Two of the most important dialysis procedures

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As we have seen in previous articles, one of the most important terms in medicine, more specifically in the renal system is dialysis. This is one of the most significant procedures for those people with kidney problems, which gives to them the possibility of having a better health quality and the opportunity for living a more normal life. In other words, thanks to this medical process, people with kidney failures can have a new chance for passing better days.

In this post, we will talk about the two principal dialysis types: the peritoneal dialysis and the Hemodialysis. Before talking about these two vital medical procedures, it is important to have a better context about what a dialysis is and why it is important for those persons with kidney issues. In addition, it is significant to show some other alternatives for the treatment of kidney diseases.

Dialysis and other treatments

We can define dialysis as the medical procedure for cleaning the blood of those people with kidney failures. Put differently, it is the artificial way for eliminating waste and other components in the blood in those persons that have problems in their renal system with the impossibility for removing all these elements by themselves. Usually, the people who need dialysis are the ones with critical renal failures. For those that do not have chronic issues, there are different and less traumatic treatments.

It is important to say, as we have mentioned in this blog, that the renal system is in charge of keeping the right levels of water and minerals in the blood. Through this vital part of the body, elements like potassium, sodium, calcium, chloride, magnesium, phosphorus and sulfate are metabolized, maintaining the required levels of these minerals for the correct performance of the human body. When kidneys and other components of this system are not working correctly for doing this, then a medical treatment is needed. If it is critical, a dialysis procedure will be required.

Having clear what a dialysis is and when it is needed, then we can talk about other renal treatments. Sometimes, when the kidney failure is not so critical, there are medicines that let the renal system to keep the adequate mineral and water levels in the blood. Another alternative is a surgery. One of the best solutions for those persons with kidney failures is a transplant, giving to the affected the possibility of having a normal working in its renal system. However, this is a more complex alternative, due to the high demand of kidneys in the world.

Hemodialysis

Under this procedure, the patient or the affected is connected into a medical dispositive called dialyzer. This mechanism cleans the blood after receiving it from the body. Here, the blood is purified, removing from it all those wasting elements which can not be eliminated by the renal system of the patient. After the blood is cleaned, it is introduced in the body, giving into it the right levels of water and minerals. In other words, through a hemodialysis, the blood is extracted for being filtered and purified in a dialyzer, then it is returned to the body.

Usually, the hemodialysis process is executed in hospitals or medical institutions, but there is the possibility of doing it at home. Some clinics give this alternative to their patients, but it requires a specialized person that understands and know how to make this procedure. It is important to say that a dialysis is usually an outpatient process and can take a few hours to be accomplished.

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Peritoneal dialysis

With a Peritoneal dialysis, the patient can clean its blood through a medical element called dialysate. Basically, with this process, it is introduced glucose through the peritoneal cavity with a tiny tube, so the peritoneal membrane works as a filter, cleaning the blood and purifying it.

This procedure is designed for being applied between 4 or 5 times in a day and for some experts, it is less efficient than an hemodialysis. The Peritoneal dialysis is used not only for cleaning the blood from toxins and other elements, but also for removing excessive fluids and to correct electrolyte problems.

However, this procedure can bring some issues to the patient, like high blood sugar levels, abdominal infections, hernias, abdomen bleeding, or catheter blocking. In other words, the Peritoneal dialysis is an excellent alternative, but for being a medical procedure where a tube is introduced into the peritoneal cavity, some problems may occur.

We have seen in this article two of the principal alternatives for treating kidney issues with dialysis, but there are other processes like the Hemofiltration, the Hemodiafiltration, the Intestinal dialysis or the Pediatric dialysis, which are excellent options depending on the patient and the condition of its renal system. In addition, it is important to say that for those situations where the renal failure is not chronic, other alternatives must be considered, like medicines or surgeries.

Related: Everything You Need to Know About Pediatric Dialysis by Joe Cosgrove

What is it like to live with dialysis?

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In the United States at least 217,000 patients need to live with dialysis. This represents national costs for over $11 billion dollars every year. This procedure needs to take place when the kidneys are unable to filter fluids and their full capacity is lost. Sometimes, patients who need to live with dialysis have to do so because they were born with a kidney condition and they cannot afford a kidney transplant.

Statistically speaking, this is a dramatic situation for thousands of people in the United States. However, most patients seem to believe that dialysis is not such a terrible thing and they have adapted to a “new normal life”. But, what does it means to live with dialysis? In this article, Joe Cosgrove will share some details related to the way patients learn to have regular lives while they depend on dialysis to survive.

The Experience

First of all, when a patient decides that it is time to go under dialysis treatment it is because its kidneys are not able to do their job. This means that dialysis becomes the only alternative to survive. Keeping this in mind makes it easier and more motivating to people who need to go under treatment.

During a regular dialysis routine, the patient needs to come to the dialysis clinic and meet the nurse at the counter. Papers and forms will be filled out and a short checkup will take place. Since most patients have done this a thousand times, the process usually doesn’t take long.

After the checkup, the patient settles into one of the comfortable recliners inside the room where the process usually takes place. The patient may be the only one in the room or not, depending on the day and time it decides to go and get the treatment.

After settling, the patient will need to prop its left arm, allowing the technician to slip a couple needles into its blood vessels (close to the wrist). One of the needles is in charge of removing the blood and the other one is in charge of taking it back to the body. These needles are attached to plastic tubes that at the same time are connected to the dialysis machine.

For the next three hours, the needles will do their job and the patient’s blood will be filtered. All this is possible thanks to the dialysis machine that stands still next to the patient’s recliner. Most patients bring a book or spend this time watching a movie or a TV show on Netflix. Sometimes, this is even the perfect moment to take a nap.

Besides from the initial moment of the procedure, when the needles need to be stuck on your veins, the dialysis process doesn’t hurt. Sometimes patients may feel dazed and their blood pressure can drop. But, other than that, the process takes place in a comfortable way.

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Living with dialysis is supposed to make things easier for patients with End Stage Renal Disease (ESRD). However, the mortality rates in the United States remain to be considerably high compared to those in Japan or Europe since many patients choose to skip the procedure or don’t accept it to last for too many hours.

Related: How To Make The Most Out Of Your Time On Dialysis

How Dialysis Works

The best way to describe the dialysis process is as an artificial kidney. This means that dialysis should be able to do what your kidneys cannot do anymore. There are two different forms of dialysis: hemodialysis and peritoneal dialysis. At least 90% of the patients in the United States who live with dialysis choose to go under the hemodialysis treatment. This is the procedure that was described in the experience above.

When patients live with hemodialysis, their blood needs to be circulated outside of the body with the help of a hemodialysis device. This device cleanses the blood and then returns it back to the body of the patient.

Not everyone is a right candidate to get hemodialysis. This is why every patient needs to have the doctor’s approval before having an entrance or access (a minor surgery on the leg, arm or neck to access the blood vessels). This access is called fistula and the patient will need to keep it clean and usable for as long as it needs to go under dialysis treatment.

The fistula is something dialysis patients need to learn how to live with since it is the only way doctors have to access the blood in a fast and effective way. Fistulas are joints between arteries and veins located under the skin that form a larger vessel where needles are inserted.

When patients don’t need to live with dialysis and only go under a temporary treatment, they can get a catheter on their neck and there is no need for them to go under this minor surgery. In the case of the fistula, the wound needs to heal before the dialysis treatment takes place. However, in case patients use a catheter, they can go under the dialysis treatment right away and the procedure is slightly different.

Great Alternatives to Perform Dialysis at Home

Since the 1960’s home dialysis has been an alternative for patients with end-stage renal disease (ESRD). Joe Cosgrove knows that both home hemodialysis (HHD) and Peritoneal dialysis (PD) have been available for decades to those who barely had the chance to go to the hospital because of their condition. However, the usage of home dialysis only became popular during recent years.

At first, home dialysis was quite uncomfortable for both patients and healthcare providers. It was an exhausting and expensive procedure that would need patients to use huge machines. Nowadays, technology has made it possible for ESRD patients to have access to home dialysis comfortably. This way, patients get the chance to have a better lifestyle while being treated.

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Home Peritoneal Dialysis

Peritoneal dialysis is the most popular dialysis treatment that can take place at home. It is easy to handle and most patients who choose this type of procedure are able to take care of it on their own. People on Peritoneal dialysis are able to use the peritoneal membrane (which covers the intestine and other organs) in the abdominal cavity to filter any type of wastes from the blood.

This dialysis solution needs the patient to get a catheter installed in the abdominal cavity. This way they catheter will stay in the abdomen for several hours while toxins and fluids are filtered from the blood vessels through the peritoneal membrane and into a special solution called dialysate.

The reason why this procedure can be performed at home is that the dwell time is programmed and easy to handle. Once the patient got the waste filtered through the membrane and diluted in the dialysate, it will be drained out of the body and a new dose of dialysate will be introduced in the abdominal cavity so the cleaning process can start all over again.

This exchange process can be done with the assistance of a machine or manually. When the process is done manually by the patient at home, all the fluid held in the abdominal cavity will need to be removed before the new solution is injected. The patient will drain the solution thanks to the gravity force, placing the empty bag to receive the fluid onto the ground. Usually, the average amount of fluid that the patient will drain at home can reach the two liters and it can be drained within 10 to 20 minutes.

The most common peritoneal dialysis machine is called a cycler and it performs the exchange process automatically. Most patients at home choose to have this machine because it makes the dialysis process easier and faster, leaving enough free time to have a regular life. An ESRD patient will plug the catheter to the machine during the evening and the machine will work during its sleep, performing at least three exchanges.

Some patients choose to carry some dialysate in the abdominal cavity during the day and drain it out at night, once they are connected to the machine. Also, some patients need to perform one exchange during the day.

One of the most amazing things about this type of home dialysis is that the nurse and the doctor will need to teach the patient and its family how to use the machine and how to perform the dialysis manually. After three weeks, the patient will be able to take care of its condition on its own.

Related: 4 things you need to do to cope with dialysis

The Merck Home Manual of Medical Information - Dialysis

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Home Hemodialysis

This type of home dialysis has been the least common. Nevertheless, there are two types of hemodialysis available for patients who want to have it performed at home. The first type is called short daily home hemodialysis and the second type is known as conventional home hemodialysis.

The conventional type of home hemodialysis usually takes place three times per week and each session takes at least 3 hours. The procedure takes places regularly, just as it does at a dialysis center. Patients who choose to have this type of home dialysis, tend to spend the dialysis time watching television, on the computer or chatting on the phone.

The other type of home hemodialysis, known as short daily home hemodialysis, need to take place at least six times every week. Each session will take just a few hours depending on the patient’s weight, health condition, lab results and other factors. Since the blood gets to be cleaned every day, patients have the chance to have a freer fluid intake and side effects such as cramps, migraine, waves of nausea and low blood pressure are controlled since they are not likely to appear.

Unlike peritoneal dialysis, home hemodialysis cannot be done manually. This means that the patient will always need to be assisted by a machine in its house. Also, for safety reasons, a partner will need to be present during the entire session so the patient can get some help. Both the patient and its partner will need to be trained on how to handle and clean the machine. The training process can take up to six weeks to be completed.