When one of our loved ones requires treatments such as dialysis, it can be quite disheartening. In order to understand the concept of dialysis a little better, our expert nephrologist and transplant surgeon, Dr Deepa Jayram tells you about the different types of dialysis and the risks involved.
Dialysis is a form of treatment that is advised for patients suffering from end-stage kidney disease. Usually when a patient has chronic kidney disease the doctor classifies it into stages based on the percentage of kidney function the patient has. This is calculated using certain formulae based on the patient’s serum creatinine levels. Generally when a person’s kidney function is less than 10 to 15 per cent of what it should be, dialysis is prescribed. This is the time the patient suffers from symptoms such as fatigue, lack of concentration, loss of appetite, nausea, vomiting, itching of the skin, restlessness of the legs, muscle aches and cramps etc, due to the build up of waste products in the blood stream (also called uraemia).
Apart from kidney failure, there are other situations that would require a patient to undergo dialysis. These are usually absolute emergent conditions such as:
- If a patient has chronic kidney disease that is gradually becoming worse and has symptoms of massive volume overload (build up of fluid in the body) which is causing the patient’s lungs to fill up with fluid, making it difficult to breath.
- Where the patient is not responding to medical management or when there is an overload of potassium in the blood. Potassium is a very important electrolyte in the body and the kidneys play a very important role in getting rid of it from the body via the urine. When the kidneys fail, and the potassium levels starts to build up in the blood stream, dialysis is used to bring their levels down to normal. An increased potassium level in the blood has severe complications such as cardiac arrhythmia and death.
- If there is very severe acid load (build up of waste materials in the blood stream) in the body there is a chance that the kidneys might not be functioning adequately and this would warrant urgent dialysis. .
Dialysis can be done in a number of ways. However, the most common methods are Hemodialysis and Peritoneal dialysis. Generally both methods are accepted well by patients but there are certain risks and complications that could occur.
- Hemodialysis is a method of dialysis where the patient goes to a hospital which has a dialysis unit or the patient has a dialysis machine at home. In both cases, medical supervision is a must. Dialysis works by pumping the blood of the patient through a filter which cleans the blood. The clean blood is then returned back to the body. The whole process usually lasts about four hours and is generally done three times a week. In order to perform hemodialysis the patient will be fitted with a catheter that is placed in one of the big blood streams in the body, usually found in the neck or the leg. However, there is risk of the catheter getting infected. An innovation that has helped in reducing the number of infections is the use of an AV graft or AV fistula. During the process the patient may feel dizzy because of the blood pressure dropping, nausea, vomiting, cramps in the legs, severe headaches, chest pain and palpitations.
- Peritoneal Dialysis is another form of dialysis which is based on fluid exchange. The doctor places a small tube or catheter in the patient’s abdomen. Through this catheter, a ‘dialysis solution’ is pumped into the patient’s abdomen. Dialysis is successful when the fluid built up within the patient’s body gets transferred through the peritoneum (a membrane lining the walls of the abdominal cavity) into the abdomen and thus the dialysis solution contained in it.
The fluid is drained out after about four to six hours, and a fresh bag is introduced into the body. This is a more gentle form of dialysis which is done on a daily basis. It can be done at home or in a clinic. One of the main drawbacks of this method, however, is that there is a risk of infection of the lining of the abdomen also called peritonitis, or an infection of the skin around the catheter.
Dialysis can help a patient live a full and healthy life if treated on time, albeit with the right medical help and a few precautions.