Dialysis

Risk Factors for Complications During the Procedure Hemodialysis Heart problems Peritoneal dialysis Adhesions or significant abdominal scar tissueInfection of the peritoneum (lining of the abdominal cavity) Abdominal herniaDiverticulitisAbdominal defects What to Expect Prior to Procedure HemodialysisWeight, blood pressure, and temperature are takenTopical anesthetic (a pain numbing medicine) is applied to the arm for needle insertionHeparin (a medication that prevents blood clotting) is given Peritoneal DialysisBefore the first treatment, the physician places a small, soft tube (approximately 24 inches long) in the abdomen, which remains there permanently. A portion of the tube remains outside the body for use in the peritoneal dialysis process. It is important to keep this access clean and dry to prevent infection. AnesthesiaFor hemodialysis, topical anesthetic. Description of the Procedure HemodialysisAn artificial kidney machine, called a dialyzer, filters the blood, and returns the cleaned blood to your body. You are connected to the dialyzer via tubes that are inserted into a vein in your arm, leg, or occasionally, neck. If hemodialysis is being performed as a temporary measure, then the catheter is likely to be inserted through the neck vein. If hemodialysis is going to be done regularly, then an access site called a fistula or shunt may be surgically created in one of your veins.

Fistulas may need as long as 2 to 3 months to fully heal or mature before they can be used on a regular basis. Occasionally a surgically created fistula may fail to heal properly, requiring either a revision or in some cases a completely new fistula to be created. For this reason, fistulas are never used in circumstances where the indications for dialysis are either emergent or temporary. Rather, they are typically created electively many months before dialysis is begun in cases of chronic renal failure where the need for dialysis is felt to be inevitable.Hemodialysis is usually done at a dialysis center or hospital, by trained technicians or nurses, or may be done at home with assistance. Hemodialysis is usually done three times a week and each treatment lasts from two to four hours. Hemodialysis 2008 Nucleus Medical Art, Inc. Peritoneal DialysisInstead of using a machine, this type of dialysis uses the abdominal lining, called the peritoneal membrane, to filter blood. A cleansing solution, called a dialysate, is infused through a tube inserted into your abdomen. Long-term peritoneal dialysis may require the surgical creation of a port in the abdomen through which this dialysate can be infused. Fluid, wastes, and chemicals pass from the tiny blood vessels in the peritoneal membrane into the dialysate, which is then drained after several hours. New dialysate can then be added to repeat the process.

There are three types of peritoneal dialysis: Continuous ambulatory peritoneal dialysis (CAPD)This is the most common type of peritoneal dialysis. A bag of dialysate is infused into the abdomen through a catheter, remains there for 3-6 hours, and is then drained. You then refill your abdomen with fresh solution through the catheter. This way your blood is always being cleaned. No machine is required, and the empty plastic bag may be hidden under clothing.Continuous cyclical peritoneal dialysis (CCPD)Fluid exchanges in this procedure are done by machine, usually at night while sleeping.Intermittent peritoneal dialysis (IPD)Uses the same type of machine as CCPD, but requires assistance and is usually done at a hospital or center. It often takes longer than CCPD. Peritoneal Dialysis 2008 Nucleus Medical Art, Inc. After ProcedureOnce blood pressure is stable, you may resume everyday activities. How Long Will It Take? The time needed for dialysis depends on a few factors: How much kidney function remainsHow much fluid weight gain has occurred since the last treatmentAmount of waste in the bodyBody sizeLevel of minerals in your body such as sodium, potassium, and chlorideDialysis method usedThe approximate time and frequency of each method:

TypeLength of procedureFrequency of procedureHemodialysis2-4 hours3 times/weekCAPD3-6 hours, plus 30 minutes to drain4 times/dayCCPD9-12 hoursEvery nightIPD12 + hours36-42 hours/week Will It Hurt?In general, dialysis procedures do not cause pain, and you will not feel the blood exchange. There may be some temporary discomfort with the insertion of the needle or tube. Possible ComplicationsAnemiaDrop in blood pressure during dialysisMuscle crampsNausea, vomitingHeadachesInfectionFeeling hot, sweaty, weak, and/or dizzyPeritonitis (infection of the peritoneum), which causes fever and stomach pain (peritoneal dialysis only) Growth problems in childrenInflammation of the heart sac (pericarditis)Neurologic problemsDisruption of calcium and phosphorus balance, resulting in weakened bones Average Hospital StayNone. Dialysis is typically done at an outpatient dialysis center or at home. Postoperative CareOnce the hemodialysis procedure is completed and blood pressure is stabilized, you are free to continue daily activities. There are some special considerations, though: Dietary GuidelinesDialysis patients should follow certain dietary guidelines at all times to maintain health and optimize the dialysis process. Patients who have peritoneal dialysis may have slightly fewer dietary restrictions than hemodialysis patients, due to the more frequent peritoneal dialysis schedule. Your doctor and a dietitian will tailor the dietary guidelines to meet your specific needs. The factors you need to pay most attention to include protein, potassium, phosphorous, fluid, sodium, and total calories.

MedicationsYour doctor may prescribe various types of medication. These include, but are not limited toBlood pressure medicationsCalcium supplements or multivitaminsPhosphorus bindersto lower phosphorus levels in the bloodDiureticsto remove excess fluidStool softeners or laxativesto prevent or treat constipation, which can be caused by decreased fluid intakeIron supplementsto increase iron intake, which is important for production of red blood cells OutcomeDialysis helps maintain blood pressure, cleaning of the blood, and chemical and hormonal exchanges that are critical to survival. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, warmth, increasing pain, excessive bleeding, or discharge at the catheter or tube insertion siteBlood or cloudiness in the peritoneal dialysis fluidNausea or vomitingAbdominal painDizziness or weakness RESOURCES: The Kidney Dialysis Foundationhttp://www.kdf.org National Kidney Foundationhttp://www.kidney.org National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)http://kidney.niddk.nih.gov CANADIAN RESOURCES: The Kidney Foundation of Canada: British Columbia Branchhttp://www.kidney.bc.ca/ The Kidney Foundation of Canada: Northern Alberta and the Territories Branch

http://www.kidney.ab.ca References: National Diabetes Information Clearinghouse (NDIC) website. Available at: http://diabetes.niddk.nih.gov/ . National Kidney Foundation website. Available at: http://www.kidney.org/ . Last reviewed February 2008 by Daus Mahnke, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.