Dialysis is a medical treatment for individuals whose kidneys no longer effectively filter waste products and excess fluid from the blood, preventing a buildup of toxins. This treatment performs the kidneys’ filtering duties, removing substances like nitrogen waste (urea), muscle waste (creatinine), and acids. It helps maintain overall health and can extend a patient’s life.
Types of Dialysis
Two main types of dialysis are available: hemodialysis and peritoneal dialysis. Both methods remove waste and extra fluid, but differ in approach and setting. The choice between them depends on a patient’s medical condition and lifestyle preferences.
Hemodialysis
Hemodialysis involves a machine that filters a patient’s blood outside the body. It typically occurs in a specialized clinic, though home treatment is also an option. Patients usually undergo hemodialysis three times a week, with each session lasting approximately three to five hours.
Vascular access is created to allow blood flow to and from the machine. The most common access is an arteriovenous (AV) fistula, surgically connecting an artery and a vein in the arm. If veins are unsuitable, an AV graft (a plastic tube connecting an artery and a vein) can be inserted. A central venous catheter, placed in a large vein in the neck or chest, is another option, often for immediate access.
Peritoneal Dialysis
Peritoneal dialysis uses the abdominal lining, the peritoneal membrane, as a natural filter. A cleansing solution, dialysate, is introduced into the abdomen through a surgically implanted catheter. This fluid remains in the abdomen for several hours, absorbing waste products and excess fluid from the blood.
After a “dwell time,” the used dialysate, now containing waste, drains from the abdomen through the catheter. This entire process is called an “exchange.” Peritoneal dialysis is usually performed daily at home, offering more flexibility than in-center hemodialysis. There are two primary methods: Continuous Ambulatory Peritoneal Dialysis (CAPD), where exchanges are done manually three to five times a day, each taking about 30 minutes, and Automated Peritoneal Dialysis (APD), which uses a machine called a cycler to perform exchanges overnight while the patient sleeps.
The Dialysis Experience
Dialysis involves specific physical and emotional sensations during and after treatment. In a clinic, hemodialysis typically occurs in a treatment room with multiple chairs or beds. Patients are connected to the dialysis machine via their vascular access.
During a hemodialysis session, patients might read, watch television, or sleep. For peritoneal dialysis, the process involves connecting and disconnecting fluid bags, either manually throughout the day or automatically overnight with a machine. While generally not painful, patients may feel a pulling sensation during fluid removal, particularly with significant fluid gain between sessions.
Common side effects include fatigue, weakness, and muscle cramps. These symptoms are often related to shifts in fluid or mineral balance during the filtering process. Some individuals may experience a temporary drop in blood pressure, leading to dizziness or nausea. Itchy skin can also occur due to the buildup of waste products between sessions. These common effects can often be managed with treatment adjustments or medication.
Dialysis treatments require a substantial time commitment. Hemodialysis typically requires several hours per session multiple times a week, plus travel time to and from the center. Peritoneal dialysis is a daily commitment, though it offers more flexibility as it’s performed at home. After a session, patients may need recovery time to manage fatigue or other temporary side effects before resuming normal activities.
Living with Dialysis
Living with dialysis requires significant adjustments to daily life, extending beyond treatment sessions. A renal diet and fluid restrictions are usually recommended to manage symptoms and prevent complications. This often involves limiting sodium, potassium, and phosphorus, as these substances can accumulate when kidneys fail.
Fluid intake is carefully monitored to prevent excess buildup, which can lead to swelling, high blood pressure, and breathing difficulties. Patients learn strategies to manage thirst, such as sipping beverages, using small cups, or consuming ice chips. Working with a dietitian helps understand these dietary complexities and create a personalized plan.
Medication management is another important aspect of living with dialysis. Patients often need various medications to control blood pressure, address anemia, or support bone health. Adhering to these schedules is important for overall well-being.
Dialysis can impact daily routines, work, and social activities. Maintaining a balance between treatment, personal life, and energy levels is a continuous process. Engaging in light physical activity and prioritizing sleep can help manage physical symptoms and improve quality of life.
Emotional well-being is also a significant consideration, as patients may experience frustration, anxiety, or depression. Support groups, counseling, and open communication with the healthcare team provide valuable emotional support. Regular medical appointments and blood tests are ongoing needs to monitor health and adjust the treatment plan.