Hemodialysis

1 What is a Hemodialysis?

When your kidneys are not working efficiently in filtering wastes, such as salts and fluids from your blood, a hemodialysis will be used.

Hemodialysis is currently the most advanced method of kidney failure treatment. This procedure can help you carry on an active life despite having failing kidneys.

A strict schedule must be followed in hemodialysis, take medications regularly and, usually, make changes to your diet.

Hemodialysis is a serious responsibility, but you do not have to go through it alone.

You will work closely with your health care team, including a kidney specialist and other professionals with experience managing hemodialysis. It is a possibility to do hemodialysis at home.

Peritoneal dialysis is another way to remove waste products from your blood when your kidneys are not carrying out their normal function.

During peritoneal dialysis, blood vessels in your abdominal lining (peritoneum) fill in for your kidneys with the help of a cleansing fluid that flows into and out of the peritoneal space.

2 Reasons for Procedure

Here are the most common reasons to receive a hemodialysis.

Your doctor will determine when you can start hemodialysis based on the following factors, your overall health, kidney function, signs and symptoms, quality of life and personal preferences.

You might begin to notice the signs and symptoms of kidney failure (uremia), such as nausea, vomiting, swelling or fatigue.

You doctor will use your estimated glomerular filtration rate (eGFR) to measure your level of kidney function.

Your eGFR is calculated with the help of the results of your blood creatinine test, sex, age and other factors. A normal value varies with age. T

his measure of your kidney function can be helpful in the planning of the treatment, including when you start hemodialysis.

Hemodialysis can be helpful to the body in the regulation of blood pressure and maintaining the proper balance of fluids and other minerals, such as potassium and sodium in your body.

Hemodialysis normally begins well before your kidneys have shut down to the point of causing life-threatening complications.

Common causes of kidney failure includes:

However, your kidney may suddenly shut down (acute kidney injury) as a result of a severe illness, complicated surgery, heart attack or any other serious problem. Certain medication can also cause kidney injury.

Some individuals who have severe long-standing (chronic) kidney failure may opt for a different path, choosing maximal medical therapy, which is also known as maximum conservative management, instead of dialysis.

This procedure involves active management of complications of advanced chronic kidney diseases, such as a fluid overload, high blood pressure, and anemia.

Ask your health care team for more information about your options.

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3 Potential Risks

Along with undergoing hemodialysis comes potential risks. The majority of individuals who need hemodialysis have a variety of health problems.

Many people's lives can be prolonged by hemodialysis, however, the life expectancy for the individuals who need it is still less than that of the general population.

Hemodialysis can be effective in replacing some of the kidney's lost functions. However, you may experience some of the related conditions listed below although not everyone experiences these issues.

Your dialysis team can help you deal with them. Low blood pressure (hypotension). A drop in blood pressure is a common side effect of hemodialysis, especially of you are diabetic.

Low blood pressure can also be accompanied by shortness of breath, abdominal cramps, and muscle cramps nausea or vomiting.

Muscle cramps. The cause of muscle cramps has not yet been clarified. Sometimes the cramps can be eased by adjusting the hemodialysis prescription.

Adjusting fluid and sodium intake between hemodialysis treatments may also help in the prevention of symptoms during treatment.

Itching. Itchy skin is also another characteristic of individuals who undergo hemodialysis. This itching is often worse during or after the procedure.

Bone disease. If you damaged kidneys no longer have the capability of processing vitamin D, which aids in the absorption of calcium, your bones may weaken.

In addition, overproduction of parathyroid hormone (a common complication of kidney failure) can release calcium from your bones. High blood pressure (hypertension).

If you consume too much salt or drink too much fluid, your blood pressure is likely to get worse and lead to heart problems or strokes.

Fluid overload. Drinking more fluids than recommended after hemodialysis may lead to life-threatening complications, such as heart failure or fluid accumulation in the lungs (pulmonary edema).

Anemia. Not having enough red blood cells in your blood (anemia) is a common complication of kidney failure and hemodialysis.

Failed kidneys reduce the production of a hormone known as erythropoietin, which stimulates the formation of red blood cells. Diet restrictions, poor absorption of iron, frequent blood tests or removal of iron and vitamins by hemodialysis can also contribute to anemia.

Inflammation of the membrane surrounding the heart (pericarditis) insufficient hemodialysis can lead to inflammation of the membrane surrounding the heart, which can interfere with your heart's ability to pump blood to the rest of the body.

High potassium levels (hyperkalemia). Potassium is usually removed from the body by the kidneys. If you eat more potassium than recommended, your potassium level may become too high. In serious cases, very high potassium levels can lead to your heart stopping.

Amyloidosis. Dialysis-related amyloidosis develops when proteins in blood are deposited on joints and tendons, causing pain stiffness and fluid accumulation in the joints.

This condition is more common in people who have undergone hemodialysis for more than five years.

Access site complications. Potentially harmful complications, such as infection, narrowing or ballooning of the blood vessel wall (an aneurysm), or blockage, can impact the quality of your hemodialysis.

Make sure you follow the instructions of your hemodialysis team on how to check for changes in your access that may indicate a problem.

Depression. Mood swings are common in people with kidney failure if you experience depression or anxiety after starting hemodialysis, talk to your health care team about effective treatment options.

4 Preparing for your Procedure

Preparation for hemodialysis begins several weeks to months before your first procedure. To allow for easy access to your bloodstream, your surgeon will create a vascular access.

This access will provide a mechanism for a small amount of blood to be safely removed from your circulation and then returned to you in order for the hemodialysis process to work.

The surgical access needs time to heal before you can begin hemodialysis treatments.

There are three types of accesses:

Arteriovenous (AV) fistula. A surgically created AV fistula is a connection between an artery and a vein, usually in the arm you use less often. This is the preferred type of access because of effectiveness and safety.

AV graft. If you blood vessels are too small to form an AV fistula, the surgeon may instead create a path between an artery and a vein using a flexible synthetic tube called a graft.

Central venous catheter. If you need emergency hemodialysis, a plastic tube (catheter) may be inserted into a large vein in your neck or near or groin.

The catheter is temporary. It is extremely important to take care of your access in order to decrease the risk of infection and other complications.

Follow your health care team's instructions about caring for your access.

5 What to Expect

Here’s what you can expect before, during, and after your hemodialysis.

Hemodialysis can be done in a dialysis center, at home or in a hospital.

The frequency of treatment varies, depending on your situation:

In-center hemodialysis. Many people get hemodialysis three times a week in sessions of three to five hours each.

Daily hemodialysis. This involves more frequent, but shorter sessions, usually performed at home six or seven days a week for about two to three hours each time.

Simpler hemodialysis machines have made home hemodialysis less cumbersome, so with special training and someone to help you, you may be able to do hemodialysis at home. You may even be able to do the procedure at night while you sleep.

There are dialysis centers located throughout the United States and in some other countries, so you can travel to many areas and still receive your hemodialysis on schedule.

Your dialysis team can help you make appointments at other locations, or you can contact the dialysis center at your destination directly. Plan ahead to make sure space is available and proper arrangements can be made.

The procedure During treatments, you sit or recline in a chair while your blood flows through the dialyzer — a filter that acts as an artificial kidney to clean your blood.

You can use the time to watch TV or a movie, read, nap, or perhaps talk to your "neighbors" at the center. If you receive hemodialysis at night, you can sleep during the procedure.

Preparation. Your weight, blood pressure, pulse, and temperature are checked. The skin covering your access site — the point where blood leaves and then re-enters your body during treatment — is cleansed.

Starting. During hemodialysis, two needles are inserted into your arm through the access and taped in place to remain secure. Each needle is attached to a flexible plastic tube that connects to a dialyzer.

Through one tube, the dialyzer filters your blood a few ounces at a time, allowing wastes and extra fluids to pass from your blood into a cleansing fluid called dialysate. The filtered blood returns to your body through the second tube.

Symptoms. You may experience nausea and abdominal cramps as excess fluid is pulled from your body — especially if you have hemodialysis only three times a week rather than more often.

If you're uncomfortable during the procedure, ask your care team about minimizing side effects by such measures as adjusting the speed of your hemodialysis, your medication or your hemodialysis fluids.

Monitoring. Because blood pressure and heart rate can fluctuate as excess fluid is drawn from your body, your blood pressure and heart rate will be checked several times during each treatment.

Finishing. When hemodialysis is completed, the needles are removed from your access and a pressure dressing is applied to the site to prevent bleeding.

Your weight may be recorded again. Then you're free to go about your usual activities until your next session

6 Procedure Results

If you do not understand your hemodialysis results, consult with your doctor.

If you had sudden (acute) kidney injury, you may need hemodialysis only for a short time until your kidneys recover.

If you had reduced kidney function before a sudden injury to your kidneys, the chances of full recovery back to independence from hemodialysis are lessened.

If hemodialysis is started in an emergency, and later it's determined you may need dialysis for the rest of your life, your dialysis team can explain other types of dialysis so that you learn which options can help you reach your goals.

Although in-center, three-times-a-week hemodialysis is more common, some studies suggest that home dialysis is linked to:

  • Better quality of life Increased well-being
  • Reduced symptoms and less cramping, headaches and shortness of breath
  • Improved appetite, sleeping patterns, energy level and ability to concentrate

Your hemodialysis care team monitors your treatment to make sure you're getting the right amount of hemodialysis to remove enough wastes from your blood.

Your weight and blood pressure are monitored very closely before, during and after your treatment.

About once a month, you'll receive these tests:

  • Blood tests to measure urea reduction ratio (URR) and total urea clearance (Kt/V) to see how well your hemodialysis is removing waste from your body
  • Blood chemistry evaluation and assessment of blood counts
  • Measurements of the flow of blood through your access during hemodialysis
  • Your care team may adjust your hemodialysis intensity and frequency based, in part, on test results.

Between treatments. Between hemodialysis treatments, you can help achieve the best possible results from your hemodialysis by:

Eating the right foods. Eating properly can improve your hemodialysis results and your overall health. While you're receiving hemodialysis, you'll need to carefully monitor your intake of fluids, protein, sodium, potassium and phosphorus.

A dietitian can help you develop an individualized meal plan based on your weight, personal preferences, remaining kidney function and other medical conditions, such as diabetes or high blood pressure.

Taking your medications as prescribed. Carefully follow the instructions from your health care team. Allowing your team to assist you by discussing your concerns.

Your health care team can present options to you and help you deal with any concerns.

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