Commencement of Dialysis Treatment

Introduction

In advanced kidney disease, where renal function is insufficient to sustain bodily processes, the implementation of dialysis or the consideration of a kidney transplant may be necessary. Kidney disease can be a consequence of injuries or health disorders such as lupus, hypertension, or diabetes. Kidney disease may manifest without any identifiable etiology.

Which Individuals Require Dialysis?

Dialysis is often initiated when patients exhibit symptomatic manifestations or when laboratory analyses indicate the presence of elevated concentrations of waste products within the bloodstream. Common manifestations of renal failure encompass symptoms such as nausea, tiredness, edema, and emesis.

The timing for initiation of dialysis depends upon several factors, including age, energy status, general health condition, laboratory findings, and the individual's level of commitment toward adhering to a prescribed treatment regimen.

What Are the Different Categories of Dialysis Techniques?

There exist two primary categories of dialysis techniques:

1. Hemodialysis: Hemodialysis is a medical procedure for treating end-stage renal disease patients.

• During hemodialysis, a medical device is employed to extract blood from the patient's body. Subsequently, the blood is filtrated using a dialyzer, also known as an artificial kidney, whereby impurities are removed before the purified blood is reintroduced into the individual's circulatory system. The duration of this surgery typically ranges from three to five hours. Hemodialysis treatment is typically administered thrice weekly in a hospital or a dedicated dialysis center.

• Hemodialysis can be performed in a clinical dialysis facility or in the comfort of one's home. Home hemodialysis enables individuals to undergo dialysis for extended durations or with increased frequency, typically ranging from three to seven sessions each week. One may engage in this activity throughout the nighttime to rest concurrently. Initially, it is necessary to undergo a modest surgical procedure to establish a direct pathway to the bloodstream. There are several methods by which this task can be accomplished.

• Utilizing a catheter, namely a central venous catheter, is a viable approach in situations where there is an urgent requirement to initiate hemodialysis. A catheter, a tube, is inserted into a vein in the neck, below the collarbone, or adjacent to the groin; this tool is intended for temporary use.

• The potential hazards associated with this particular modality of dialysis encompass the following: infection, compromised blood flow, obstruction due to the formation of scar tissue, thrombosis, anemia, and acute myocardial infarction.

2. Peritoneal Dialysis: This involves the internal cleansing of blood within the body. Intraperitoneal administration of a specialized fluid facilitates the removal of waste substances from the bloodstream, which occurs through the perfusion of minute arteries within the abdominal cavity. Subsequently, the fluid is removed.

• Home-based dialysis is the customary modality for this particular form of renal replacement therapy. One may find peritoneal dialysis preferable to hemodialysis due to the absence of regular visits to a dialysis center or hospital. Additionally, there are fewer limitations in terms of dietary choices.

• The potential hazards associated with this particular dialysis modality include skin infections surrounding the catheter, with the development of peritonitis. This infection may arise when bacteria infiltrate the abdominal cavity through the catheter. The utilization of an abdominal catheter, along with the infusion of fluid into the abdominal cavity, has the potential to induce a reduction in abdominal muscular strength, hence increasing the likelihood of developing a hernia. Weight gain might also be a potential consequence of this particular form of dialysis.

• The patient is planning to have a minor surgical procedure about three weeks before starting peritoneal dialysis. A medical professional will teach the patient to practice peritoneal dialysis (PD) at home and advise on preventing infection at the catheter insertion site. The catheter aids in transporting dialysis fluid from a bag into the abdominal cavity. This solution effectively absorbs waste and extra fluids from the human body. After many hours, the liquid is moved into a separate container.

3. Continuous Renal Replacement Therapy (CRRT): This is a form of dialysis employed in the intensive care unit (ICU) setting as a critical intervention for patients who are in an unstable condition and cannot withstand conventional dialysis procedures. The process of waste product and fluid removal occurs continuously and gradually throughout 24 hours.

What Are the Side Effects?

The experience should not elicit pain. If experiencing pain during or following a medical intervention, it is imperative to inform the healthcare provider promptly. However, it is possible to experience adverse effects. One possible inclusion is:

• Pruritus, sometimes called itchy skin, is a sensory symptom of unpleasant sensations.

• Hypotension, particularly in those with diabetes.

• Sleep disorders

• The phenomenon of fluid overload and the occurrence of infections.

• This pertains to the psychological condition known as depression, as well as the related phenomenon of mood swings.

• The symptoms of nausea and vomiting are commonly observed in several medical conditions.

• Muscle cramps, also known as skeletal muscle cramps, are involuntary and painful contractions of skeletal muscles that occur suddenly and

• Fatigue is a state of extreme tiredness or exhaustion often accompanied by a decrease.

What Are the Methods to Maintain Good Health After Dialysis?

• Monitoring the access site regularly for signs of redness, pus discharge, and edema is recommended. If any symptoms are observed, it is advisable to contact one's healthcare provider.

• It is imperative to maintain cleanliness and dryness of the bandage that is used to cover the catheter.

• It is imperative to ensure that individuals assisting with the treatment adhere to proper hand hygiene practices, which involve thorough handwashing with soap and water before and after the care provision.

Conclusion

Dialysis serves as a critical therapeutic intervention for individuals afflicted with kidney failure or end-stage renal disease (ESRD), effectively preserving their lives. Patients have the option to remain on dialysis for an extended period or until they can undergo a kidney transplant. Various forms of dialysis exist. There exists a divergence in preferences among individuals about the location for conducting dialysis, with certain individuals opting for the convenience of home-based dialysis. In contrast, others prefer receiving treatment at a hospital or dedicated dialysis center. The healthcare provider is capable of doing a comprehensive assessment of dialysis alternatives to identify the most suitable treatment modality for the individual.