What is Dialysis?
Dialysis of kidney is a medical treatment that uses a machine or a special fluid to filter waste products from the blood when the kidneys are not functioning properly. The goal of dialysis is to:
1. Remove waste products, such as urea, creatinine, and other toxins
2. Regulate electrolyte levels
3. Control fluid balance
4. Manage blood pressure
5. Improve overall health and well-being
Dialysis works by:
1. Diffusion: Waste products pass from the blood into a special fluid called dialysate
2. Ultrafiltration: Excess fluids are removed from the blood
3. Convection: Waste products are removed from the blood using a convective force
Who Needs Dialysis?
Dialysis Of Kidney is typically needed for individuals with:
1. End-Stage Renal Disease (ESRD): Permanent kidney failure, requiring lifelong dialysis of kidney or transplantation.
2. Acute Kidney Injury (AKI): Sudden kidney failure, often reversible with dialysis.
3. Chronic Kidney Disease (CKD): Advanced stages (4-5) with significant kidney impairment.
4. Kidney damage: Due to conditions like diabetes, hypertension, or glomerulonephritis.
5. Overdose or poisoning: Requiring rapid removal of toxins.
6. Electrolyte imbalance: Severe imbalances, such as hyperkalemia (high potassium levels).
7. Fluid overload: Excessive fluid buildup, often due to heart failure or liver disease.
8. Uremia: High levels of urea in the blood, causing symptoms like nausea, vomiting, and fatigue.
9. Kidney failure due to medication: Certain medications, like certain antibiotics or chemotherapy, can cause kidney failure.
10. Genetic kidney diseases: Inherited conditions, such as polycystic kidney disease (PKD).
Procedure Detail
Types Of Dialysis
There are two ways to get Dialysis of kidney:
- Hemodialysis
- Peritoneal dialysis
Steps Before Hemodialysis
Before hemodialysis, the following steps typically occur:
1. Pre-dialysis preparation:
– Patient assessment
– Vital sign check (blood pressure, temperature, pulse)
– Weight measurement
– Review of medications
2. Vascular access preparation:
– Cleaning and disinfecting the access site (fistula, graft, or catheter)
– Applying a topical anesthetic (if needed)
3. Dialyzer preparation:
– Selecting the appropriate dialyzer size and type
– Priming the dialyzer with saline solution
4. Machine setup:
– Configuring the hemodialysis machine
– Setting the treatment parameters (time, blood flow rate, dialysate flow rate)
5. Bloodwork and lab tests:
– Drawing blood samples for pre-dialysis lab tests (e.g., electrolytes, urea, creatinine)
6. Medication administration:
– Giving medications as prescribed (e.g., anticoagulants, vasodilators)
7. Patient positioning and comfort:
– Helping the patient get comfortable in the dialysis chair or bed
– Adjusting the chair or bed as needed
8. Connection to the dialysis machine:
– Connecting the vascular access to the dialyzer
– Starting the blood pump and dialysate flow
These steps prepare the patient and equipment for a safe and effective hemodialysis treatment. The healthcare team will also review the patient’s medical history, allergies, and current condition to ensure personalized care.
What Happens during hemodialysis?
During hemodialysis of kidney , the following processes occur:
1. circulation of blood
– Blood is pumped out of the body through the vascular access
– Blood flows through the dialyzer, where waste products are removed
– Cleaned blood is returned to the body
2. Dialysis process:
– Waste products (urea, creatinine, potassium) diffuse from the blood into the dialysate
– Excess fluids are removed through ultrafiltration
– Electrolytes and minerals are balanced
3. Dialysate circulation:
– Dialysate is pumped through the dialyzer, absorbing waste products
– Used dialysate is discarded and replaced with fresh solution
4. Monitoring and adjustments:
– Patient’s vital signs (blood pressure, heart rate, temperature) are monitored
– Treatment parameters (blood flow rate, dialysate flow rate) are adjusted as needed
5. Anticoagulation:
– Anticoagulants (heparin) are administered to prevent blood clotting in the dialyzer
6. Fluid removal:
– Excess fluids are removed, helping to control fluid overload and blood pressure
7. Waste product removal:
– Urea, creatinine, and other waste products are removed from the blood
8. Electrolyte balance:
– Electrolytes (potassium, sodium, calcium) are balanced to maintain normal levels
9. Treatment completion:
– The treatment is completed after the prescribed time (usually 3-4 hours)
– The patient is disconnected from the dialysis machine
The healthcare team continuously monitors the patient and the treatment process to ensure safe and effective hemodialysis.
Side effects of hemodialysis
Common side effects of hemodialysis of kidney:
1. Fatigue
2. Weakness
3. Dizziness
4. Nausea and vomiting
5. Headaches
6. Muscle cramps
7. Low blood pressure
8. Itching
9. Restless leg syndrome
10. Sleep disturbances
11. Anxiety and depression
12. Fluid overload
13. Electrolyte imbalance
14. Infection
15. Blood clotting
16. Vascular access complications
17. Hypotension
18. Hypertension
19. Cardiovascular disease
20. Malnutrition
Less common but serious side effects:
1. Dialyzer reactions
2. Air embolism
3. Hemolysis
4. Sepsis
5. Cardiac arrest
Long-term complications:
1. Amyloidosis
2. Osteoporosis
3. Anemia
4. Neuropathy
5. Cognitive impairment
It’s important to note that not everyone will experience side effects, and their severity can vary. Regular monitoring and adjustments to treatment can help minimize side effects and prevent complications.
Peritoneal Dialysis
Peritoneal dialysis (PD) is a type of dialysis that uses the lining of the abdominal cavity (peritoneum) as a filter to remove waste products from the blood.
Here’s how it works:
1. A catheter is inserted into the abdominal cavity.
2. A special fluid called dialysate is infused into the cavity through the catheter.
3. The dialysate absorbs waste products from the blood through the peritoneum.
4. The waste-filled dialysate is then drained from the cavity and discarded.
5. Fresh dialysate is infused to repeat the process.
Types of peritoneal dialysis:
1. Continuous Ambulatory Peritoneal Dialysis (CAPD): manual exchanges done 4-5 times a day.
2. Automated Peritoneal Dialysis (APD): machine performs exchanges at night.
3. Continuous Cycling Peritoneal Dialysis (CCPD): combination of CAPD and APD.
Advantages:
1. More flexible schedule
2. No need for vascular access
3. Better fluid removal
4. More comfortable than hemodialysis
Disadvantages:
1. Requires manual exchanges or machine use
2. Increased risk of peritonitis (infection)
3. Weight gain due to sugar in dialysate
4. Limited effectiveness for large patients
Peritoneal dialysis is a suitable option for patients with:
1. End-stage renal disease (ESRD)
2. Acute kidney injury (AKI)
3. Chronic kidney disease (CKD)
4. Residual renal function
What Happens before peritoneal dialysis?
Before peritoneal dialysis, the following steps typically occur:
1. Evaluation: Patient assessment to determine suitability for PD.
2. Catheter insertion: Surgical placement of a PD catheter into the abdominal cavity.
3. Training: Patient education on PD procedures, including:
– Catheter care
– Dialysate handling
– Exchange techniques
– Infection prevention
4. Dialysate selection: Choosing the appropriate dialysate solution.
5. Prescription: Doctor’s order outlining treatment parameters:
– Exchange frequency
– Volume
– Duration
– Dialysate composition
6. Preparation: Preparing the patient and equipment:
– Weighing the patient
– Measuring vital signs
– Preparing the dialysate
– Setting up the exchange equipment
7. Initial fill: Filling the abdominal cavity with dialysate for the first time.
8. Equilibration: Allowing the dialysate to equilibrate with the body’s fluids.
9. First exchange: Performing the initial dialysate exchange.
10. Monitoring: Closely monitoring the patient for:
– Infection signs
– Catheter function
– Fluid balance
– Waste removal
This preparation ensures a safe and effective start to peritoneal dialysis treatment.
What Happens during peritoneal dialysis?
During peritoneal dialysis, the following processes occur:
1. Fill: Dialysate is infused into the abdominal cavity through the catheter.
2. Dwell: The dialysate remains in the cavity for a prescribed time (usually 4-6 hours).
3. Exchange: The spent dialysate is drained from the cavity and discarded.
4. Repeat: Steps 1-3 are repeated according to the treatment schedule.
5. Diffusion: Waste products (urea, creatinine, potassium) diffuse from the blood into the dialysate.
6. Ultrafiltration: Excess fluids are removed from the body through the dialysate.
7. Electrolyte balance: Electrolytes (sodium, potassium, calcium) are balanced.
8. Waste removal: Waste products are removed from the body.
9. Fluid removal: Excess fluids are removed to control fluid overload.
10. Monitoring: The patient is monitored for:
– Infection signs
– Catheter function
– Fluid balance
– Waste removal
Side effects of peritoneal dialysis
Common side effects of peritoneal dialysis:
1. Infection (peritonitis): Bacterial infection of the abdominal cavity
2. Catheter complications: Exit site infections, tunnel infections, or catheter blockage
3. Fluid overload: Excess fluid in the body, leading to swelling, hypertension, and heart problems
4. Dehydration: Excessive fluid removal, causing dehydration and electrolyte imbalance
5. Electrolyte imbalance: Abnormal levels of sodium, potassium, calcium, or magnesium
6. Hypotension: Low blood pressure due to rapid fluid removal
7. Hypertension: High blood pressure due to fluid overload or electrolyte imbalance
8. Abdominal pain: Discomfort or pain in the abdominal cavity
9. Nausea and vomiting: Gastrointestinal symptoms due to dialysate or infection
10. Fatigue: Feeling tired or weak due to fluid shifts or electrolyte imbalance
11. Weight gain: Increased weight due to fluid retention or sugar absorption from dialysate
12. Blood sugar changes: Hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar)
13. Constipation: Infrequent bowel movements due to fluid shifts or medication
14. Exit site leakage: Dialysate leakage around the catheter exit site
Less common but serious side effects:
1. Sepsis: Blood infection
2. Abscesses: Pus-filled pockets in the abdominal cavity
3. Adhesions: Scar tissue formation in the abdominal cavity
4. Hernias: Weakening of abdominal muscles
5. Respiratory problems: Fluid overload or infection affecting breathing
Precautionary measures for patients after dialysis
After dialysis of kidney, patients should take the following precautionary measures:
1. Monitor vital signs: Track blood pressure, temperature, and pulse regularly.
2. Fluid intake: Limit fluid consumption to avoid fluid overload.
3. Dietary restrictions: Follow a kidney-friendly diet, limiting sodium, potassium, and phosphorus.
4. Medication adherence: Take prescribed medications as directed.
5. Infection prevention:
– Wash hands frequently
– Avoid close contact with people who are sick
– Keep the catheter exit site clean and dry
6. Catheter care: Follow proper catheter care and maintenance techniques.
7. Wound care: Monitor and maintain any surgical wounds or incisions.
8. Blood sugar control: Monitor and manage blood sugar levels.
9. Regular follow-up: Attend scheduled appointments with healthcare providers.
10. Emergency preparedness: Know what to do in case of emergencies like power outages or travel.
11. Physical activity: Gradually increase physical activity, avoiding heavy lifting or strenuous exercise.
12. Travel precautions: Plan ahead, packing essentials like medication and supplies.
13. Vaccinations: Stay up-to-date on recommended vaccinations.
14. Mental health support: Seek support for emotional and mental well-being.
15. Family support: Encourage family members to learn about dialysis and offer support.
By following these precautionary measures, patients of dialysis of kidney can minimize complications, ensure effective treatment, and improve their overall quality of life.
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