Hemodialysis

Overview

Hemodialysis is a vital treatment for advanced kidney failure, wherein a machine effectively filters out waste, salts, and excess fluid from your blood when your kidneys can no longer perform this essential function. To maintain an active lifestyle despite failing kidneys, you must adhere to a strict treatment schedule, regularly take prescribed medications, and make necessary dietary adjustments. While hemodialysis is a significant responsibility, you won’t have to manage it alone. Collaborating closely with a dedicated healthcare team, including kidney specialists and experienced professionals in hemodialysis management, can provide essential support. There’s also the option of home-based hemodialysis to consider.

Reasons for undergoing the procedure

Determining when to commence hemodialysis is a decision that involves multiple considerations, with the guidance of your healthcare provider. these factors include:

• Overall health: Your general health status is a crucial factor. it’s important to assess whether you have any underlying health conditions that might impact your ability to undergo hemodialysis and benefit from it.
• Kidney function: The level of your kidney function is assessed using the estimated glomerular filtration rate (egfr). this value is determined through a blood creatinine test, taking into account factors such as age and sex. the egfr provides a measure of your kidney function, which is instrumental in planning your treatment and deciding when hemodialysis should begin.
• Signs and symptoms: Monitoring for signs and symptoms of kidney failure, known as uremia, is crucial. symptoms like nausea, vomiting, swelling, or fatigue can indicate the need for intervention.
• Quality of life: Your quality of life and how kidney failure is affecting it play a significant role in deciding when to start hemodialysis. this includes assessing how the condition impacts your daily activities and well-being.
• Personal preferences: Your preferences and values are important in making this decision. some individuals may prioritize treatments that improve their quality of life, while others may prefer aggressive medical interventions.

Common causes of kidney failure include:

• Diabetes
• High blood pressure (hypertension)
• Kidney inflammation (glomerulonephritis)
• Kdney cysts (polycystic kidney disease)
• Inherited kidney diseases
• Long-term use of kidney-harming medications

Additionally, kidney function can suddenly deteriorate due to acute kidney injury, which can be triggered by severe illnesses, complicated surgeries, heart attacks, or certain medications.

For those with severe chronic kidney disease, there are alternatives to immediate dialysis initiation. some may choose maximal medical therapy or palliative care to manage complications of advanced kidney disease while focusing on symptom management and quality of life. others may be candidates for preemptive kidney transplantation rather than starting dialysis. the decision depends on individual health circumstances, and it’s essential to consult with your healthcare team for personalized guidance on your treatment options. hemodialysis often begins before kidney function reaches life-threatening levels to help control blood pressure and maintain fluid and mineral balance in the body.

Risk

Hemodialysis is a critical treatment for individuals with various underlying health issues, although it does not provide the same life expectancy as the general population. While hemodialysis can effectively replace some kidney function, patients may encounter several related conditions. Here are some of these potential issues, but not everyone will experience all of them. Your healthcare team is there to assist you in managing these challenges:

• Anemia: Anemia, characterized by insufficient red blood cells, is a frequent complication of kidney failure and hemodialysis. Kidney dysfunction reduces the production of erythropoietin, a hormone responsible for red blood cell formation. Additionally, dietary restrictions, poor iron absorption, frequent blood tests, and the removal of iron and vitamins during hemodialysis can contribute to anemia.
• Muscle cramps: The cause of muscle cramps during hemodialysis is not entirely clear, but it is a common occurrence. Adjusting the hemodialysis prescription or regulating fluid and sodium intake between treatments may help alleviate these symptoms.
• High blood pressure (hypertension): Consuming excessive salt or fluids can worsen high blood pressure, potentially leading to heart problems or strokes.
• Access site complications: Complications such as infection, narrowing, ballooning of blood vessels (aneurysm), or blockage can affect the quality of hemodialysis. It’s crucial to follow your dialysis team’s guidance for monitoring changes in your access site.
• Low blood pressure (hypotension): A drop in blood pressure is a common side effect of hemodialysis, often accompanied by symptoms like shortness of breath, abdominal cramps, muscle cramps, nausea, or vomiting.
• Amyloidosis: Dialysis-related amyloidosis may develop when blood proteins accumulate on joints and tendons, causing pain, stiffness, and joint fluid buildup. This condition is more common in individuals who have undergone hemodialysis for an extended period.
• Itching: Many individuals undergoing hemodialysis experience itchy skin, which can be especially bothersome during or after the procedure.
• Pericarditis: Insufficient hemodialysis can cause inflammation of the pericardium, the membrane surrounding the heart. This condition can interfere with the heart’s ability to pump blood effectively.
• Sleep problems: Sleep disturbances are common among people receiving hemodialysis, possibly due to sleep apnea or discomfort from restless legs or body aches.
• Potassium imbalances: Hemodialysis regulates potassium levels, and improper removal of potassium can lead to irregular heartbeats or arrhythmias.
• Fluid overload: Hemodialysis removes excess fluids from the body, so consuming more fluids than recommended between treatments can result in life-threatening complications such as heart failure or pulmonary edema.
• Depression: Mood changes, including depression and anxiety, are common in individuals with kidney failure. If you experience these issues after starting hemodialysis, it’s essential to discuss effective treatment options with your healthcare team.

Before the procedure

Hemodialysis preparation begins weeks or months in advance of the initial treatment. A surgeon will make a vascular access to their bloodstream so that it may be easily accessed. For the hemodialysis process to function, the access offers a way for a little amount of blood to be securely taken out of the bloodstream and then put back into it. Before starting hemodialysis treatments, the surgical access must recover.

Three different kinds of access includes:

• Arteriovenous (AV) fistula: An artery and vein are connected via a surgically made AV fistula, which is typically used in the arm. The effectiveness and safety of this type of access make it the recommended option.
• AV graft: A flexible synthetic tube known as a graft may be used by the surgeon to establish a passage between an artery and a vein if the blood vessels are too narrow to form an AV fistula.
• Central venous catheter: A plastic tube, called a catheter, may be placed into a major vein in the patient’s neck in the event that emergency hemodialysis is required. The catheter is only meant to be used temporarily.

Taking care of the access site is essential in order to lower the risk of infection and other complications. Observe the directions provided by the healthcare provider regarding access maintenance to the site.

During the procedure

The dialyzer, a filter that cleans blood by functioning as an artificial kidney, is used on patients who sit or lie down in a chair during treatments. During this time, they can read, nap, watch TV or a movie, or perhaps chat with their “neighbors” at the center. They can sleep through the process if their hemodialysis is performed at night.

• Preparation: Assessment are made on temperature, pulse, blood pressure, and weight. The area of skin that covers the access site, which is where blood exits and re-enters the body during the treatment procedure, is cleaned.
• Beginning: Two needles are placed through the access site into the arm during hemodialysis, and they are taped there to stay in place. Every needle has a flexible plastic tubing attached to it that attaches the dialyzer.

The dialyzer allows wastes and excess fluid to pass from the circulation into a cleansing fluid called dialysate by filtering a few ounces of blood at a time through a single tube. The second tube brings the filtered blood back into the body.

• Indicators: If the patient has accumulated a substantial quantity of fluid in between dialysis sessions, they may feel sick and have cramps in their abdomen when the extra fluid is removed from their body. If they have discomfort during the treatment, inquire with the care team about ways to reduce side effects, such as modifying the hemodialysis’s speed, their medicine, or the fluids they use.
• Monitoring: Throughout each treatment, the patient’s blood pressure and heart rate will be monitored multiple times due to the potential for fluctuations as extra fluid is removed from the body.
• Completion: The needles are taken out of the access site when hemodialysis is finished, and a pressure dressing is placed there to stop the bleeding. They may weigh themselves once more. After then, they can carry on with their regular activities until their next meeting.

After the procedure

If a patient encounters a sudden (acute) kidney injury, hemodialysis may be necessary for a temporary period while their kidneys undergo recovery. However, if the patient already had reduced kidney function prior to the abrupt injury, their chances of achieving full kidney function recovery and becoming independent from hemodialysis are lower.

Outcome

In-center hemodialysis three times a week remains a prevalent option, but recent research indicates that opting for at-home dialysis can offer various advantages. These benefits encompass enhanced energy levels and sleep patterns, a reduction in symptoms such as headaches, nausea, and cramps, and an overall enhancement in one’s well-being and quality of life. In contrast to the traditional in-center approach, selecting home dialysis can provide a more pleasant experience, addressing multiple aspects of both physical and mental well-being.

In order to ensure that the patient is receiving the appropriate dosage of hemodialysis to adequately remove waste products from their blood, the hemodialysis care team keeps an eye on the patient during treatment. Before, during, and after the procedure, regular checks are made on the patient’s weight and blood pressure. Patients will get these tests around once every month:

• Blood tests that assess the body’s ability to eliminate waste products during hemodialysis by measuring the urea reduction ratio (URR) and total urea clearance (Kt/V).
• Assessment of blood counts and blood chemistry.
• Blood flow measurements made during hemodialysis through the access location

The findings of the tests may influence how frequently and how intensely the hemodialysis is administered by the healthcare providers.

Hemodialysis can be administered to patients in a hospital, at home, or at a dialysis facility. Depending on the circumstances, the frequency of treatment varies:

• In-center hemodialysis: Hemodialysis is often administered three times a week in sessions lasting three to five hours each.
• Daily hemodialysis: This involves shorter, more frequent sessions that are often completed at home six or seven days a week for roughly two hours each.

With specialized training and assistance, patients may be able to do hemodialysis at home thanks to more affordable and user-friendly devices. It’s possible that they could perform the surgery while they’re sleeping at night.

In case the patient is planning to travel, they can get in touch with the dialysis center directly at their destination, or the dialysis team can assist them in scheduling appointments at other locations. To ensure that there is room and that the right arrangements can be made, plan beforehand.