Dialysis Explained

Dialysis Explained

What is Dialysis?

Dialysis is a life-saving therapeutic procedure that performs the function of the kidneys when they are unable to work properly. It removes waste products, excess fluids, and toxins from the blood, helping maintain electrolyte balance and preventing the buildup of harmful substances. Dialysis is essential for people with kidney failure or severe kidney disease.

Procedure Classification

• Type: Therapeutic Procedure
• Explanation: Dialysis is a treatment that replaces kidney function, helping patients manage kidney failure and maintain normal bodily processes.

Dialysis Statistics

• In the UK, over 30,000 patients receive dialysis annually.
• Worldwide, around 3 million people rely on dialysis treatment.
• End-stage renal disease (ESRD) is the leading reason for dialysis, often resulting from diabetes or high blood pressure.

Types of Dialysis

1. Hemodialysis: Blood is filtered outside the body using a dialysis machine and returned after removing waste.
2. Peritoneal Dialysis: Uses the body’s peritoneal membrane (abdominal lining) to filter waste via a catheter.
   • Continuous Ambulatory Peritoneal Dialysis (CAPD): Done manually throughout the day without a machine.
   • Automated Peritoneal Dialysis (APD): Uses a machine to perform dialysis at night.

Anatomy and Physiology

Dialysis primarily focuses on the renal (kidney) system and bloodstream:

• Kidneys: Normally filter waste and fluids from the blood.
• Blood Vessels (arteries and veins): Blood is accessed via a fistula, graft, or catheter for hemodialysis.
• Abdominal Cavity (Peritoneum): Used as a filtering membrane in peritoneal dialysis.

Who needs Dialysis?

• Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD).
• People with severe kidney damage due to conditions such as:
  • Diabetes (Type 1 or Type 2).
  • High blood pressure (Hypertension).
  • Polycystic kidney disease.
• Acute kidney injuries that cause temporary kidney failure.

Costs & Coverage

• Cost in the UK: Hemodialysis costs around £30,000–£40,000 per year per patient.
• NHS Coverage: Dialysis is provided free of charge under the NHS for eligible patients.
• Private Insurance: Most private insurance policies cover dialysis treatments when medically required.

Health Symptoms & Illnesses

Dialysis is often used to treat or manage:

• Kidney failure (ESRD or acute kidney injury).
• Uremia: Build-up of toxins in the blood.
• Fluid overload: Excess fluid in the body.
• Electrolyte imbalances (e.g., potassium and sodium levels).

Health Professionals

• Nephrologists: Kidney specialist who oversees dialysis treatment.
• Dialysis Nurses: Administers and monitors dialysis sessions.
• Vascular Surgeons: Creates access points like fistulas for hemodialysis.
• Dietitians: Helps manage nutrition tailored to dialysis needs.
• Technicians: Operate dialysis machines and assist during treatments.

Questions to Ask

• What type of dialysis is best for me—hemodialysis or peritoneal dialysis?
• How often will I need dialysis?
• How long will each session last?
• Can I perform dialysis at home?
• What are the side effects of dialysis?
• How will dialysis affect my daily routine?
• What dietary changes do I need to make?
• Are there risks of infections or complications?

Dialysis Process

Before the Procedure

• For hemodialysis, a vascular access (fistula, graft, or catheter) is created.
• For peritoneal dialysis, a catheter is inserted into the abdomen.
• Patients are advised to follow dietary and fluid restrictions.

During the Procedure

Hemodialysis:

1. Blood is drawn from the body through the vascular access.
2. Blood passes through a dialysis machine that filters out waste and excess fluids.
3. Clean blood is returned to the body.
4. Each session lasts 3–4 hours and is done 3 times per week.

Peritoneal Dialysis:

1. Dialysis fluid is introduced into the abdominal cavity through a catheter.
2. Waste and excess fluids pass from the blood into the fluid through the peritoneal membrane.
3. The fluid is drained and replaced regularly.

After the Procedure

• Blood pressure and weight are monitored to check fluid balance.
• Patients can resume most normal activities after dialysis sessions.

Recovery Process

• Recovery is immediate after dialysis, but fatigue is common after hemodialysis sessions.

Preparation

Nutrition Dos and Don’ts

• Do:
  • Eat high-protein foods (fish, chicken, eggs).
  • Limit potassium (bananas, oranges, spinach).
  • Follow a low-sodium diet.
• Don’t:
  • Consume too much fluid.
  • Eat foods high in phosphorus (dairy, nuts, beans).

Lifestyle Dos and Don’ts

• Do:
  • Follow medical advice on exercise.
  • Monitor fluid intake daily.
  • Maintain hygiene to prevent infections.
• Don’t:
  • Skip dialysis appointments.
  • Smoke or consume alcohol excessively.

Results

Dialysis does not cure kidney disease but effectively removes waste, toxins, and fluids from the body. Blood tests are performed regularly to assess:

• Electrolyte levels (e.g., potassium, sodium).
• Blood urea nitrogen (BUN) and creatinine.
• Hemoglobin levels to monitor anemia.

Diagnosis

Dialysis supports diagnosis by helping manage and monitor conditions like kidney failure and fluid overload, which can be identified via blood tests and symptoms.

Risks and Benefits

Risks:

• Infection (catheter-related or fistula infections).
• Low blood pressure during hemodialysis.
• Peritonitis (infection in peritoneal dialysis).
• Fatigue or muscle cramps.

Benefits:

• Removes waste and toxins.
• Prevents complications of kidney failure.
• Prolongs life for patients with kidney disease.

Alternatives

• Kidney Transplant: A long-term solution for kidney failure.
• Conservative Management: Lifestyle changes and medication for non-dialysis patients.
• Continuous Renal Replacement Therapy (CRRT): For acute kidney failure in critical care settings.

Health Monitoring

Health professionals regularly monitor:

• Blood pressure, weight, and fluid balance.
• Blood tests for kidney function.
• Access points for infections or blockages.

Clinical Products

• Erythropoietin (EPO): Medication to treat anemia.
• Phosphate Binders: Reduce phosphorus levels in blood.
• Potassium Binders: Manage high potassium levels.
• Dialysis Catheters: Used for blood access in hemodialysis.
• Home Dialysis Machines: For patients performing dialysis at home.

Services

• NHS Dialysis Units: Provide hemodialysis services across the UK.
• Home Dialysis Programs: Allow patients to perform dialysis at home.
• Renal Dietitian Services: Customized nutrition advice.
• Private Dialysis Centers: Faster access to dialysis for private patients.
• Support Groups and Apps: Provide education, reminders, and peer support.

Frequently Asked Questions

1. What is dialysis?
   A procedure to replace kidney function by removing waste and excess fluids.
2. How long does dialysis take?
   Hemodialysis takes 3–4 hours, 3 times per week.
3. Is dialysis painful?
   The procedure is generally painless, though discomfort at the access point can occur.
4. Can dialysis be done at home?
   Yes, peritoneal dialysis and home hemodialysis options are available.
5. Are there any side effects?
   Fatigue, low blood pressure, and infections are possible.
6. How long can someone live on dialysis?
   Patients can live for 10–20 years or more with proper treatment.
7. What happens if I miss dialysis sessions?
   Missing sessions can lead to a build-up of toxins and severe complications.
8. Can I eat and drink normally on dialysis?
   Diet must be carefully managed to control fluid and nutrient intake.
9. What’s the difference between hemodialysis and peritoneal dialysis?
   Hemodialysis filters blood externally; peritoneal dialysis uses the abdominal lining.
10. Will dialysis cure my kidney disease?
    No, it manages the condition but does not cure kidney failure.