Dialysis

Dialysis is a kidney replacement option, when transplant is not immediately available, that does some of the things healthy kidneys do. It is needed when your own kidneys fail or can no longer function well enough to take care of your body’s needs.

There are two main types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis (Hemo)

Hemodialysis (Hemo) – This entails using a machine to clean waste from your blood. Your blood flows on one side of an artificial membrane, with special fluid on the other side. The membrane permits waste molecules (extra fluid, electrolytes, etc.) that have built up in the blood to pass into the fluid and be removed, thus cleaning your blood.

• Home hemodialysis – dialysis that is done at home with an assistant and your own dialysis machine.
• In-center, self-care hemodialysis – dialysis done in a center with you doing as much as possible with the assistance of staff at the dialysis center.
• In-center hemodialysis – dialysis that is done in a center with the staff providing all of the care. 

Required for hemodialysis:

Dialysis access

When you are in need of dialysis, your doctor will require you to have a vascular access surgically placed. This will provide access to your bloodstream in order to allow blood to be cleaned by the dialysis machine. It will stay with you as long as you are on dialysis.

There are two types of vascular access designed for long-term use.

An arteriovenous (AV) fistula is a surgically created connection from an artery to a vein. Your surgeon will typically place an AV fistula in the forearm or upper arm as an outpatient procedure; occasionally, doctors require patients to stay overnight after the procedure. The procedure is done under local anesthesia, only numbing the area where the AV fistula is created. An AV fistula generally requires two to three months to mature before it can be used; if it fails to mature, the procedure must be repeated.

This type of access is recommended because it:

• Provides good blood flow for dialysis;
• Lasts longer than other types; and,
• Is less likely to get infected or cause blood clots

An arteriovenous graft is a looped, synthetic tube that connects an artery to a vein. This type of access is also placed in an outpatient procedure using local anesthesia. You can generally use an AV graft two to three weeks after surgery. It is generally more likely to have issues with infection and clotting but a well-cared for graft can last several years.

A third type of access, a venous catheter is not intended for long-term use. It is a tube inserted into a vein in your neck, chest, or groin area. The tube splits in two after it exits your body to carry blood to the dialyzer and then back again. A venous catheter will be used if you progress to kidney failure quickly and there is not enough time for placement of a permanent access before starting dialysis. This type of access is more likely to become infected, cause clots, etc. It is preferential to begin hemodialysis with a fistula or graft.

Caring for your vascular access is key to your health. Recommendations for such care include:

• Keep the access area clean at all times;
• Use the access only for dialysis;
• Do not bump or cut the access;
• Check the “thrill” in the AV fistula or AV graft daily. The “thrill” is the rhythmic vibration a person can feel over their access;
• Report any signs of infection including redness, tenderness and/or pus;
• Do not let anyone put a blood pressure cuff on your access arm;
• Do not let anyone draw blood from your access arm;
• Do not wear jewelry or tight clothes over the access site;
• Do not sleep with the access arm under the head or body;
• Do not lift heavy objects or put pressure of any kind on the access arm; and,
• Do not get your venous catheter wet.

Peritoneal dialysis (PD)

Peritoneal dialysis (PD) – a type of dialysis that removes extra fluid, electrolytes and wastes using the lining of the abdominal cavity (peritoneum). PD requires a soft plastic tube be surgically placed in your belly. A sterile cleansing fluid is then put into your belly via the tube to filter the fluid.

There are two ways to do peritoneal dialysis:

Continuous ambulatory peritoneal dialysis (CAPD) – this is done on a continuous basis. It is machine-free and happens while you go about your normal life, including work, school, or social activities. It is done by hooking a plastic bag of cleaning fluid to the tube in your belly then raising the bag to shoulder level. This allows gravity to pull the fluid into your belly. When the bag is empty, it is removed and thrown away. After 30 to 40 minutes, the fluid is drained from your belly (through the plastic tube) and discarded. This process is usually done three, four, or even five times each day.

Continuous cyclic peritoneal dialysis (CCPD) – the process for CCPD is the same as for CAPD, but it is done during the night using a machine to make the exchanges while you sleep.