What is Kidney dialysis? Types, Complications and Procedures
Introduction
Dialysis is an artificial process to filter blood. It becomes crucial to clean blood due to kidney failure. It is a treatment in which a dialyser (machine) filters blood to remove fluids and waste.
When the kidneys fail to filter blood, waste accumulates in the blood. A dialyser is a machine that filters blood to remove waste.
Dialysis became the standard treatment in the 1970s. However, it was first successfully used in the 1940s. Millions of people with renal failure receive dialysis treatment in the world.
In dialysis, blood enters the dialyser, which then filters the blood from waste. A dialyser removes the extra waste products and fluids from blood. After the cleaning of blood, the cleaned blood returns to the body.
Read more about What are Kidneys, Structure and Anatomy?
Understanding Kidney Dialysis
Dialysis becomes necessary when kidney function declines. It starts when the kidneys are working at about 10% of their normal capacity.
Dialysis is a lifetime treatment unless a patient gets a healthy kidney through a transplant.
Without dialysis, salts and other waste products accumulate in the blood. This waste in the blood can damage other organs.
It becomes crucial because of kidney failure. But it is also necessary in acute kidney failure.
Acute kidney failure occurs over a short time (some days to weeks) due to a serious illness or accident. And dialysis can treat acute kidney failure as a short-term procedure.
Kidneys fail due to chronic kidney disease. Due to CKD, the kidneys worsen over the years.
There are two types of dialysis: haemodialysis and peritoneal dialysis.
Hemodialysis
In haemodialysis, the blood goes through a machine called a hemodialyzer. It filters the blood and returns the cleaned blood to the body.
Peritoneal Dialysis
Peritoneal dialysis is another method of dialysis. In this process, tiny blood vessels inside the abdominal lining filter blood through a dialysis solution.
The solution consists of water, salts, and other additives. It absorbs waste products from the blood through blood vessels in the lining. The fluid is then drained from the body.
There are two types of peritoneal dialysis.
- Continuous Ambulatory Peritoneal Dialysis (CAPD)
- Automated Peritoneal Dialysis (APD).
Both methods offer greater flexibility than traditional haemodialysis.
Continuous Ambulatory Peritoneal Dialysis (CAPD) involves the patient manually performing fluid exchanges throughout the day.
Automated peritoneal dialysis uses a machine to perform exchanges overnight when the patient sleeps.
According to the National Kidney Foundation, 10% of the total population is affected by chronic kidney disease worldwide.
And millions of people die each year due to a lack of resources to afford treatment.
More than 2 million people around the world are getting treatment, either dialysis or a kidney transplant. However, this number represents only 10% of the people who actually need treatments.
This means many people who need help with kidney failure are not receiving the care they require.
When is Kidney Dialysis Needed?
According to the National Kidney Foundation, a renal patient needs dialysis when kidney function drops to 15% or less.
There are five stages of kidney disease.
The fifth stage is end-stage renal failure. It is a condition where the kidneys work only 10-15% of normal kidney functioning.
The renal patient needs to start dialysis when the condition and symptoms become severe.
Doctors also prescribe dialysis based on lab test results and severe renal symptoms.
Dialysis is a temporary treatment for sudden kidney failure. This treatment continues until the kidneys recover.
Most often, kidneys fail suddenly for various reasons. For example, dehydration, urine flow obstruction, and exposure to toxins.
Key Symptoms That Show You Need Dialysis
Fatigue
Extreme fatigue, tiredness, or weakness are symptoms of kidney failure.
Nausea and Vomiting
On-and-off complaints of nausea and vomiting.
Shortness of Breath
Difficulty in breathing due to excessive fluid in the lungs.
Swelling (Edema)
Accumulation of fluid in the body, especially in the legs, feet, and hands.
Muscle Cramps
An imbalance of minerals like potassium and calcium can lead to cramps.
Confusion
Toxin buildup can affect brain function, leading to difficulty concentrating or mental confusion.
High Blood Pressure
Kidneys regulate blood pressure, and failure results in disruption of blood pressure management.
These symptoms show that the kidneys are no longer effectively working and filtering waste from the body.
Hence, it requires dialysis to restore balance.
Take control of your kidney health today—Learn More About Glomerulonephritis and Its Management!
How Kidney Dialysis Works
Medication is no longer effective for patients suffering from end-stage renal disease.
Dialysis and kidney transplant options are left for renal failure patients.
It is important to note that dialysis is not a permanent cure for kidney failure. It is a lifetime treatment.
Haemodialysis and peritoneal dialysis are two types of dialysis.
The choice between them depends on multiple factors.
These factors are the patient's lifestyle, medical condition, treatment availability, and personal preference.
Haemodialysis
During haemodialysis, a dialyser machine (artificial kidney) filters the blood.
This machine also maintains blood pressure and balances minerals like sodium, potassium, and calcium in the blood.
The blood is passed through a tube into a dialyser. It is divided into two parts, separated by a thin wall.
- As blood passes through one part of the filter. A special fluid (containing electrolyte solution) in the other part removes waste from the blood.
- The filtered blood from the dialyser then returns back to the body through a tube.
Doctors make an arteriovenous fistula in the arm to attach a tube. Once created, this fistula or graft serves as a long-term access point for dialysis.
With proper care, it can last about 5 to 10 years or longer.
Peritoneal Dialysis
It is another method of dialysis. In this method, healthcare providers insert the catheter into the abdomen before weeks of dialysis.
The process involves pumping dialysis fluid into the peritoneal cavity (the lining of the abdomen).
It absorbs waste products from the blood through blood vessels.
The fluid is then drained from the body.
This dialysis usually performs at home. However, it can perform while travelling too. However, it's not a treatment option for everyone with kidney failure. There are two types of peritoneal dialysis.
- Automated peritoneal dialysis (APD)
It uses a cycler machine to perform the dialysis procedure. - Continuous ambulatory peritoneal dialysis (CAPD)
This process can take place manually.
Home Dialysis Options
Haemodialysis and peritoneal dialysis both can be done at home under specific circumstances. Peritoneal dialysis is the most common type of home dialysis treatment.
In peritoneal dialysis, patients dialyse daily at home with little or no assistance. Because the process is convenient and accessible.
The highly vascular peritoneal membrane covers the internal organs. It is located inside the abdominal cavity. This internal membrane removes waste products and extra fluid from their blood flow.
The dialysis solution enters the abdomen via a catheter. It stays there for a few hours. The waste moves to the dialysis solution through blood vessels.
Waste and excess fluid from the dialysate are removed once the dialysate dwell period is over.
The cleaning starts after every new solution exchange.
The exchange process consists of the drain, fill, and dwell phases.
This exchange process is carried out manually or through a cycler (device).
Benefits of Home Dialysis Option
- Ensures greater flexibility to schedule dialysis sessions at home
- Provide high quality of life due to home treatment.
- Reduces expenses and travel time during each visit.
- Improves patient autonomy and control over the dialysis process.
Challenges Regarding Home Dialysis Option
- Requires a specific and dedicated space in the home.
- Emotional and physical burden of self-management during treatment.
- Higher risk of infection if not performed correctly.
- Strict treatment schedules are required.
Equipment and Training Required for Home Dialysis
- Dialysis machine (for haemodialysis or peritoneal dialysis).
- Water filtration or cycler for peritoneal dialysis.
- Medical supplies (dialysis solutions, needles, catheters).
- Need for proper storage for equipment and medications.
Proper training is a must in setting up and operating the dialysis machine to use at home.
- Education on proper hygiene and management to prevent infections.
- Proper handling during emergency procedures.
- Requires continuous support from healthcare providers for monitoring and advice.
The Kidney Dialysis Procedure
The dialysis process involves careful monitoring and follow-up.
The detailed process of haemodialysis and peritoneal dialysis is here:
Pre-Dialysis Preparations for Haemodialysis:
Before starting haemodialysis, a patient needs to undergo a minor surgical procedure. So that it becomes easy to gain access to the bloodstream.
This procedure involves the formation of an AV fistula, AV grafting, or catheter insertion.
Arteriovenous fistula (AV fistula)
An arteriovenous fistula is made by connecting an artery and a vein in the arm for a dialysis procedure.
Arteriovenous graft (AV graft)
If the artery or vein is too short to connect, the surgeon will use a graft (a soft, hollow tube) to connect them. The graft enlarges the connected artery and vein to facilitate dialysis. It helps blood flow in and out of the body faster.
Catheter
If dialysis needs to start quickly. The doctor inserts a small tube (called a catheter) into a vein. This vein could be of the neck, chest, or leg to temporarily treat the patient.
What happens during haemodialysis?
During haemodialysis, the dialyser (a filter) pumps the blood.
A dialyser is sometimes called an “artificial kidney.” It filters the blood like kidneys do. The dialysis machine is responsible for performing the following functions.
- A needle removes blood from the arm, neck, chest, or leg. It is done through an AV fistula, AV graft, or catheter. Then it goes into a dialyser machine for filtration.
- The thin wall separates the dialyser into two sections.
- The blood passes through one part of the dialyser. Blood then circulates through the filter. Waste into the blood and then moves into the dialysis solution. A special fluid on the other part of the dialyser removes the waste from the blood. This cleansing liquid contains water, salt, and other additives.
- The blood is then returned to the body through a different needle in the arm.
- Adjust the blood flow in and out of the body by monitoring blood pressure.
Post-Dialysis Care in haemodialysis
Some people experience fluctuations in blood pressure during or immediately after haemodialysis.
They may experience nausea, dizziness, or faintness. It is because of electrolyte imbalance and high blood pressure.
The other side effects of hemodialysis also include
- Chest pain or back pain.
- Headaches
- Skin Irritation
- Muscle cramps.
- Restless legs syndrome.
Pre-Dialysis Preparations for Peritoneal Dialysis:
The catheter (a thin, soft tube) is inserted through the stomach. It is placed through the stomach into the peritoneum. It is important to do it three weeks before the dialysis.
This catheter stays in place permanently. The patient can perform their own dialysis at home. They should perform the dialysis according to the surgeon's instructions.
What Happens During Peritoneal Dialysis?
Peritoneal dialysis involves the following steps.
- The catheter placed in the abdomen is connected to a branch of a Y-shaped tube. Then it is connected to a bag containing dialysis solution. The solution is moved through the tube and catheter into the peritoneal cavity.
- When the fluid bag is empty, disconnect the bag and catheter after a 10-minute interval.
- Close the catheter with a cap.
- The patient can perform their usual activities while the dialysis solution is inside the peritoneal cavity. The procedure takes about 60 to 90 minutes.
- After this, remove the catheter's cap. Use the other branch of the Y-shaped tube to drain the fluid into an empty bag.
- The whole process needs to be repeated four times a day.
Some people prefer to do peritoneal dialysis at night. With automated peritoneal dialysis (APD), a machine called a cycler pumps fluid in and out of the body, even during sleep.
Post-Dialysis Care in Peritoneal Dialysis:
After peritoneal dialysis, the fluid in the belly can make one feel uncomfortable due to bloatedness or fullness.
The treatment is not painful, but the stomach may appear bigger than normal when it's filled with liquid.
Which Type of Dialysis is Preferable?
Both types of dialysis can filter blood. But peritoneal dialysis has more advantages compared to haemodialysis. It includes.
- More convenient and reliable for daily routine
Compared to haemodialysis, peritoneal dialysis can be done at home, at work, or in any other clean and dry space. It is a more convenient method and can be done during work, travelling, or even while sleeping.
- Least restriction on Diet
Peritoneal dialysis allows for a more flexible diet compared to haemodialysis. Because it is a continuous process, less potassium, sodium, and fluids build up in the body.
- Long-lasting kidney function
In renal failure, the kidneys lose most of their functioning capability. However, in peritoneal dialysis, the kidney function lasts slightly longer than in haemodialysis.
- No needle insertion in veins
In haemodialysis, needles are inserted into veins every time the blood is cleaned. Peritoneal dialysis does not require needle insertion.
The one-time catheter is placed only in the abdomen before peritoneal dialysis to filter and clean the blood outside the body.
What Should I Choose for Dialysis?
Consultation with a nephrologist is the best option for choosing the type of dialysis required based on the kidneys' functioning.
However, the selection of the type of dialysis depends on the following factors.
- Kidney function.
- The overall health of the patient
- Personal preferences.
- Home situation.
- Living lifestyle.
|
Considerations of Peritoneal Dialysis |
|
|
Peritoneal dialysis is a better option if the renal patient is:
|
Peritoneal dialysis is not a viable option for the renal patient if:
|
Table 01: Considerations of Peritoneal Dialysis
Life on Kidney Dialysis
How to Adjust Daily Life on Kidney Dialysis
Life on dialysis feels like a big change. But proper planning and time management help renal patients cope better with it.
The biggest challenge for dialysis patients is scheduling their treatment on time. Because they need to perform it several times a week, and each session lasts about four hours.
Better scheduling helps to balance daily life, work, and other activities around it.
Working people need to schedule a dialysis time that fits into their routine.
The majority of people prefer to have their treatments early in the morning or late in the day. So they can keep a balance between their working life and family.
It’s important to consult with a doctor to find a routine that works best for them.
Besides scheduling a dialysis routine, it’s important to keep yourself active and do things you enjoy. This could be spending time with friends, exercising, or having hobbies.
Staying active and social helps you to feel more active and have control of your life.
How to Manage Diet and Lifestyle on Kidney Dialysis
One needs to modify one's diet during dialysis.
Otherwise, the kidneys will be unable to remove some things from the blood. For example, potassium, sodium, and phosphorus.
That's why patients should reduce the consumption of bananas, potatoes, salt, and dairy products. Because these foods cause heart disease.
That's why dietitians provide a personalised diet plan for patients on dialysis.
It is important to control diet and fluid intake.
Increased fluid intake leads to fluid accumulation in the lungs, which can affect patients' breathing.
It is also advisable for patients on dialysis to exercise to maintain good health.
Even simple activities such as walking or performing yoga-like poses increase overall health and optimise mood.
How to Manage Side Effects of Kidney Dialysis
The side effects of dialysis should be managed in daily life.
Some patients tend to experience fatigue and tiredness after dialysis. That's why doctors advise them to rest whenever they feel exhausted.
One potential risk of dialysis is muscle cramps due to low fluid intake.
To avoid future episodes of muscle cramps, it is advised to seek medical advice and consume enough water.
However, these side effects are associated with dialysis, and some measures can be taken to address them.
Modifying the schedule, altering diet, or exploring methods to ease mental and physical loads can regulate such symptoms.
Protecting Kidneys in Kids: Essential Health Tips & Prevention - Explore Now
Life Expectancy and Quality of Life
Haemodialysis and kidney transplants are two treatments for kidney failure.
Both dialysis have their own positive and negative qualities.
Dialysis normally provides a shorter life expectancy.
And it requires many hours on the chair, leaving the patient feeling tired, and strict restrictions on diet.
It is quite frequent in nature and does not require the performance of an operation.
However, kidney transplant patients have longer life expectancies.
Transplant achieves much better improvement in the quality of life and limitations.
Controversially, transplants require major surgery, possible rejection of organs, and the use of immunosuppressive drugs throughout an individual’s life.
Comparing Dialysis and Kidney Transplant
|
Aspect |
Dialysis |
Kidney Transplant |
|
Life Expectancy |
|
|
|
Quality of Life |
|
|
|
Pros |
|
|
|
Cons |
|
|
|
Success Rates |
|
|
|
Suitability |
|
|
Table 02: Comparison of Dialysis and Kidney Transplant
Complications and Risks
Potential Risks or Complications Associated with Hemodialysis
Infection is one of the major complications that may occur when an AV fistula or grafting is done.
This may cause inadequate blood circulation, blood vessel blockage by scar tissues and even the formation of blood clots.
In dialysis, the dialysis needles usually come from the arm of a renal patient or from a tube coming from a dialysis machine.
The blood leak detection system helps doctors and other health facility workers to prevent any adverse outcomes.
It ceases operation occasionally to prevent excessive blood loss to protect the patient from blood loss.
Potential Risks or Complications Associated with Peritoneal Dialysis
Since peritoneal dialysis involves using a catheter to connect with the peritoneum, some individuals are vulnerable to a rise in catheter-related infections.
This may cause peritonitis. It is an infection that occurs when bacteria enter the abdomen through the catheter.
The symptoms of this infection are vomiting, nausea, fever, and abdominal pain.
Read more about What are Kidney Infections? Symptoms, Cause, Diagnosis and Treatment
Pumping fluid using an abdominal catheter weakens abdominal muscles over time, resulting in a hernia.
A hernia occurs when one of the organs pushes through the muscle or tissue that is supposed to hold it. Especially in the abdominal or groin region.
It forms a lump between the abdomen and upper thigh, and surgeons may remove it surgically.
While on peritoneal dialysis, the body achieves weight gain. It happens due to dextrose and other sugar-containing substances in the dialysis solution.
Advances and Alternatives in Kidney Dialysis
Latest Advancements in Kidney Dialysis
According to Orlando Research Clinical Center, about 808,000 people in the United States are suffering from end-stage renal disease (EDRD).
Among these, 69% of the population requires dialysis. However, dialysis is a life-saving procedure, and it has essentially remained so for years.
Fortunately, the latest advancements in kidney dialysis technology make the process easier and more accessible.
The recent updates in hemodialysis include an improved dialyzer membrane for better toxin removal, a precise fluid management system, and wearable dialysis devices to increase mobility.
Additional advancements in automation and dialysis sensors also enhance patient safety and treatment procedures.
These are some of the latest advancements in the technology of kidney dialysis treatment methods.
Wearable Artificial Kidney (WAK)
A wearable artificial kidney is one of the exciting developments in dialysis technology.
It is a portable battery power design that can easily be worn on a belt.
It is very effective because it provides continuous dialysis, similar to natural kidney function. Its advantages include
- Allows patients to move around more freely and be more independent.
- It improves the fluid balance of the body and controls metabolism.
- It removes the need to use large amounts of dialysis fluid.
Implantable Artificial Kidney
An implantable artificial kidney is another advancement in the treatment of kidney failure.
It is a surgically implanted device that works continuously.
It uses the patient's blood pressure for a filtration process that eliminates the need for external pumps.
Further research is ongoing to develop and implement it.
It comprises a hemofilter made of silicon nanopore membranes for delicate filtration.
It also contains a bioreactor with cultured renal tubule cells responsible for electrolyte balance.
Implantable artificial kidney provide the following benefits:
- It eliminates the need for external dialysis treatment.
- It provides continuous treatment results that improve outcomes.
Besides advantages, it also has some challenges, like
- Biocompatibility and long-term functionality.
- Prevention of blood clotting and infection.
Advancements in Haemodialysis
There are more recent advances in haemodialysis for effective treatment and better outcomes. It includes
- Hemodiafiltration (HDF)
Hemodiafiltration (HDF) combines diffusion and convection to increase the rate of solute removal.
Some studies have shown it to improve cardiovascular outcomes.
- High-Flux Dialyzers
The improved membrane technology allows for better removal of middle molecules and shortens treatment duration, resulting in improved outcomes.
- Expanded Hemodialysis (HDx)
In expanded haemodialysis, medium cut-off membranes are used to remove a wider range of uremic toxins.
This has the potential to improve clinical outcomes and quality of life.
Improvements in Peritoneal Dialysis (PD)
The recent advances and improvements in peritoneal dialysis are listed below.
.png)
- Automated Peritoneal Dialysis (APD) Systems
The APD system introduces advanced cyclers with improved user interfaces and remote monitoring techniques.
These systems help integrate data and telemedicine with smartphones for data tracking and telemedicine.
- Wearable PD Devices
These wearable PD devices are compact and convenient for continuous ambulatory peritoneal dialysis (CAPD).
They improve mobility and reduce the burden of multiple exchanges.
- Novel PD Solutions
It provides biocompatible solutions with reduced glucose degradation products, preserving the peritoneal membrane's ability to function better.
Nanotechnology in Dialysis
The nanotechnology in dialysis includes
- Nanostructured Membranes
The advancement in nanostructured membranes enhances the selectivity and permeability to remove toxins.
This results in reduced dialysis treatment duration and improved efficiency.
- Nanoparticle-based Sorbents
They ensure highly specific removal of toxins by using functionalized nanoparticles.
They have the potential for targeted removal of toxins, specifically uremic toxins.
Artificial Intelligence (AI) and Machine Learning in Kidney Dialysis
In the world of AI, recent advancements have grown in dialysis technology. It includes
- Predictive Analytics
AI algorithms aid in predicting further complications and optimising treatment parameters at an advanced level.
It also allows patients to make personalised treatment plans based on individual patient history and diagnosis.
- Automated Fluid Management
Machine learning algorithms help with precise control of ultrafiltration. It has the potential to improve hemodynamic stability during dialysis treatment.
- Remote Monitoring and Telemedicine
AI-powered systems allow real-time monitoring for home dialysi
Improvements in Vascular Access
Over the past 60 years, dialysis vascular access was restricted only to fistula, graft, and central venous catheter (CVC). The improvements in vascular access over time include
- Bioengineered Blood Vessels
A recent development in dialysis access is tissue-engineered vascular grafts. They have the potential to reduce complications and improve the longevity of dialysis procedures.
- Novel Catheter Designs
The new technique of vascular access uses novel catheters with antimicrobial coatings to reduce infection risk.
The unique and improved designs also reduce thrombosis and improve its flow characteristics.
Portable and Mobile Dialysis Systems
The portable and Mobile Dialysis Systems is another advancement in dialysis treatment that includes
NxStage System One
It ensures a compact haemodialysis system for home and travel use. It provides flexibility in treatment schedules and locations.
Tablo Haemodialysis System
This is an all-in-one dialysis machine with a simplified user interface.
It is designed for use in various settings, including homes and skilled nursing facilities.
The advancements in dialysis technology are experiencing rapid improvement with new ideas in bioengineering, materials science, and artificial intelligence.
These advancements lead to better, easier, and more comfortable dialysis treatments for patients.
Moreover, wearable and implantable artificial kidneys are changing the way kidney treatment is done. It give patients more freedom and a better quality of life.
Frequently Asked Questions (FAQs)
How Does Dialysis Work?
There are two ways to filter blood. One is haemodialysis, and the other is peritoneal dialysis.
In haemodialysis, blood filters through a machine. However, in peritoneal dialysis, a cleaning solution is used in the abdominal cavity to absorb waste from blood.
How Often Do I Need Dialysis?
The frequency of dialysis depends on the type.
Hemodialysis requires three sessions a week, while peritoneal dialysis is usually performed daily. However, it can be done at home while you sleep.
Can I Live a Normal Life on Dialysis?
A person on dialysis can live a normal life, but their energy levels may fluctuate. Many people continue working, exercising, and enjoying hobbies while on dialysis.
What Are the Side Effects of Dialysis?
Common side effects of dialysis are fatigue, muscle cramps, low blood pressure, and nausea. Other symptoms, such as infections or other issues related to the dialysis access point, may also appear over time.
How Long Can Someone Live on Dialysis?
Many people can live for years on dialysis with proper care and balancing life. Life expectancy depends on individual health conditions, age, and treatment process.
Is dialysis painful?
The dialysis procedure is generally not painful. However, some discomfort can occur at the site of needle insertion.
Am I Supposed to Follow a Special Diet on Dialysis?
Yes, dialysis patients are required to follow a specialised diet. They need to restrict sodium, potassium, phosphorus, and fluids.
A renal dietitian helps patients customise a meal plan to suit their specific needs.
Can I Travel While on Dialysis?
Yes, people can travel with proper planning. Peritoneal dialysis allows people to travel. Always coordinate with your healthcare provider before planning a trip.
Conclusion
Kidney dialysis allows renal patients to continue their daily activities. Patients can remain passionately engaged, and stay connected with their loved ones.
It provides a necessary means to filter waste and excess fluids from the body.
Renal failure is not the end of life. Dialysis is an affordable treatment method for those facing kidney failure.
While the dialysis process is challenging, many patients adapt to it and find ways to maintain their quality of life.
Dialysis is not suitable for everyone, such as those who are much older or have other severe medical conditions.