Intermittent hemodialysis is a medical procedure used to treat kidney failure, a condition where the kidneys can no longer effectively filter waste products and excess fluid from the blood. This treatment takes over the functions a healthy kidney would normally perform. Its purpose is to remove harmful toxins, balance electrolytes, manage fluid levels, and help control blood pressure. It is a life-sustaining therapy for individuals with end-stage renal disease or acute kidney injury.
Mechanism of Intermittent Hemodialysis
Intermittent hemodialysis operates by circulating a patient’s blood outside the body through a specialized machine. This process involves several components: the dialysis machine, a filter known as a dialyzer (often called an artificial kidney), and a specially formulated dialysate solution.
Blood is drawn from the patient’s body through a vascular access point and flows through tubing into the dialyzer. Inside the dialyzer, the blood passes through thousands of tiny fibers that act as a semi-permeable membrane.
On the other side of this membrane, the dialysate solution flows in the opposite direction. The dialysate is a sterile fluid containing specific concentrations of electrolytes and minerals, mimicking healthy blood plasma. This counter-current flow maximizes the efficiency of waste removal.
Waste products like urea and creatinine, along with excess electrolytes such as potassium and phosphorus, move from the blood into the dialysate through diffusion. This process involves solutes moving from an area of higher concentration in the blood to an area of lower concentration in the dialysate, across the semi-permeable membrane.
Fluid removal, known as ultrafiltration, occurs through hydrostatic pressure. The dialysis machine creates a pressure difference across the dialyzer membrane, forcing excess water and some dissolved substances from the blood into the dialysate. This ensures that the patient’s fluid balance is maintained.
Once the blood has been filtered and cleansed, it is returned to the patient’s body through another set of tubing connected to the vascular access. The dialysate, now containing the removed waste products and excess fluid, is discarded. The process is monitored by sensors and alarms on the dialysis machine for safety and effectiveness.
The Treatment Experience
Before an intermittent hemodialysis session begins, a patient undergoes routine checks. This includes measuring their weight, blood pressure, and temperature to assess their fluid status and condition. These measurements help the medical staff tailor the treatment to the patient’s needs for the session.
Connecting to the dialysis machine involves accessing the patient’s vascular access site. For patients with an arteriovenous fistula or graft, two needles are inserted into the access point: one to draw blood out to the machine and another to return the cleaned blood. If a catheter is used, it can be connected directly to the dialysis tubes without the need for needles.
During the treatment, which lasts 3 to 5 hours, patients are seated comfortably in a clinic or hospital setting. Medical staff regularly monitor blood pressure, blood flow rates, and the machine’s parameters to ensure the process is running smoothly. Patients may read, watch television, or rest during this time.
Immediately after the session, common side effects can occur. Many patients experience fatigue, drained, or lightheadedness. Muscle cramps are a frequent occurrence due to the rapid removal of fluid and electrolytes. These effects subside within a few hours after treatment.
Living with Intermittent Hemodialysis
Intermittent hemodialysis treatments are scheduled three times a week, with each session lasting 3 to 5 hours. This regular schedule helps to manage waste buildup and fluid levels in the body. Frequency and duration can be adjusted based on individual medical needs and remaining kidney function.
Patients undergoing intermittent hemodialysis need to adhere to dietary and fluid restrictions. This involves limiting intake of sodium, potassium, and phosphorus, as these minerals can accumulate between treatments. Fluid intake is monitored to prevent fluid retention, which can lead to swelling and high blood pressure.
Medication adherence is an important aspect of living with hemodialysis. Patients take medications to manage associated conditions, such as blood pressure control, anemia, and bone health. Regular medical follow-ups with nephrologists, dietitians, and other healthcare providers are necessary to monitor health, adjust treatment plans, and address any complications.
Living with intermittent hemodialysis can present long-term challenges. Persistent fatigue is a common complaint, impacting daily activities. Patients may experience skin itching, sleep disturbances, and changes in appetite. Strategies for managing these challenges involve medication, dietary adjustments, and counseling.
Maintaining a social life and engaging in hobbies is challenging due to the time commitment of treatments and side effects. However, many patients find ways to adapt by scheduling activities around their dialysis sessions and connecting with support groups. Proper management and a supportive care team can help individuals lead fulfilling lives despite the demands of treatment.