Hemodialysis is a treatment for kidney failure where a special machine is used to filter the blood and remove wastes, extra fluid and extra salt. This involves either inserting two needles into the fistula or a graft and drawing blood via a pump into the dialysis machine. In this machine, the blood travels through filters where it is rid of the waste, extra salt and fluid and then returned back into the body. Hemodialysis does only a part of the function intended for the kidney and is therefore not considered a cure for end stage renal disease (ESRD).
What equipment and supplies are needed for hemodialysis?
This includes the hemodialysis machine, the dialyzer, dialysis solution and needles.
What is a vascular access?
A vascular access is of two types, a temporary access and a permanent one.
A temporary access is usually a venous catheter that is inserted in a prominent vein in the neck, chest or rarely, the groin. This catheter is placed when kidney function deteriorates quickly and there is not enough time to place a more permanent access. In addition, the renal failure may only be temporary and a catheter is usually adequate for the dialysis.
A long lasting vascular access is of two types, arteriovenous (AV) fistula and an AV graft.
The fistula is a surgical procedure performed by a vascular surgeon connecting an artery directly to a vein. This procedure is usually placed on the forearm or upper arm. The fistula causes the vein to get thick and expand and is then used for the placement of the needles.
Advantages of a fistula include:
- lower complication rates
- lasts longer
AV graft is a surgical connection between an artery and vein with the help of a synthetic graft. The graft usually has higher rates of complications such as blood clots, narrowing of the connections between the graft and the blood vessels and infections.
Where can hemodialysis be done?
Most patients need their treatments at a dialysis center. There are almost 6,500 centers in the US. The treatments are usually 3 to 5 hours long three times a week. Dialysis treatments are usually covered by Medicare and supplemental insurance. The approximate cost of dialysis is $ 89,000 per year per patient.
Home hemodialysis is also an option for some patients after they are trained on how to perform the treatments and take care of the equipment. Advantages include having a flexible schedule and it lets the patient do more frequent or longer treatments.
What dietary restrictions are encouraged on dialysis?
Dietary changes will depend on the underlying disease, weight and activity level. Each dialysis unit usually has a dietitian that can help with dietary changes.
Protein that is of high quality is encouraged but phosphorus levels need to be monitored. Since hemodialysis does not remove the excess phosphorus, intake of protein, dairy products, peanut butter, peas, dried beans and nuts need to be restricted. Excess phosphorus can weaken bones and cause the skin to itch.
Too much fluid can cause problems such as excessive swelling and can lead to cardiac failure. Fluid intake is closely monitored on dialysis and so is the intake of sodium and potassium.