What is hemodialysis?
Kidneys remove toxins along with extra water as urine. So when somebody develops kidney failure, it gets difficult to get rid of toxins and extra water. Hemodialysis is a treatment process where these toxins are removed by making the blood pass through a filter, also known as a dialyser. The blood which has passed through this filter is much cleaner and is then returned to the body. The process of taking out and returning blood is done using an access- which may be a catheter, AV fistula or an AV graft. As one gets rid of the toxins and extra water, the patient starts feeling better. This may be noticed as improved appetite, ability to eat better, an ease in breathing and a sense of having better strength.
How long is hemodialysis needed?
Hemodialysis is an artificial way to remove toxins and extra water from the body- the job which is normally taken care of by the kidneys. When the function of kidneys is affected to an extent that toxins or fluid is troubling to the patient, hemodialysis is advised. So dialysis is needed till the kidneys start functioning well. This often happens in certain kidney diseases, broadly coming under the category of “Acute Kidney Injury”. When the kidneys recover from an acute injury, dialysis may not be needed any more. However, if the kidneys are an irreversible disease, they may never recover their function. Such patients have Chronic Kidney Disease and require dialysis lifelong or until they receive a kidney transplant.
How does my blood go into a dialysis machine?
Hemodialysis is a treatment process wherein the blood (loaded with accumulated toxins) is pumped through a filter (dialyser) and the cleaner blood is returned to the patient’s body. This process of taking out blood and returning it is done using a hemodialysis access. This access may be – a catheter, an AV fistula or an AV graft.
A catheter is generally placed in one of the veins in the neck/thigh. It is generally used when the patient doesn’t have a usable fistula/graft. Since it carries a certain risk of infection, having a usable AV fistula is desired. An AV fistula is created by connecting the blood vessels- an artery and a vein usually in the wrist, forearm or arm. The vessels mature in about a month or two to allow a good blood flow. Since a fistula doesn’t involve any foreign object, it is rare for a fistula to get infected. An AV graft is similar to fistula but uses a synthetic material to connect a vein and artery. It may be an option for patients with suboptimal vessels.
What is a “Good Dialysis” ?
A good dialysis session ensures that toxins are removed efficiently. The efficiency of hemodialysis depends on the following factors:
A) Blood Flow: The higher the blood flow, the more frequently the blood passes through the filter (dialyzer), leading to greater toxin removal during dialysis.
B) Duration: The longer the blood circulates through the filter, the more toxins can be removed. A typical dialysis session lasts about 4 hours. Shortening this time can result in inefficient toxin removal.
C) Frequency: While normal kidneys work 24/7 (168 hours a week) to remove toxic wastes from the body, dialysis cannot match this efficiency. However, more frequent dialysis sessions can improve toxin removal.
D) Suitable Filter: Filters vary in their efficiency, though most available filters already do a good job. Patients with greater body mass may however benefit with filter with larger surface area. Conversely, kids and adults with a small frame do well with smaller filters.
E) Type of Dialysis: A modality called hemodiafiltration may provide additional benefit. A good access allowing a good blood flow is quintessential.
How to avail benefits of a good dialysis?
As we discussed in previous posts- blood flow, duration and frequency of dialysis are major determinants of a good dialysis. As a patient, you can take care of following-
A) Access care- dialysis access is the lifeline of a dialysis patient. Find out from your doctor, as to how to care for your catheter or graft or fistula.
B) Blood flow- better the blood flow, greater the toxin removal. If your access doesn’t allow a good blood flow, speak to tour doctor about options.
C) Duration- Do not be in a hurry to get your dialysis session terminated. More time on dialysis allows more quantity of toxins to be removed. Every minute matters.
D) Frequency- in the same way, do not skip dialysis sessions. Infact skipping sessions can be dangerous as it can lead to life-threatening levels of potassium and fluid in lungs.
E) Cut down of liquid intake- Drinking too much water or other liquids can make the patients uncomfortable or cause breathless. Limit your fluid intake as prescribed by your doctor.
What does a better dialysis do to you?
Good dialysis means efficient toxin removal. Patients feel better- they are able to eat well and function well in their day to day life. They feel lesser fatigue and report better stamina. When the fluid removal is good, they are less likely to feel breathless and remain free of any swelling. Good dialysis along with good nutrition go hand in hand ensuring a longer and healthier life.
What else can the dialysis patients do to make their lives better?
It would be an understatement that being regular with dialysis is the first step to ensure good health. If you are sick, speak to your doctor to find out if any change in your dialysis prescription is needed. Do not skip dialysis without informing your doctor. It may be dangerous because of potassium or fluid accumulation.
Cutting down your liquid intake goes a long way in ensuring good health. By limiting your liquid intake, you can avoid discomfort of body swelling and breathlessness typically occur prior to next scheduled dialysis session. Also, larger volume of liquid removal during a session can lead to problems like cramps, low blood pressure and cause heart dysfunction on a long-run.
With good dialysis, appetite generally improves. Patients are able to eat better. An increase in diet portions and a protein-rich diet is paramount in improving overall quality of life.
How can the dialysis patients improve their nutrition?
With a few weeks of regular dialysis, patients generally regain their appetite. They get rid of nausea and vomiting, are able to eat better and feel less tired.
It is advisable to take a protein rich diet. Protein can be incorporated in the diet by a number of ways. Eggs, chicken and fish are good sources of protein. Vegetarians may choose cottage cheese (paneer), lentils (daal), soya protein, grams (like chana, chhole) and beans (like rajma) etc.
Too much salt can lead to water retention and high BP. It is therefore important to limit salt in the diet.
Eating frequent meals is often better tolerated than consuming larger portions infrequently. Cut down total liquid intake in favour of increasing the portion of a nutritious meal. Fruit juices should be absolutely avoided because of high content of potassium.
Regular exercises can also help in improving appetite.
How to take care of AV fistula?
Hemodialysis access is the lifeline of a dialysis patient and every care must be taken to ensure its wellness. While complications may occur with utmost care, they are much less likely to occur, if certain precautions are taken:
A) Hygiene- it is safe to wash the fistula hand with soap and water. But avoid scratching the area. Never try to remove any scab.
B) Daily check- most fistulas have a vibration over and around them. If this is absent or any there is any change, speak to your doctor.
C) Avoid pressure- avoid traumatising the fistula. Avoid wearing tight clothes, jewellery, watch, carry heavy times or sleep on the arm. Do not allow anyone to measure blood pressure on the arm with a functioning fistula.
D) Know the warning signs- if there any pain, redness or warmth, this may indicate an infection. An undue bulge or throb should also raise a concern and should be notified to the doctor. If there’s any bleeding after needle removal, apply gentle pressure. If the bleeding does not stop or is excessive, report to the hospital emergency room immediately.
How to take care of a dialysis catheter?
While an AV fistula is always a desirable access for hemodialysis, may patients depend on central venous catheters for dialysis. This may happen because a fistula may never have been created in the first place or is malfunctioning. Catheters may also be needed if patient does not have good vessels to allow creation of a fistula.
Infection may occur at the site of insertion of a catheter and may cause bloodstream infection. Patients may notice pain and redness in case of exit-site infection. In blood stream infection, fever, chills or low blood pressure can occur during dialysis or soon thereafter.
To reduce the risk of infection,
-Avoid touching the catheter or skin near the catheter with your bare hands.
-Frequently wash your hands with soap and water.
-If the dressing gets wet or dirty in between the sessions, report to the dialysis centre and get it replaced.
-Make sure the catheter is touched only with soap-washed or sanitiser-cleaned hands or with gloves on.
-Speak to the doctor if you develop any fever, chills or blood pressure during or soon after dialysis.
