How Does Dialysis Treat Kidney Failure?

Kidneys are part of the human urinary system. On either side of the spine, these two bean-shaped organs lay below the rib cage. They remove toxins from the blood and replace it with filtered and nutrient-rich blood to the bloodstream. The extra water and waste make urine, moving from the kidneys into the bladder. The kidneys also help regulate blood pressure. Kidneys filter your blood by eliminating waste and excess water, producing urine.

Dialysis is a type of treatment that replicates the functions of healthy kidneys. It is required when your kidneys are no longer capable of fulfilling your body’s requirements.

One needs dialysis when they acquire end-stage renal failure, which typically occurs once they’ve lost 85 to 90% of their kidney function and have a GFR (glomerular filtration rate) of less than 15. The GFR is a measurement of how successfully your kidneys filter blood. Dialysis maintains your body balance when your kidneys fail by:

1. Elimination of waste, salt, and excess water from the body and prevent accumulation of the same in the body
2. Maintains a safe level of specific chemicals in your blood, such as potassium, sodium, and bicarbonate
3. Regulates blood pressure

Kidney failure is usually irreversible. Some types of acute kidney failure, also known as acute renal failure, do improve with treatment. Dialysis may only be required for a short time in some cases of acute renal failure until the kidneys recuperate. The kidneys do not recover in chronic or end-stage renal failure, and the patient will require dialysis for the rest of his life.

Dialysis is often performed in a hospital, a dialysis unit outside of a hospital, or at home. Depending on the patient’s medical state, the patient and doctors decide on the best dialysis venue, mutually.

Types Of Dialysis

There are two types of dialysis, namely:

1. Hemodialysis  |  2. Peritoneal dialysis

What is Hemodialysis?

A machine takes blood from your body, filters it via a dialyzer (artificial kidney), and returns the cleansed blood to your body using hemodialysis. This 3- to 5-hour procedure may be performed three times each week in a hospital or dialysis clinic. Hemodialysis can also be performed at home. You may require at-home treatments four to seven times a week for fewer than two hours each time. You can undergo hemodialysis at night while sleeping.

Procedure of Hemodialysis

Before beginning hemodialysis, you will have a small surgical operation to allow better access to the bloodstream. You may have:

1. Arteriovenous fistula (AV fistula): An artery and vein in your arm are connected by a surgeon
2. Arteriovenous graft (AV graft): If the artery and vein are too short to unite, your surgeon will use a graft (a soft, hollow tube) to join them

AV fistulas and grafts increase the connected artery and vein, making dialysis access more convenient. They also aid in the quicker flow of blood in and out of the body. If dialysis is required instantly, your physician may insert a catheter (a thin tube) into a vein in your neck, chest, or leg to enable temporary access. Your physician will educate you on how to keep the fistula or graft infection-free.

The dialysis machine performs the following functions during hemodialysis:

1. Removes blood from a needle in your arm
2. Circulates blood through a dialyzer filter, transferring waste into a dialysis solution. This washing liquid is made up of water, salt, and other ingredients
3. Returns filtered blood to your body through a separate needle in your arm
4. Checks your blood pressure to see how quickly blood moves in and out of your body

Side Effects Of Hemodialysis

Low blood pressure can occur during or soon after hemodialysis for certain individuals. You may feel dizzy, nauseous, or faint. Other hemodialysis side effects include:

1. Chest pain or back pain
2. Headaches
3. Itchy skin
4. Muscle cramps
5. Restless legs syndrome

The duration for dialysis depends on various factors like:

1. Your kidney functions
2. Fluid weight gained in between dialysis
3. Quantity of your body waste
4. Your body weight
5. The kind of prosthetic kidney is utilised in dialysis

Each hemodialysis treatment typically lasts four hours and is performed three times a week.

High-flux dialysis, a kind of hemodialysis, requires less time. You can consult with your doctor to determine whether it is an appropriate therapy for you.

Potential Risk Of Hemodialysis

Some individuals experience complications with the AV fistula or graft. An infection, inadequate blood flow, or a blockage caused by scar tissue or a blood clot are all possibilities.

During dialysis, the dialysis needle seldom comes out of the arm, nor does a tube come out of the machine. A blood leak detecting device warns patients  and medical personnel of the situation. The machine is temporarily turned off while the problem is resolved. This mechanism guards against blood loss.

Peritoneal Dialysis

Peritoneal dialysis involves the use of microscopical vessels inside the abdominal lining (peritoneum) to filter blood with the use of a dialysis solution. This solution is a cleansing liquid made up of water, salt, and other additives. Peritoneal dialysis is performed at home.

There are two approaches to this treatment:

1. Continuous ambulatory peritoneal dialysis (CAPD) is performed manually. The only type of peritoneal dialysis that is performed without the use of machinery is Continuous Ambulatory Peritoneal Dialysis (CAPD). You do it yourself four or five times a day at home or at work. Through the catheter, you insert a bag of dialysate (approximately two quarts) into your peritoneal cavity. The dialysate remains there for around four to five hours before being drained back into the bag and discarded. This is known as an exchange. Each exchange requires the use of a new bag of dialysate. You can go about your normal activities at work, school, or home while the dialysate is in your peritoneal cavity.
2. Automated peritoneal dialysis uses a machine. APD (Automated Peritoneal Dialysis) is often performed at home using a specific equipment known as a cycler. This is similar to CAPD,  except that it involves a number of cycles (exchanges). Each cycle lasts around an hour and a half, and exchanges take place throughout the night while patients sleep.

Procedure Of Peritoneal Dialysis

A small surgical procedure will be performed around three weeks before you begin peritoneal dialysis. A soft, thin tube (catheter) is inserted through your abdomen and into the peritoneum by a surgeon. This catheter is permanently implanted. A healthcare expert will educate you how to administer peritoneal dialysis at home and how to prevent catheter-site infections.

The steps in a peritoneal dialysis are: