HEMODIALYSIS

INTRODUCTION

Hemodialysis is a procedure used to clean your blood. It removes waste products and fluid from the blood to maintain electrolyte balance. Hemodialysis machines and dialyzers are also called “Artificial kidneys”. Hemodialysis is used to treat advanced kidney failure by filtering waste, fluid, and salt from the blood because your kidneys are no longer healthy to do their work effectively. It is one of the best methods for kidney failure.

Hemodialysis can be an outpatient and inpatient therapy. It can help to control blood pressure and also maintain various minerals such as potassium, sodium, and calcium in your blood and maintain body fluid, which begins before your kidneys fail and causes life-threatening complications.

Hemodialysis can make you feel healthy and help you to live longer.

WHAT ARE THE SIGNS AND SYMPTOMS OF KIDNEY FAILURE?

Signs: –

  • Sapping your energy levels.
  • Increased need to go to the washroom.
  • Your urine consists of an excessive number of bubbles because of having a high concentration of protein in your urine.
  • swelling around your eyes.
  • Experience muscle cramps.
  • Skin gets itchy and dry.
  • Sometimes blood or red spots in urine.

Symptoms: –

  • Shortness of a breath.
  • Weakness.
  • Swelling in your legs and ankle.
  • Too much urine or not enough urine.
  • Itching.
  • Irregular heartbeat.
  • Nausea.
  • Vomiting.
  • Chest pain or pressure.
  • Seizures or sometimes coma.
  • Muscle cramps.
  • Fatigue.

CAUSES OF KIDNEY FAILURE

  • Diabetes.
  • Hypertension (high blood pressure).
  • Glomerulonephritis.
  • Kidney cyst.
  • Non-steroidal anti-inflammatory drugs from long-term use can harm kidneys.

HEMODIALYSIS COMPLICATIONS

  •  Hypotension [22-55%] – low blood pressure is the most seen side effect of Hemodialysis. Hypotension occurs because of many reasons such as; abdominal cramps, muscle cramps, shortness of breath, vomiting, or nausea.
  •  Muscle cramps [5-20%] – during Hemodialysis, muscle cramps are the most common symptom. We can say, by adding more medication to the Hemodialysis prescription, the chances of muscle cramps will decrease. Also, adjusting sodium and fluid intake may help prevent symptoms during Hemodialysis treatment.
  •  Nausea and vomiting [5-15%] – it is accompanied by hypotension.
  •  Headache [5%] – headache is one of the very common symptoms of Hemodialysis.
  •  Itching [5%] – during Hemodialysis, some people may suffer from itchy skin. This can be seen both during or after the procedure.
  •  The problem in sleeping – sleeping problems occur because of breaks in breathing during sleep, sometimes also because of itching or restlessness.
  •  Anemia – is a condition in which a lack of red blood cells in your body is a very common risk factor in Hemodialysis. Restriction in diet, periodic blood tests, and beggarly absorption of vitamins and iron can lead to anemia.
  •  Depression – suffering from lots of mood swings during treatment is common. Many people go through depression and anxiety after the Hemodialysis treatment.
  •  Hypertension – absorbing salt in too much amount will lead to a rise in blood pressure which causes a heart-related problem such as heart attack.
  •  Chest pain [2-5%]
  •  Back pain [2-5%]

DIALYSIS INDICATION

  •  Acidosis has a ph.<7.1.
  •  Electrolyte imbalance will be k + >6.5 MeQ/L
  •  GFR value is < 10ml/min.
  •  There will be an Overload of fluids that is pulmonary edema.
  •  Uremic symptoms will increase the level of nitrogenous waste products.

PRINCIPLE OF HEMODIALYSIS

  •  Diffusion – it is a passive movement of solute through a semipermeable membrane.
  •  Ultra-filtration – the solute and fluid removal through a semipermeable membrane down a pressure gradient.

PREPARATION OF HEMODIALYSIS

  • It takes several weeks to a month to start dialysis. 
  • In Hemodialysis, vascular access is required. Insert IV only in veins below the wrist.
  • Surgical access requires some time to heal before the beginning of treatment.

In vascular access surgery, three types of accesses are required – 

  • An arteriovenous (AV) fistula.
  • An AV graft.
  • A catheter.

Arteriovenous (AV) fistula

AV fistula is long-term access. A surgical connection is created between two structures that are the structure of an artery and the second is an adjacent native vein. An artery carries blood away from the heart and veins carry blood back to the heart.

The AV fistula makes the blood vessel wider so that the surgeon can easily place the needle that allows blood to flow and return from the machine.

Procedure of AV fistula are: –

  • The blood flow rate will be 300-500 ml/min.
  • Dialysate will be 500-800 ml/min.
  • It lasts for 4 hours which is usually done 3 times per week.

AV Graft

If there is any problem with having an AV fistula, then we use an AV graft. A fistula is not used when a blood vessel is too thin or small so for creating a path between artery and veins, we use a synthetic tube called a graft.

AV graft used just after the surgery. This sometimes causes repeated blood clots which can block the blood flow through the graft.

Central venous catheter 

The catheter is a small soft tube that is inserted through the neck, chest, and leg. It is an emergency Hemodialysis, used as a temporary access. In this process, local anesthesia is required to keep you calm and relaxed.

HEMODIALYSIS PROCEDURE

When blood flows through the dialyzer in which the filter machine acts as an artificial kidney, you can sit or relax and watch web series or whatever you like, without any tension or stress. Sometimes Hemodialysis has been given at night so during the process you can sleep also.

Now procedure contains 5 steps, they are: –

  1. Preparation – Firstly, your body weight, blood pressure, temperature, and pulse should be checked. Secondly, your access site should be checked, and lastly, cleansing of your access site from where blood leaves and enters your body.
  2. Starting – for starting the Hemodialysis process, two needles are inserted inside the veins that are the access site and tapped so that it doesn’t move from their position. Now both of these needles are attached to the dialyzer. One tube can filter your blood and the second one takes the filtered blood back to your body.
  3. Symptoms – during this whole process, you may suffer from nausea or vomiting-like symptoms because of excreted excessive fluid from your body. It also causes abdominal cramps. 

It can be reduced by decreasing the speed of your Hemodialysis process.

  1. Monitoring – because of drawing excessive fluid from the body, there should be a need of checking blood pressure and heart rate during the treatment.
  2. Finishing – after Hemodialysis, the needle has been removed and applied to dress the site to prevent bleeding. Your Weight should be recorded and then you are free to go home.

RESULT

If you are suffering from any kidney injury or kidney failure, Hemodialysis is the only method to cure your kidneys. Hemodialysis can help you to recover fully and give you a second chance to live your life happily.

Many doctors and patients are preferring home dialysis other than in-center dialysis. Home Hemodialysis has been done three times per week for a better life, decreased symptoms such as nausea and cramps, help in proper sleep, and increase in wellbeing. 

During Hemodialysis, doctors and technicians can monitor your body and help in faster recovery. They monitor your weight and blood pressure both during and after the treatment.

After completing one-month treatment, some blood tests should be run to measure urea reduction ratio and total urea clearance and also measure blood flow through the access site.

DURING TREATMENT

If you want better results of Hemodialysis you should focus on: –

  1. Should take the right and prescribed food – eating properly and eating healthy can cure any problem. When you are receiving Hemodialysis, you should take food rich in protein, vitamins, potassium, phosphorus, sodium, etc. during Hemodialysis, the doctor prescribed a dietitian, who helps you to maintain your weight and kidney function.
  2. Should take prescribed medicines – never skip your medicines that are prescribed by your doctor. If you are having any side effects after taking the prescribed medicine, you should immediately contact your health care team.
  3. Ask a question if you have any doubt – your doctor or technician can help you to deal with any problem regarding treatment.

PLACES TO RECEIVE HEMODIALYSIS

You can receive Hemodialysis treatment at home and also in the center. This can depend on how serious your condition is.

  • In center Hemodialysis – many people get Hemodialysis treatment at a hospital three times per week.

The session consists of 3 – 5 hours each.

 

  • Home Hemodialysis – this is the shortest session and is very frequent. It is usually performed at home by the technician.

This treatment requires 6 to 7 days per week.

The session consists of about 2 hours each time of the process. 

In-home Hemodialysis, simple machines are used. Also, home dialysis can be done by anyone who gets special training in this.

Home Hemodialysis is also the best method to do the procedure at night. It can relax the patient and help them to get great sleep as well as tension-free treatment at night.

There are many centers and hospitals in the United States, where you can travel and still receive your Hemodialysis on time. Your doctors and technician help you to make contact and appointments there.

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