decide to stop, toxins will build up in your blood (uremia). Kidney failure is fatal without treatment. If you have kidney failure, you may survive a few days or weeks without dialysis.

How common is dialysis?

Dialysis is common. Over 2 million people throughout the world treat kidney disease with dialysis or a kidney transplant.

Treatment Details:

What are the types of dialysis?

There are two types of dialysis:

* Hemodialysis
* Peritoneal dialysis

What is hemodialysis?

Hemodialysis is the most common type of dialysis. It utilizes a dialysis machine that:

* Removes blood from your body, usually from a vein in your arm
* Filters it through an artificial kidney (dialyzer)
* Returns clean blood to your body

You can get hemodialysis from a dialysis center or at home. Most people receive in-center hemodialysis at least three times per week. Depending on the type of at-home hemodialysis, you may need it three to seven days per week, and sessions may last between three and eight hours.

Before you start hemodialysis, a surgeon will enlarge some of the blood vessels (an artery and vein) in your arm to make dialysis access easier, as well as to allow blood to flow in and out of your body faster.

What is peritoneal dialysis?

Peritoneal dialysis uses the inner lining of your abdomen (peritoneum) to filter your blood. You add a dialysis solution (dialysate) into your peritoneum that helps the blood vessels in the area filter your blood. Afterward, you drain the solution into a bag outside of your body. Healthcare providers call this process an exchange.

There are two main types of peritoneal dialysis:

* Continuous ambulatory peritoneal dialysis (CAPD). This type uses a bag that you put above your shoulder, and gravity slowly pulls the dialysate into your abdomen. The process takes about 30 minutes before you drain the solution into a bag. You must perform CAPD between three and five times each day.
* Automated peritoneal dialysis (APD). This type uses a machine to automatically add dialysate to your peritoneum and drain it. Each session consists of three to five exchanges. Most people perform APD while they’re asleep.

Before you start peritoneal dialysis, a provider will surgically insert a permanent soft tube (catheter) into your abdomen. They’ll teach you how to add the dialysate and later drain the solution through the catheter.

How long does dialysis last?

It depends on the type of dialysis.

In-center hemodialysis takes about three to four hours to complete, and you’ll likely need it at least three times per week. Depending on the type of at-home hemodialysis, you may need it three to seven days per week, and sessions may last between three and eight hours.

Continuous ambulatory peritoneal dialysis usually takes about 40 minutes, and you’ll likely need three to five sessions each day. Automated peritoneal dialysis may take eight to 12 hours, and you may need to do it every day.

Risks / Benefits:

What are the benefits of dialysis?

The primary benefit of dialysis is that it treats kidney failure by filtering waste products and excess fluid from your blood. Without dialysis — or a kidney transplant — kidney failure is fatal.

Both types of dialysis have distinct benefits. Talk to a healthcare provider — they can review both types of dialysis with you and recommend one that’s best for you and your lifestyle.

Can kidneys start working again after dialysis?

Dialysis can’t cure end-stage kidney disease or kidney failure. Unless you get a kidney transplant, you’ll need dialysis for the rest of your life.

What are the risks or complications of dialysis?

Both types of dialysis have risks. They both increase your risk of infection.

Hemodialysis may eventually lead to poor blood flow or a blockage from scar tissue or a blood clot. Rarely, the dialysis needle may come out of your arm, or a tube may dislodge from the machine. But a detection system will temporarily shut down the machine and alert medical staff to protect you from blood loss.

Peritoneal dialysis increases your risk of peritoneum inflammation (peritonitis). Over time, it can weaken your abdominal muscles and increase your risk of developing a hernia.

Talk to a healthcare provider about the complete list of risks or complications for each type of dialysis.

Is dialysis painful?

You may feel a slight pinch during hemodialysis when a healthcare provider inserts a needle. But the process isn’t painful.

Peritoneal dialysis isn’t painful. But the dialysate in your abdomen can make you feel bloated, cold and uncomfortable.

Recovery and Outlook:

What is life expectancy on dialysis?

Life expectancy varies from person to person, with some people living for many years on dialysis. Your outlook depends on many factors, including:

* Your age
* Your overall health
* The cause of your kidney failure

If you get a kidney transplant, you can stop dialysis when your new kidney starts working.

Will I have activity restrictions while I’m on dialysis?

Many people on dialysis continue to live active lives, including working, raising families and traveling. When you travel, a healthcare provider can help arrange for you to get dialysis at a center at your travel destination. If you’re doing peritoneal dialysis, you can take dialysis solution bags and a portable home dialysis machine (if necessary) with you.

If you use peritoneal dialysis, you may need to limit your exercise or certain physical activities when your abdomen fills with dialysate. Otherwise, exercise is OK for people on dialysis. Talk to your provider about specific activities and sports.

When To Call the Doctor:

When should I call a healthcare provider?

Call your healthcare provider if you experience:

* Trouble peeing
* Dizziness, fainting, unusual thirst (dehydration) or other signs of low blood pressure
* Nausea and vomiting
* Signs of infection, including a fever, chills, headache or oozing and discoloration at your catheter site
* Severe abdominal pain
* Signs of a hernia, such as an unusual bulge in your abdomen or groin.

Additional Information

Dialysis, in medicine, is the process of removing blood from a patient whose kidney functioning is faulty, purifying that blood by dialysis, and returning it to the patient’s bloodstream. The artificial kidney, or hemodialyzer, is a machine that provides a means for removing certain undesirable substances from the blood or of adding needed components to it. By these processes the apparatus can control the acid–base balance of the blood and its content of water and dissolved materials. Another known function of the natural kidney—secretion of hormones that influence the blood pressure—cannot be duplicated. Modern dialyzers rely on two physicochemical principles, dialysis and ultrafiltration.

In dialysis two liquids separated by a porous membrane exchange those components that exist as particles small enough to diffuse through the pores. When the blood is brought into contact with one side of such a membrane, dissolved substances (including urea and inorganic salts) pass through into a sterile solution placed on the other side of the membrane. The red and white cells, platelets, and proteins cannot penetrate the membrane because the particles are too large. To prevent or limit the loss of diffusible substances required by the body, such as sugars, amino acids, and necessary amounts of salts, those compounds are added to the sterile solution; thus their diffusion from the blood is offset by equal movement in the opposite direction. The lack of diffusible materials in the blood can be corrected by incorporating them in the solution, from which they enter the circulation.

Although water passes easily through the membrane, it is not removed by dialysis because its concentration in the blood is lower than in the solution; indeed, water tends to pass from the solution into the blood. The dilution of the blood that would result from this process is prevented by ultrafiltration, by which some of the water, along with some dissolved materials, is forced through the membrane by maintaining the blood at a higher pressure than the solution.

The membranes first used in dialysis were obtained from animals or prepared from collodion; cellophane has been found to be more suitable, and tubes or sheets of it are used in many dialyzers. In the late 1960s hollow filaments of cellulosic or synthetic materials were introduced for dialysis; bundles of such filaments provide a large membrane surface in a small volume, a combination advantageous in devising compact dialyzers.

Dialysis—which was first used to treat human patients in 1945—replaces or supplements the action of the kidneys in a person suffering from acute or chronic renal failure or from poisoning by diffusible substances, such as aspirin, bromides, or barbiturates. Blood is diverted from an artery, usually one in the wrist, into the dialyzer, where it flows—either by its own impetus or with the aid of a mechanical pump—along one surface of the membrane. Finally the blood passes through a trap that removes clots and bubbles and returns to a vein in the patient’s forearm. In persons with chronic kidney failure, who require frequent dialysis, repeated surgical access to the blood vessels used in the treatments is obviated by provision of an external plastic shunt between them.

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