Hemodialysis

Hemodialysis

In hemodialysis, a special filter called a dialyzer is used that works like an artificial kidney to purify the blood. During treatment, blood passes through tubes into the dialyzer, which filters and removes waste and excess water. Then the purified blood flows back into the body through another series of tubes. The dialyzer is connected to a machine that controls blood flow and removes waste from the blood.

Hemodialysis should usually be done three times a week. Each treatment lasts 3 to 5 hours, or more. During the same, the patient can read, write, sleep, chat or watch television.

How to prepare ?
If you choose hemodialysis, you have to establish a pathway to the bloodstream several months before you receive the first treatment. You may have to spend a night in the hospital, but many patients are placed on this path as ambulatory. Access is an effective way to get blood out of the body into the dialysis machine and return it to the patient without causing discomfort. The two main types of access are fistula and graft

The surgeon makes a fistula using the patient’s blood vessels. An artery of the arm is usually connected directly to a vein. The increased blood flow causes the vein to grow and strengthen so that it can be used for frequent punctures. This is the preferred type of access. It may take several weeks before it is ready to be used

The graft connects an artery with a vein by means of a synthetic tube. Unlike the fistula, it does not have to develop, so it can be used sooner, but it can present more infection problems and the presence of clots.

The needles are placed inside the access path to draw blood. The patient is given a local anesthetic to minimize pain during dialysis.

If kidney disease has progressed rapidly, there may not be time to establish a permanent vascular access before starting hemodialysis treatments. It may be necessary to use a temporary catheter, which is a tube that is inserted into a vein in the neck, chest or leg, near the groin. Sometimes a catheter is used as a long-term access route. The catheters that will be needed for more than 3 weeks are designed to go under the skin in order to increase comfort and reduce complications.

Possible Complications
Problems with venous access are the most common reasons for hospitalization among people receiving hemodialysis. Among the frequent problems are infections, blockage by clots and poor blood flow. These problems can prevent the treatment from working. You may have to do repeated surgeries to get access that works properly.

Other problems can be caused by rapid changes in the balance of water and some chemicals in the body during treatment. Two of the common side effects are muscle cramps and hypotension, or sudden drop in blood pressure. Hypotension, or low blood pressure, can make the patient feel weak, dizzy, or feel like vomiting.

You will probably need a few months to adjust to hemodialysis. Side effects can often be treated quickly and easily, so you should always report your appearance to the doctor and dialysis staff. You can avoid many of the side effects by eating a proper diet, limiting the intake of fluids and taking the drugs that are formulated.

Diet for hemodialysis patients
Hemodialysis and a proper diet help to reduce the waste that accumulates in the blood. In all dialysis centers there is a nutritionist available to help the patient plan their meals according to the doctor’s instructions. When choosing foods, you should remember the following:

• Eat balanced amounts of high protein foods, such as meat, poultry and fish.
• Control the amount of potassium you eat. Potassium is a mineral found in salt substitutes, in some fruits (bananas and oranges), in vegetables, chocolate and nuts. Excess potassium can be dangerous .
• Limit the amount of fluid you drink. When the kidneys do not work, water quickly accumulates in the body. Excess fluid causes tissues to swell and can cause high blood pressure, heart problems, and cramping and hypotension during dialysis.
• Avoid salt. Salty foods cause thirst and cause the body to retain water.
• Limit foods such as milk, cheese, nuts, dried beans and dark cola drinks because they contain large amounts of a mineral called phosphorus. Excess phosphorus in the blood causes calcium to leave the bones, which makes them weak and brittle, and can cause arthritis. To avoid bone problems, the doctor may formulate special medications that you should take every day with meals as directed.

Advantages and disadvantages

Each person reacts differently to similar situations. What can be a negative factor for one person can be positive for another. The table mentions the general advantages and disadvantages of hemodialysis performed in a dialysis center and home hemodialysis.

Hemodialysis in a Dialysis Center

Advantage

+ The centers that carry it out are everywhere.
+ There are trained professionals at your side at all times.
+ You can get to know other patients.

Disadvantages

– The treatments are programmed by the center and are relatively difficult to modify.
– You must go to the center to receive the treatment.

Home hemodialysis

Advantage

+ You can do it at the time you prefer (but as often as the doctor orders).
+ You do not have to move to a center.
+ You acquire a sense of independence and control of treatment.

Disadvantages

– You must have a person to help you.
– Helping with treatments can be stressful for your family.
– Your assistant and you need training.
– Need space at home to store the machine and implements.