What is Hemodialysis? Hemodialysis is a process via which a machine is used to conduct the dialysis procedure/ an artificial kidney in the form of a device is used to clean the blood. Minor surgery is done to enable the blood into the dialyzer. This surgery is usually in the arm. It is an intensive process which requires the patient to stay in the hospital and always be under medical scrutiny. Hemodialysis filters waste removes extra fluid and balances electrolytes. It is a very intensive process and is usually administered when the patient has reached a state of end state renal disease, and the kidney cannot function on its own. It helps control blood pressure and balance the minerals such as potassium, sodium, and calcium, in blood. Symptoms that indicate that the patient needs dialysis:
- Increased amount of urea, creatinine and potassium in the blood
- Sleepiness, fainting, or a coma in severity
- Decreased urine output (400 ml per day)
- Swelling of feet and ankles, and itching
- Extreme weakness and loss of weight
- Nausea, vomiting, loss of appetite
- Kidney failure harms the heart
- Trouble breathing
- muscle cramps
- Lung water
How do hemodialysis catheter or fistula work?
Dr R Sanjay Rampure, Consultant – Nephrology, Manipal Hospitals says that "in hemodialysis, a dialyzer (or artificial kidney) filters the blood. The dialyzer is a hollow plastic tube with many tiny filters and a semipermeable membrane. The semipermeable membrane is used to filter out water and wastes out of the patient's blood through diffusion. Protein, blood cells, and other important things remain in blood because they are too big to pass through the membrane. The smaller waste products in the blood, such as urea, creatinine, potassium, and extra fluid pass through the membrane and are washed away". "You need to create access to your bloodstream via a small surgery. This is in the form of a fistula, graft, or catheter. You will sit in a chair during the procedure, and needles will be placed where the fistula/graft or catheter have been created. A pump will draw out the blood and send it to another machine called the dialyzer, which will clean it out, and then the clean blood is sent back into the body through the second needle" states Dr Salil Jain, Director & HOD, Nephrology & Kidney Transplant, Fortis Memorial Research Institute, Gurugram).
How to prepare for hemodialysis? Explains Dr R Sanjay Rampure
Preparation for hemodialysis starts several weeks/months before the first procedure. The surgeon creates vascular access (to access the bloodstream). Blood is removed from circulation and then returned to the body for the process to work. It is essential to take care of the access site to reduce the possibility of infection and other complications. To allow easy access to the bloodstream, the surgeon creates vascular access. This access provides a mechanism for a small amount of blood to be safely removed from the circulation and returned to the body for the process to begin. There are three types of accesses:
- AV graft: When blood vessels are too small to form an AV fistula, the surgeon creates a pathway between a vein and an artery using a flexible, synthetic tube called a graft.
- Central venous catheter: In emergency hemodialysis, a plastic tube (catheter) may be inserted near the groin or into a large vein in the neck.
- Arteriovenous (AV) fistula: This is a connection between an artery and a vein.
What are the advantages of hemodialysis? Explains Dr Salil Jain
Some benefits of hemodialysis include:
- It has a relatively low risk of infection: hemodialysis uses arteriovenous (AV) fistula, which is a piece of suitable equipment to be used to access a person’s blood compared to a catheter. Therefore, it reduces the chances of an infection.
- It requires less time: it takes place approximately thrice a week with each session lasting for around three to five hours; therefore, it leaves most of the week dialysis free.
- It required less surgical interventions: AV fistulas, the equipment used in hemodialysis lasts for many years, this does not require additional surgeries.
Dr R Sanjay Rampure shares the disadvantages of Hemodialysis
It can be expensive, and one must stay in the hospital for long periods. It can be very traumatic also for the patient undergoing the same. It is not a small procedure in totality and is indicative of a severe health concern. The right amount of dialysis is determined in consultation with your doctor, and multiple tests need to be conducted, and the entire procedure requires constant monitoring and testing.
What are the complications associated with hemodialysis? Shares Dr Salil Jain
People who have hemodialysis have different health problems and can be at risk of developing various health difficulties, some of them are discussed below:
- Anaemia: Anaemia is a common complication of hemodialysis. Kidney failures reduce the production of a hormone called erythropoietin that helps in the formation of red blood cells; therefore, because of not having enough red blood cells in the body one may develop anaemia.
- Infection of the membrane enclosing the heart: when there is insufficient hemodialysis, it can cause inflammation of the membrane surrounding the heart which makes it difficult for the heart to pump blood to other parts of the body
- Low blood pressure: this is a common side effect of hemodialysis, especially if it has diabetes. It can further be accompanied by shortness of breath, abdominal cramps, muscle cramps, and nausea or vomiting.
- Bone diseases: due to hemodialysis, our bodies may be unable to produce vitamin D, which helps in absorbing calcium; therefore; as a result, our bones may weaken.
- Sleeping issues: people with hemodialysis face sleeping issues that may occur due to breathing problems, or pain in the muscles or bodies.
Dr R Sanjay Rampure shares safety and benefits regarding hemodialysis
When kidney function is declining with time, dialysis is a safe and effective alternative to keep one healthy. It is essential to know that the Hemodialysis process is among the most advanced technologies used in outpatient settings. Through proper safety checks and controls, good capability of the health care worker delivering the service, and an engaged and informed patient, it is possible to achieve a fair and safe dialysis environment. The following aspects need to be monitored and prioritized in a dialysis setup:
- Ending and initiation of the dialysis session
- Type and labels of dialyzer used
- Amount of blood thinner used
- Medications and infections
- Fluid removal on dialysis
- Many metabolic waste products typically removed by kidneys accumulate in the blood and other body tissues in kidney failure. Very high levels of these cause kidney failure symptoms like decreased apatite, nausea and vomiting.
- Haemodialysis is a process to clear the blood of metabolic waste products like urea, creatinine and acid in a patient with kidney failure. Blood flows through an artificial kidney-filter, where blood urea, creatinine and many other metabolic waste products are filtered, accumulated fluid and salt is removed.
- Haemodialysis is a life-saving procedure which needs to be continued at a regular interval to maintain optimum health. Discontinuation of dialysis leads to severe sickness. Patients with chronic kidney disease are prepared for dialysis 3-4 months prior by creating AV fistula.
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