It is a treatment that helps your kidneys continue to work when they have stopped working properly.
It removes salt and waste from your body, maintains a safe level of chemicals in your blood, and keeps your blood pressure under control.
When do I need dialysis?
Your kidneys are two bean-shaped organs that are located just below your rib cage, on either side of your spine. They remove waste from your body, level your blood pressure, and keep your bones strong.
They also make sure you have the correct amount of chemicals, such as potassium and sodium (salt), in your blood. Finally, they produce the hormone that makes your body create red blood cells.
Types of kidney dialysis
- Hemodialysis : Your blood passes through a filter outside your body, is cleaned, and then returns to you. This is done in a dialysis center or at home.
- Peritoneal dialysis – Your blood is cleaned inside your body. A special fluid is placed in your abdomen to absorb wastes from the blood that passes through small vessels in the abdominal cavity. The fluid is then drained. This type of dialysis is usually done at home.
Who needs this treatment?
If you have chronic kidney disease, you will need dialysis or a kidney transplant at some point. “Chronic” means that you have been slowly losing kidney function over a period of time.
Some people choose to start dialysis before they develop symptoms of kidney failure, such as nausea or fatigue, bloating, and vomiting. Even if you don’t have symptoms, you can choose to start treatment if lab tests show toxic levels of waste in your blood.
When you should start dialysis depends on your age, energy level, general health, and how willing you are to commit to a treatment plan. Although it can make you feel better and live longer, it involves a lot of your time.
Your doctor will inform you when to start treatment. He will also explain which type may work best for you.
First, you will need minor surgery to create direct access to your bloodstream. This can be done in several ways:
Fistula (also known as arteriovenous fistula or AV fistula) : An artery and a vein meet under the skin of your arm. Most of the time, this is done where it is not written. An AV fistula takes only about 6 weeks to heal before it can be used for hemodialysis. So, it can be used for many years.
Graft (arteriovenous or AV graft) : A plastic tube is used to join an artery and a vein under the skin. This heals in just 2 weeks, so you can start hemodialysis faster. This will not last as long as a fistula. You will likely need another graft after a few years.
The risk of infection is higher with a graft. You will also need to see your doctor more often to make sure the graft remains open.
Catheter (central venous catheter) : This method is an option if you need to start hemodialysis very quickly. A flexible tube (catheter) is placed in a vein in the neck, under the collarbone, or near the groin. It should only be used for a short time.
During hemodialysis, you will sit or lie down in a chair. A technician will place two needles in your arm where the fistula or graft is located.
A pump in the hemodialysis machine slowly draws your blood and then sends it through another machine called a dialyzer. This works like a kidney and filters extra salt, waste, and fluids. The cleaned blood is sent back to your body through the second needle in your arm.
You can receive hemodialysis in a hospital, dialysis treatment center, or at home. If you have it in a center, the sessions last 3 to 5 hours, and you will probably only need them three times a week. If you have home hemodialysis, you will need treatments for 6 to 7 days for 2 to 3 hours at a time.
Some people read or watch television during treatment. If you have home hemodialysis, you may be able to do it at night while you sleep.
How does peritoneal dialysis (PD) work?
It uses the lining of your belly to filter your blood. A few weeks before starting treatment, a catheter is placed near your belly button. Once the area recovers, you will receive training on how to do PD as you will give it to yourself.
You will use the catheter to transfer the dialysis solution from a bag to your stomach. This special liquid contains water with salt and other additives. It absorbs waste and extra fluids into your body. After a few hours, you will drain it into a separate bag. This process is called “exchange.”
There are two types of PD
- Continuous Cycler Peritoneal Dialysis (CCPD): This uses a machine to do your exchanges.
- Continuous ambulatory peritoneal dialysis (CAPD): You will perform your exchanges by hand.
You will likely make four to six exchanges per day. Your doctor can help you decide which type fits your lifestyle. Some people do both.
It shouldn’t hurt. If you have pain during or after treatment, tell your doctor immediately. It can have side effects, however low blood pressure is common. You could also have:
- Dry or itchy skin
- Muscle cramps.
- Feeling very tired
You can decrease side effects by being careful what you eat and drink. Your doctor can tell you how much fluids, protein, and salt to have. Try to stay away from things that can harm your kidneys, such as alcohol, tobacco, or illegal drugs.
Hemodialysis patients are also at increased risk for infections.
Try these tips to stay healthy:
- Check your access site daily for redness, pus, and swelling. If you see any, call your doctor.
- Keep the bandage that covers your catheter clean and dry.
- Make sure anyone helping you with your treatment washes their hands before and after with soap and water.
What if I want to stop dialysis?
This treatment should maintain or improve your quality of life. But you can choose not to have it or stop at any time.
If you do, be sure to talk to your doctor about other treatments that can help you. Changes to your diet or lifestyle can improve your quality of life.
If you want to stop dialysis because you feel depressed or embarrassed, your doctor may ask you to speak with a counselor first.
Sharing your feelings, taking antidepressants, or doing both can help you make a more informed decision.