dialysis overview

Overview of Dialysis

  • Dialysis is a treatment to remove waste products, extra fluids, and toxins from the blood when kidneys are not functioning adequately.

  • Types of dialysis include hemodialysis and peritoneal dialysis, which each utilize different methods for filtering blood or waste removal.

Hemodialysis

Process

  • Involves accessing blood through a fistula using two needles (one for blood withdrawal and the other for returning cleaned blood).

  • Blood is sent through a dialyzer where it is cleaned by a dialysate; dirty blood goes out while clean blood returns to the patient.

  • A semipermeable membrane in the dialyzer allows for the exchange of waste products.

  • Heparin is administered to prevent blood clotting during the process.

Fistula Access

  • AV fistula connects an artery to a vein creating a larger blood vessel for efficient blood flow.

  • Arterialized fistulas appear bulgy and blue, indicating good access.

  • Placement requires surgery and it may take 6 weeks to 6 months to mature.

Alternative Access Methods

  1. Graft - A piece of plastic tubing; can elevate infection risk.

  2. Catheter - Inserted if immediate access is needed; can be placed in internal jugular or subclavian veins.

Monitoring and Complications

  • Assess the fistula for signs of infection, clots, and ensure blood flow.

  • Check for bruit (buzzing sound with a stethoscope) and thrill (vibration felt) to verify the function of the fistula.

  • Complications: hypotension, muscle cramps, loss of blood, infection, and potential upsurge of hepatitis.

  • Dialysis does not replace kidney function completely but assists in managing symptoms and preventing complications.

Peritoneal Dialysis

Procedure

  • Involves placing a catheter in the abdomen for filtration through the peritoneum.

  • Comprises three phases: Fill, Dwell, and Drain which take several hours.

  • Continuous Ambulatory Peritoneal Dialysis (CAPD) requires manual exchanges every few hours.

  • Automated Peritoneal Dialysis runs automatically overnight via a machine.

Monitoring and Complications

  • Check for adequate outflow (should be more than what was put in); if less, investigate for possible causes (kinks, constipation).

  • Watch for signs of infection (fever, redness) and peritonitis (cloudy outflow).

  • Other potential complications: abdominal pain, hernias, low back problems, and fluid imbalance.

Dialysis Decisions

  • Factors affecting choice between hemodialysis and peritoneal dialysis include patient dexterity, personal preferences, abdominal surgeries, and overall health.

  • Patients on peritoneal dialysis must monitor for high blood sugar levels due to glucose in dialysate.

Nutrition Considerations

Diet Restrictions

  • Patients not on dialysis: low protein diet to minimize kidney burden.

  • Patients on dialysis: high protein consumption due to protein loss during treatment.

  • Potassium and phosphorus intake must be regulated; high potassium foods include bananas and oranges.

  • Phosphate binders help control phosphorus levels during meals.

Kidney Transplant

Overview

  • May involve a kidney from a deceased or living donor.

  • Better outcomes seen with living donor kidneys (95% success rate).

  • New kidneys are usually placed without removing old ones.

Immunosuppressive Therapy

  • Essential to prevent rejection of the new kidney; includes medications like corticosteroids and cyclosporine.

  • Monitoring for signs of rejection, such as decreased urine output, fever, and lethargy.

Rejection Types

  1. Hyperacute - Occurs minutes to hours after transplant.

  2. Acute - Days to months after the procedure.

  3. Chronic - Months to years later and typically irreversible.

Complications in Dialysis and Transplant

Hemodialysis

  • Cardiovascular issues, hypotension during treatments, and muscle cramps due to rapid fluid removal.

Peritoneal Dialysis

  • Infections, hernias due to abdominal pressure, and pulmonary issues from fluid pushing against the lungs.

Transplantation

  • Increased cancer risk due to immunosuppressants and concerns regarding recurrent kidney disease or infections.

Conclusion

  • Decision-making in dialysis and transplant relies on personal health, lifestyle, and understanding the implications of each treatment method.