What is Dialysis?
BDS (Bachelor of Dental Surgery), 6 years of experience
What is the meaning of Dialysis?
Dialysis is the process by which excess fluid, wastes, and toxins are removed from the body of people whose kidneys do not function properly. The kidneys are two bean-shaped organs situated on either side of the spine just below the rib cage. The kidneys are essential organs that perform major functions such as:
- Filtration of the blood to remove toxic waste products from the body.
- Regulation of blood pressure
- Regulation of sodium and potassium
- Production of an active form of vitamin D that promotes strong and healthy bones.
- The production of erythropoietin plays a role in the production of red blood cells.
When kidneys stop performing these functions (kidney failure), harmful levels of fluid and waste accumulate in the blood that can damage the body. In such people, dialysis performs the functions of the failed kidneys and helps people lead a longer and healthier life.
Let us try to tell you in detail about dialysis through this article.
- Why is Dialysis done?
- What are the types of Dialysis?
- What is the procedure of Dialysis?
- How to take care after Dialysis?
- What are the risks of Dialysis?
- What is the cost of Dialysis in India?
Why is Dialysis done?
Dialysis is the choice of treatment in kidney failure where the kidneys perform only 10%-15% of their normal function. The causes of kidney failure include-
- Diabetes mellitus ( Know more about- What is Diabetes? Causes, Symptoms, Treatment, Precautions )
- Hypertension- elevated blood pressure. ( Know more about- Diet Plan for Hypertension )
- Glomerulonephritis- A condition in which there is inflammation of the tiny filters in the kidney (glomeruli)
- Polycystic kidney disease- It is a condition in which clusters of cysts develop within the kidneys, causing the kidneys to enlarge and lose function over time.
- Vasculitis- Inflammation of blood vessels.
Signs and symptoms of kidney failure include–
- Decreased urine output.
- Fluid retention, i.e., swelling in the legs, ankles, and feet.
- Shortness of breath
- Fatigue
- Nausea, vomiting, and loss of appetite
- Sleep disturbances
- Chest pain and persistent itching
In some cases of acute or sudden kidney failure occurring due to a serious illness, complicated surgery, or because of certain medications, dialysis may be needed only for a short duration of time till the kidneys regain their normal function. However, in chronic or end-stage kidney failure, dialysis may be required for a lifetime. In such chronic cases, the patient can alternatively opt for a kidney transplant wherein a healthy kidney from a donor is placed into the recipient’s body. ( Know more about- What is Kidney Transplant? Purpose, Procedure, Aftercare, Cost )
What are the types of Dialysis?
There are three types of dialysis:
Hemodialysis- This is the most common type of dialysis. In this process, an artificial kidney known as the hemodialyzer filter helps remove waste and excess fluid from the blood. In order to get blood into the artificial kidney, your doctor will need to make vascular access (entrance) into your blood vessels. This surgical access site needs time to heal, and hence it is made several weeks before dialysis starts. There are three types of accesses-
- Arteriovenous (AV) fistula- An artery and vein are connected to each other. Due to its effectiveness and safety, it is the most preferred type of access. Dialysis can begin 2-3 months after an AV fistula type access.
- AV graft- In this type of access, a connection between an artery and vein is made using a flexible, synthetic tube known as a graft. It is mostly done in cases where the blood vessels are too small to form an AV fistula. Dialysis can begin 2-3 weeks after making an AV graft.
- Central venous catheter- In this type, a plastic tube known as a catheter is inserted into a large vein of the neck or groin. This type of access is usually done in cases of emergency dialysis and is for short-term or temporary use.
To reduce the chances of infections and other complications it is extremely important to take good care of the access site. Hemodialysis usually takes about 3-5 hours per session and is performed about 3 times a week. However, this duration can reduce if the frequency of dialysis increases. The length of the treatment varies depending on the size of your body, the amount of waste in your body, and your current health condition.
Peritoneal dialysis- In this process, a peritoneal dialysis catheter is implanted into the patient’s abdomen, and the blood is cleaned inside the body, unlike hemodialysis. The catheter helps filter the blood through the peritoneum, a tissue that lines the abdominal wall and provides a covering around the organs of the abdomen. During treatment, a special fluid called the dialysate is introduced that slowly flows through the peritoneum and absorbs all the waste and excess fluid in the body. After the waste is drawn out of the bloodstream by the dialysate, it is drained out of the abdomen. Peritoneal dialysis is repeated about 4-6 times each day, and the process can take a few hours.
Types of peritoneal dialysis-
- Continuous ambulatory peritoneal dialysis (CAPD)- In this type, the peritoneum is filled with dialysate and drained several times a day. CAPD does not require a machine and is performed during the day when the patient is awake.
- Continuous cycling peritoneal dialysis (CCPD)- In this process, a machine is needed to cycle the fluid in and out of the abdomen. CCPD is performed at night while the patient is asleep.
- Intermittent peritoneal dialysis (IPD)- IPD uses the same machine as CCPD, but the procedure takes much longer and is usually done in the hospital.
Continuous renal replacement therapy (CRRT) also known as hemofiltration, is mainly used in the intensive care unit (ICU) for patients suffering from acute or sudden kidney failure. In CRRT, a machine passes the blood through a tube and a filter that helps remove waste products and excess water. The blood is then returned to the body along with the replacement fluid. CRRT is performed every day for 12-24 hours until the patient is out of the ICU.
What is the procedure of Dialysis?
Dialysis can be done in a dialysis center, a hospital, or at home.
The procedure depends on the type of dialysis:
- Hemodialysis –
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- Your vascular access site will be cleansed, and you will be weighed before starting dialysis. You will then be asked to sit or recline in a comfortable chair for the rest of the dialysis procedure.
- Your healthcare provider will check your blood pressure, breathing, heart rate, pulse, and temperature. Your blood pressure will be monitored throughout the dialysis.
- Two needles will be placed in your access site to allow blood to flow in and out of the body. In case you find this uncomfortable during your initial dialysis sessions, you can ask your doctor to numb the area.
- The needles are then attached to tubes that are connected to a dialyzer where the blood is filtered.
- Each session takes about 3-4 hours, and during this time you can read, nap, watch television or talk to others around you.
- Once the session is completed, the needles from the access site will be removed and a dressing will be applied on the site.
- Peritoneal dialysis –
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- Your blood pressure, weight, heart rate, pulse, and temperature are checked. You will also be asked to empty your bowel and bladder before starting peritoneal dialysis.
- The peritoneal catheter is inserted into the abdomen under aseptic conditions to minimize the risk of contamination and infection.
- The warmed-up dialysate is infused into the peritoneum, which will absorb the waste and excess fluid present in the body.
- After the waste is drawn out of the bloodstream by the dialysate, it is drained out of the abdomen. Peritoneal dialysis is repeated about 4-6 times each day, and the process can take a few hours.
- Continuous renal replacement therapy (CRRT)-
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- In CRRT, a machine passes the blood through a tube and a filter that helps remove waste products and excess water.
- The blood is then returned to the body along with the replacement fluid.
- CRRT is performed every day for 12-24 hours until the patient is out of the ICU.
How to take care after Dialysis?
The patient may require some special care after dialysis.
- The most important aspect to keep in mind after dialysis is your diet. Discuss a diet plan with a dietician, who can guide you on what and how much to eat and drink.
- A good and well-balanced diet is necessary to restore all the nutrients that are lost during dialysis. However, care should be taken not to consume too many nutrients as excess nutrients get accumulated in the body. ( Know more about- Home Remedies for Kidney Cleansing )
- Regulate your water intake. Accumulation of excess water can lead to increased blood pressure, swelling, etc.
- Restricted salt intake in the diet.
- Reduce consumption of foods rich in potassium and phosphorus such as meat, fish, beans, and dairy products such as milk and curd in the diet.
What are the risks of Dialysis?
- Risks of hemodialysis-
- Hypotension or low blood pressure that may be accompanied by shortness of breath, abdominal and muscle cramps, nausea, or vomiting.
- Muscle cramps- These cramps can be relieved by adjusting the fluid and sodium intake between hemodialysis treatments.
- Itching
- Sleep disturbances due to sleep apnea, i.e., breaks in breathing during sleep or due to restless, aching legs.
- Anemia- Due to kidney failure, there is reduced production of erythropoietin (which stimulates red blood cell formation) and hence, the patient is at risk of anemia. Diet restrictions due to dialysis, frequent blood tests, and removal of iron and vitamins during dialysis also contribute to anemia.
- Bone disorders- Due to kidney failure, the kidneys are not able to convert vitamin D from supplements and sun into an active form of vitamin D that leads to the weakening of bones. ( Know more about- What is a Kidney Stone? Types, Causes, Symptoms, Treatment )
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- Hypertension
- Fluid overload- Consumption of excess fluid between hemodialysis sessions can lead to life-threatening complications such as pulmonary edema.
- Pericarditis or inflammation of the membrane surrounding the heart.
- Hyperkalemia or increase potassium levels.
- Access site complications such as infection, ballooning or narrowing of blood vessels, sepsis.
- Amyloidosis- wherein an abnormal protein known as amyloid accumulates in the kidney and interferes with its functioning.
- Depression and anxiety
- Risks of peritoneal dialysis –
- Weight gain and fever
- Peritonitis, which is the inflammation of the membrane lining the abdominal wall.
- Stomach pain and abdominal muscle weakening
- Hernia
- Risks of continuous renal replacement therapy (CRRT) –
- Infection
- Hypothermia- decreased body temperature
- Decreased blood pressure.
- Bleeding
- Electrolyte disturbances
- Anaphylaxis – severe allergic reaction
What is the cost of Dialysis in India?
The total cost of hemodialysis in India can range from around INR 12,000 to INR 15,000 per month, and the cost of peritoneal dialysis is between INR 18,000 to INR 20,000 per month. However, the cost of treatment can vary across different hospitals.
If you are coming from abroad, apart from the cost of dialysis treatment, there will be some additional expenses such as hotel accommodation and local travel. Apart from this, the patient is kept in the hospital for 2 to 8 days after treatment. So the total cost of dialysis in India comes to be around INR 20,000 to INR 25,000.
We hope we were able to answer your questions on dialysis through this article.
If you need more information about dialysis and want to get the procedure done, contact a Nephrologist.
We only aim to provide you with information through the article. We do not recommend any medicine or treatment to anyone. Only a doctor can give you the best advice and correct treatment plan.
