Dialysis - Uses, Types, and Risks

What Is Dialysis?

The kidneys filter blood to remove the waste and excess fluid from the body. The waste products are sent to the bladder to eliminate during urination.

Dialysis is a procedure performed by a machine that functions the same as kidneys when they have failed. It filters and purifies the blood using a machine, and so it helps to keep the fluids and electrolytes in balance when the kidneys cannot do their job. It has been used since 1940 to treat people with kidney failure. End-stage kidney failure occurs when the kidneys perform only 10 to 15 percent of their normal function.

Why Is Dialysis Used?

Dialysis is a procedure in which a machine performs and regulates the function that kidneys do and keeps the body running normally. Without dialysis, the organs will be damaged as the salts and other waste products start to accumulate in the blood and poison the body. But dialysis is not the only cure for kidney disease or injury; it needs different treatments in addition to address those concerns. The following are the uses of dialysis, that is, performing the functions of kidneys. They are:

1. Prevent excess water, waste, and other impurities from accumulating in the body.

2. Helps to control blood pressure.

3. Regulate the levels of chemical elements like sodium and potassium in the blood.

4. Activates a form of vitamin D, improving the absorption of calcium.

What Duration Will a Person Require Dialysis For?

The duration of dialysis required varies. In certain instances, kidney failure might be temporary, and dialysis could cease upon kidney recovery. However, individuals with kidney failure often necessitate a kidney transplant. When an immediate transplant is not feasible, dialysis is necessary until a compatible donor kidney is procured. If a transplant is not a viable option, such as due to health constraints preventing major surgery, dialysis could be a lifelong necessity.

What Are the Types of Dialysis?

There are three types of dialysis; they are:

1. Hemodialysis.

2. Peritoneal dialysis.

3. Continuous renal replacement therapy.

1. Hemodialysis:

Hemodialysis is the most common type, and it uses an artificial kidney known as a hemodialyzer to remove the excess waste and extra fluid from the blood. Hemodialysis treatments last for three to five hours and are performed three times a week. Most hemodialysis treatments are performed in the hospital environment, doctor's office, or dialysis center. The treatment length depends on:

• Body size.

• The amount of waste present in the body.

• The current state of health.

Procedure - The blood removed from the body is filtered through the hemodialyzer, and the filtered blood is then returned to the body with the help of the dialysis machine. In order to get the blood flow to the artificial kidney, the doctor performs minor surgery to create an entry point (vascular access) into the blood vessels. The three types of entry points are:

• Arteriovenous (AV) Fistula: It connects an artery and a vein. It is designed for long-term dialysis treatment and is the preferred option. People who receive this entry point are ready for hemodialysis after two to three months.

• AV Graft: This type is also designed for long-term dialysis treatment, and it is a looped tube. People after AV grafts are ready for hemodialysis after two to three weeks.

• Vascular Access Catheter: It is inserted into the neck's large vein and is designed for short-term or temporary use.

After being on hemodialysis for an extended period, the doctor will feel that you are ready to give yourself dialysis treatments at home. This is more common in people who need long-term treatment.

2. Peritoneal Dialysis:

A peritoneal dialysis catheter is inserted inside the abdomen, and the catheter filters the blood through the peritoneum. During treatment, dialysate, which is a special fluid, flows into the peritoneum. Dialysate absorbs waste out of the bloodstream, and it is drained from the abdomen. This procedure takes place for a few hours and is repeated four to six times a day. However, the fluid exchange can be performed when sleeping or awake. The different types of peritoneal dialysis are:

• Continuous Ambulatory Peritoneal Dialysis (CAPD) - In continuous ambulatory peritoneal dialysis, the abdomen is filled and drained multiple times a day. This method is done when the patient is awake and does not require a machine.

• Continuous Cycling Peritoneal Dialysis (CCPD) - Continuous cycling peritoneal dialysis cycles the fluid in and out of the abdomen and is usually done while sleeping.

• Intermittent Peritoneal Dialysis (IPD) - Intermittent peritoneal dialysis is usually performed in the hospital and also performed at home. It uses the same machine as continuous cycling peritoneal dialysis, but the process takes a longer time.

3. Continuous Renal Replacement Therapy (CRRT):

Continuous renal replacement therapy is also known as hemofiltration and is used in acute kidney failure patients in intensive care units (ICU).

Procedure - The dialysis machine passes the blood through the tubing, and the filter removes waste products and water. The blood then returns to the body with the replacement fluid. This procedure is performed 24 hours a day.

What Are the Risks Associated With Dialysis?

All three forms of dialysis save our life, but they also carry some risks.

Risks Associated With Hemodialysis:

The risks associated with hemodialysis are,

• Low blood pressure.

• Anemia.

• Difficulty sleeping.

• Itching.

• High blood potassium levels.

• Muscle cramping.

• Pericarditis.

• Irregular heartbeat.

• Sepsis.

• Bloodstream infection.

• Sudden cardiac death - It is the leading cause of death for people undergoing dialysis.

Risks Associated With Peritoneal Dialysis:

The risks associated with peritoneal dialysis are,

• Increased risk of infections in or around the catheter site in the abdominal cavity; that is, after the catheter is implanted, a person may experience peritonitis (infection or inflammation of the membrane lining the abdominal wall).

• High blood sugar.

• Stomach pain.

• Weight gain.

• Abdominal muscle weakening.

• Hernia.

• Fever.

Risks Associated With CRRT:

The risks associated with continuous renal replacement therapy are,

• Infection.

• Delayed renal recovery.

• Hypothermia.

• Low blood pressure.

• Bleeding.

• Weakening of bones.

• Electrolyte disturbances.

• Anaphylaxis.

Conclusion:

When people find it difficult to cope with dialysis treatment and its side effects, they consider stopping the treatment. In that case, the doctor checks weight and blood pressure as it helps to determine whether the dialysis is adequate. Before stopping treatment, ask individual concerns to know if there are any risks associated with stopping the treatment at any time. If the patient cannot cope up, then he or she is advised to visit a mental health professional before ending the life-saving treatment. When the underlying condition causing the kidney failure is not corrected, stopping the dialysis treatment will eventually lead to death