Dialysis

Definition

Dialysis is a treatment used when the kidneys do not work well. It removes harmful substances from the blood when the kidneys cannot.

There are different types of kidney dialysis. This article focuses on hemodialysis.

Alternative Names

Artificial kidneys; Hemodialysis; Renal replacement therapy

Description

WHAT IS HEMODIALYSIS?

Hemodialysis removes blood from the body and sends it across a special filter with solutions. The filter helps remove harmful substances. The blood is then returned to the body.

If you have hemodialysis, your health care team will need a way to get to the blood in your blood vessels. This is called access. You may need this for a little while (temporary) or for a long time (permanent).

Temporary access involves putting a hollow tube (called a catheter) into a large vein, usually in your neck, chest, or leg near the groin. This is most often done in emergency situations for short periods of time. However, some catheters can be used for weeks or even months.

Permanent access is created by surgically joining an artery to a vein, usually in the arm. There are two ways to do this:

WHERE TO HAVE DIALYSIS

Hemodialysis is most often done in a special dialysis center. Patients usually have three treatments a week. It takes about 3 - 4 hours each time. Many people feel tired for several hours after the dialysis.

Sometimes, dialysis can be done at home. Home dialysis is usually done using one of two schedules:

Home hemodialysis treatments help keep blood pressure lower. Many patients no longer need blood pressure medicines. Nightly treatments do a better job of removing waste products. It is done more slowly, so it's easier on the heart and access site.

A dialysis nurse can train patients to do home dialysis. Patients do not have to buy a machine. Supplies can be delivered. Both the patient and any caregivers must learn to:

TAKING CARE OF YOUR GRAFT OR FISTULA

Avoid all pressure on the access site. If the graft or fistula clots, you may need a new one.

Learn how to feel the access site for the "thrill." This is a sign that the site is still functioning. If the thrill disappears, call your health care provider immediately.

Do not miss or skip any dialysis sessions. Make sure you arrive on time. Many centers have busy schedules. You may not be able to make up the time if you are late.

Watch the access site for swelling, bleeding, or signs of infection. Call your health care provider immediately if you have a fever or other signs of infection.

It is important to follow a strict kidney dialysis diet.

Why the Procedure Is Performed

The kidneys' main job is to remove toxins from the blood. A buildup of waste products can lead to death.

The kidneys also help:

Dialysis is used to treat patients with chronic kidney disease. Your doctor and nurse will begin discussing dialysis with you before you need it.

Dialysis also may be used when the kidneys suddenly stop working (also called acute renal failure).

Sometimes, hemodialysis can be used to quickly remove drugs or poisons from the body.

Risks

Risks of dialysis include:

This list is not all-inclusive.

Outlook (Prognosis)

See: End-stage kidney disease

References

Tolkoff-Rubin N. Treatment of irreversible renal failure. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 133.

Mitch WE. Chronic kidney disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 131.