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Dialysis, Hemodialysis, Peritoneal dialysis, Dialysis Versus kidney transplant

Dialysis

  • Hemodialysis 
  • Peritoneal dialysis 
  • Dialysis versus kidney transplant

Hemodialysis: – is one of the important therapy for renal replacement. In this the patients who are suffering from end stage renal disease (ESRD) or chronic kidney disease stage 5 undergo dialysis. Hemodialysis is a form of dialysis in which harmful toxins are partially removed also excess water is taken out. It also controls important electrolytes like sodium, potassium. It controls increased   phosphorus levels, increased acid level in the blood. It improves appetite, volume overload, swelling in the body. It also improves brain function, heart function. It also strengthens bones and muscles. 

Problems of Hemodialysis
It also in hospital it has to visit in hospital twice or thrice in a week.
That is why in some areas still Hemodialysis facility is not available. So, it is not practical for patients living in remote areas to get dialysis done. It is a painful procedure because for Hemodialysis needless are pricked.
Chances of blood related infections like hepatitis b, hepatitis c etc.
Need, a vascular access because in some patients a vascular access is a problem.

Advantages of hemodialysis
Rapid correction and rapid fluid removal which is not possible with peritoneal dialysis. 

Disadvantages of haemodialysis
Use of heparin (I.e. anticoagulant) which prevents clothing of blood and increases the risk of bleeding

Cost of Dialysis

Cost of Haemodialysis: – Mainly depends on what the hospital is charging for one session of haemodialysis.
The charges mainly depends on location of the Centre, quality of the RO system, whether the Centre is under nephrologist guidance, senior and trained dialysis technicians, and competition between different centres nearby.
In Delhi/NCR the most of the dialysis centres are charging between Rs.2000 to Rs.4000/ for single session with new dialyzer. For reuse dialyzer charges are lower. So for a patient who is on twice a week dialysis Rs.25000-40000/PM Since, the patient who is thrice a week on dialysis costs Rs.35000-50000 /PM (The above cost, is only for dialysis sessions).
The cost of medications, which includes injection erythropoietin, anti-hypertensive, phosphate binders, calcium supplements, diuretics, antacids, multi-vitamins, vitamin-d supplement, protein supplements, iron supplements, L- Carnitine, vaccinations and others, Rs.8000 – 20000/PM.

Cost of investigations is approximately Rs.1000-5000/PM.

How do I ready for Haemodialysis?

Need to discuss with your Nephrologist (Kidney Specialist, Kidney Doctor). Discussion regarding dialysis which one to choose either haemodialysis or peritoneal dialysis. Need to discuss with your kidney transplant doctor (kidney transplant physician) which one is better dialysis or kidney transplant. Obviously patient has to choose dialysis centre. In deciding the dialysis centre there are certain factors to choose like nearby areas, adequate facilities, trained dialysis technicians, nephrologist, and others.
Now a day’s haemodialysis can be done at home also.  For that adequate infrastructure, facilities, dialysis technician and patient’s clinical condition are the important factors to take care. If you plan to have haemodialysis at home, you will need to get your home ready. You will need a dialysis machine and supplies. You might need to make changes to your home’s plumbing or electricity.
You also need to prepare your body for haemodialysis by having surgery ahead of time. Your doctor will create an “access,” which is a way for the blood to leave and return to your body during haemodialysis. An access is usually created under the skin in the lower part of the arm. An access needs time to heal before it can be used.

Vascular access for hemodialysis
There are 3 different types of access:
  • AV fistula – Most people get this type of access. To make this access, a doctor does surgery to connect an artery directly to a vein. An AV fistula needs to heal for 1 to 2 months or more before it can be used for dialysis.
  • AV graft – To make this access, a doctor uses a rubber tube to connect an artery to a vein. An AV graft needs to heal for 2 weeks before it can be used for dialysis.
  • Central venous catheter – To make this access, a doctor puts a tube in a large vein (usually in the neck). This access is usually used only short-term or if people don’t have any other access. It doesn’t work as well as an AV fistula or AV graft.
How do I take care of my dialysis vascular access?

For central venous catheter, the dialysis staff will cover the catheter site with a clean dressing and waterproof bandage each time you have dialysis. You should keep the dressing and bandage in place until the next dialysis session.
If you have an AV fistula or graft, here is what you should do:

  • Wash it with soap and warm water every day and before each dialysis treatment.
  • Check it every day to make sure that it’s working normally and blood is flowing through it. When your access is working normally, you should be able to feel a vibration (called a “thrill”) over the area.
  • Be careful with arm that has the fistula or graft. It’s important that you not get an injury on that arm.
  • Do not scratch or pick at your access.
  • Do not wear tight clothes or jewellery on the arm with the access.
  • Do not sleep on the arm with the access.
  • Do not let anyone take blood from or measure blood pressure in the arm with the access.
  • Do not wear sharp or glass bangles.
  • Problems with an AV fistula or graft access and when to call your doctor or dialysis technician if:
  • You don’t feel a vibration – possibly your access has stopped working or closed up.
  • Your access is red or warm – could be your access is infected or cellulitis.
  • Your access bleeds a lot after haemodialysis.

High BP during Dialysis

Hypertension is common in dialysis patient. Patients should monitor their blood pressure (BP) frequently at home. Nowadays digital (automatic) bp machines are easily available in market. These machines are more or less do accurate measurements as compared to manual machines.
Ambulatory blood pressure monitoring (ABPM) is considered the gold standard for the diagnosis of hypertension.
Some dialysis patients develop very high blood pressure during dialysis. Treatment for that

  • Control of volume over load
  • Achieving optimal dry weight
  • Increase dialysis time
  • Reduce dialysate sodium
  • Optimizing antihypertensive medications
  • Taking extra antihypertensive medication during dialysis

Special instructions for dialysis patient:

  1. Regular maintenance hemodialysis thrice weekly.

If patient has good urine output, stable renal functions, minimal symptoms, potassium and phosphorus are controlled and inter-dialysis weight gain is not much than patient can come twice weekly.

  1. Good high protein low potassium diet
  2. Good physical activity.
  3. Regular investigation as per protocol.
  4. Vaccination as per protocol.
  5. Control of inter-dialysis weight gain.
  6. Care of Vascular access
  7. Care of dialysis catheter (avoid water soakage or soiling of catheter dressing).
  8. Fistula (no blood pressure measurements and intravenous pricks on fistula arm)

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