Hemodialysis is a process of filtering wastes and fluid from your body, after your kidneys are no longer healthy. Hemodialysis is one of the ways to treat advanced kidney failure and it helps one carry on an active life despite having failed kidneys.
With hemodialysis, one also needs to follow a healthy diet, take medications regularly as well as follow a strict treatment schedule. Although hemodialysis is a serious responsibility, you can work closely with a healthcare team rather than shouldering it alone. Dialysis can be done in a hospital or in your home as well. Based on your medical condition, it is always up to you and your doctor to decide, which option is best.
Your doctor can help you determine when you should start hemodialysis based on several factors, which include your overall health, kidney function, signs and symptoms, quality of life and also your personal preferences.
Your doctor uses the estimated glomerular filtration rate, to measure how well your kidney is functioning and this helps in planning your treatment including when to start hemodialysis.
Hemodialysis helps your body control blood pressure as well as to maintain the proper balance of fluid as well as various minerals, like potassium and sodium in the body. Normally, hemodialysis begins quite sometime before your kidneys have shut down to the point of causing complications that can be life-threatening.
Diabetes, high blood pressure, blood vessel inflammation, kidney cysts are some of the main causes of kidney failure. Your kidneys can also shut down all of a sudden after a severe illness, a heart attack or complicated surgery, or any such serious problem. Sometimes certain medications might also cause kidney injury. Some people with severe long-standing kidney failure can opt for a different path, choosing maximal medical therapy, which is called maximum conservative management as well, instead of dialysis. Some can also go choose to go for a kidney transplant.
Preparation for hemodialysis usually starts several weeks to months before your first procedure. For allowing easy access to your bloodstream, a surgeon will be creating vascular access. The access provides a mechanism for a small amount of blood to be safely removed from your circulation after which it is returned to you in order for the process of hemodialysis to work. The surgical access requires time to heal before you begin hemodialysis treatments.
There are three different types of accesses-
- Arteriovenous fistula: A surgically created AV fistula, which is a connection between an artery and a vein, usually in your non-dominant arm. Due to its effectiveness as well as safety, this is the most effective as well as safe method.
- Central venous catheter: If you require emergency hemodialysis, a plastic tube might be inserted into a large vein in your neck or near your groin. The catheter is for a temporary basis.
- AV graft: If your blood vessels are found to be too small for creating an AV fistula, your surgeon may instead choose to create a path between an artery and a vein using a flexible, synthetic tube which is called a graft.
During the treatment procedure, you sit or recline in a chair while your blood flows through the dialyzer, a filter that acts as an artificial kidney to clean the blood. At this time, you can read a book, watch a movie or even take a nap. If you receive it during the night, you can just sleep while the procedure is on.
Your weight, blood pressure, temperature and pulse are checked at first. The skin which is covering your access site, which is the point where blood leaves as well as re-enters the body during treatment, is cleansed.
At first, two needles will be inserted into your arm through your access site, and taped in place to make it remain secure. Each needle is attached properly to a flexible plastic tube that connects to a dialyzer. Through one tube, the dialyzer filters the blood a few ounces at a time, which allows wastes and extra fluids to pass from your blood into a cleansing fluid which is called dialysate. Then, the filtered blood returns to your body, with the help of the second tube. The needles in your fistula or graft can be uncomfortable and most patients get used to this within some time. Talk to your dialysis care team and make sure you are comfortable during the treatment.
Keep in mind that you might be experiencing some symptoms like nausea or abdominal cramps. This is due to the fact that excess fluid is being pulled from the body, especially if you are having hemodialysis three times a week, rather than more often. If you feel too much discomfort, you can ask your care team to help minimize the side effects by taking measures like adjusting the speed of your hemodialysis, your medication or your hemodialysis fluids.
Since blood pressure and heart rate can keep fluctuating as excess fluid is being drawn from the body, your blood pressure and heart rate will be checked multiple times during every treatment.
When the hemodialysis is complete, the needles are removed from your access site. After this, a pressure dressing is applied for preventing bleeding. Your weight might need to be recorded once more. After this, you are free to carry on your usual activities, until your next session.
If you had a sudden kidney injury, you might need hemodialysis only once in a short time, until they recover. If you had reduced kidney function before a sudden injury to the kidneys, the chances of full recovery back to independence from hemodialysis are quite less.
Three-times a week hemodialysis is quite common and according to a few types of research, it has been suggested that home dialysis is linked to:
- Increased well-being
- Better quality of life
- Reduced symptoms and less cramping, headaches as well as shortness of breath
- Improved appetite, sleeping patterns, energy level and the ability to concentrate.
Your hemodialysis care team will monitor your treatment to make sure that you are getting the right amount of hemodialysis to remove enough wastes from your blood. Your weight and blood pressure are monitored very closely before, during as well as after your treatment. About once a month, you will receive these tests:
- Blood tests for measuring urea reduction ratio and total urea clearance, for making sure how well your wastes are being removed from your body.
- Blood chemistry evaluation as well as an assessment of blood counts.
- Measurements of the flow of blood through the access during your hemodialysis.
Despite its benefits, hemodialysis can also cause a variety of health problems. Some of them include low blood pressure, muscle cramps, sleep problems, itching, anemia, fluid overload, bone diseases, high blood pressure, complications in the access site complications, high potassium levels, inflammation of the membrane which surrounds the heart, amyloidosis or depression.