Dialysis is a process where people without kidneys or with kidney failure can eliminate waste and excess water from their blood. It is also known as renal replacement therapy. Healthy kidneys usually carry out the job of eliminating waste and balancing blood and water levels. Kidneys also play a role in regulating metabolism, but dialysis can’t replicate that.
Patients who have lost up to 90% of their kidney function are eligible for dialysis. Studies show that chronic kidney disease affects over 800 million individuals.
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What is dialysis?
Kidneys filter up to 150 litres of blood. If waste builds up in the blood, it can lead to coma and death. Waste build-up can be caused by chronic, long-term, or acute illnesses that affect the kidneys. Injury can also lead to kidney failure.
Dialysis prevents buildup from reaching harmful levels. It also removes toxins from the blood.
Types of dialysis
1. Intermittent haemodialysis
This involves the blood moving outside the body into a special machine with filters. A catheter is injected into a vein, and the blood flows through the machine, which removes waste and flows out another catheter that returns blood to the body.
Intermittent haemodialysis is the standard form of ICU and non-ICU care for patients with acute kidney failure. It uses intermittent solute removal by filtering. It also lasts about 3-4 hours daily, thrice a week.
The procedure can be done at home or a specialised hospital. The most complicated part of the procedure is enlarging the vein to ensure the catheter fits. However, it depends on how much kidney function the patient still has and how much fluid weight was gained since the last treatment.
Home dialysis is safe for people who remain stable on dialysis. They have no pre-existing conditions that would make dialysis unsafe. Patients also need to have suitable blood vessels for the procedure. It should be done by a professional.
One important thing to note is that patients must use their non-access arm to measure blood pressure. Drawing blood for tests should also be done on the other arm.
2. Peritoneal dialysis
This method works through osmosis. A solution rich in minerals and glucose is run through a tube into the peritoneal cavity. This is the gap that surrounds the intestines. The peritoneal membrane is also semi-permeable. The peritoneal cavity has an internal lining that can filter blood.
The solution is left in the cavity to absorb waste and drained out of a tube to be thrown out. It is repeated multiple times during the day or overnight. The solution is rich in glucose which causes waste fluid to move from the blood to the solution to dilute it.
It takes a longer period to remove the same amount of waste from the blood. It’s less efficient than intermittent haemodialysis. But the procedure provides more independence and freedom. It can be done without going to a clinic.
A patient needs a small surgical procedure to insert a catheter into the abdomen that remains closed until dialysis.
The two types of peritoneal dialysis are:
- Continuous ambulatory peritoneal dialysis (CAPD)
- Continuous cyclic peritoneal dialysis (CCPD)
CAPD has no machinery. The solution is left in the cavity for eight hours and immediately replaced with a fresh solution. This takes place up to five times daily.
CCPD, or automated peritoneal dialysis, uses a machine each night to exchange fluids. Patients can keep the fluid during the day. It can also be changed once daily.
It’s perfect for children, older people, and those still working, at school, or travelling.
3. Continuous renal replacement therapy
This is 24-hour dialysis used in the ICU. It has lower risks of hypotension and slower fluid removal than intermittent haemodialysis.
4. Temporary dialysis
This limited dialysis is suitable for sudden or acute kidney failure. It’s also recommended for people who need treatment for toxicity, a drug overdose, a sudden injury to the kidney, and chronic heart disease.
It can cause hypotension, cramps, nausea, vomiting, headaches, chest pain, back pain, itchiness, fever, and chills.
The shortfalls of dialysis
Using dialysis means patients need to be careful about their diet and habits. Patients also need to take medication.
The waste in the blood is still more than that of people with functional kidneys. Dialysis will affect body functions like pregnancy. People undergoing the treatment will have lower chances of getting pregnant. Pregnancy is also not recommended during this period because it will be high-risk.
Dialysis can cause muscle cramps, low blood pressure among patients with diabetes, sleep problems, fluid overload, swelling and infections at the dialysis site, depression, and mood swings.
The procedure can also be inaccessible for people who can’t afford the procedure. Studies additionally show that financial and access constraints in developing countries block access for many at-need patients.
The benefits of dialysis
Dialysis can improve the quality of life for people with chronic kidney failure and increase their lifespan by 20 years or more.
Peritoneal dialysis has fewer fluid and diet restrictions. You must also stop smoking and exercise as your doctor directs to keep your catheter safe.
It is a great way to maintain your health until you get a kidney transplant. It also reduces trips to the hospital for renal failure or complications.
In addition, it reduces the risk of other chronic kidney disease complications such as heart and blood pressure problems, anaemia, and bone density problems.
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