Dialysis & Transplantation

Dialysis

What Is Dialysis?

Dialysis is a process that removes the body's waste from the blood through a semi-permeable membrane. It replaces some of the functions that the kidney can no longer perform. Using this process, the imbalance in the body can be corrected.

How Will I Know I Need To Start Dialysis?

You will need to start dialysis once your blood creatinine level is more than 10 mg/dL, even though you do not have symptoms of kidney failure. You will fair better if you start your treatment earlier as compared to those who start much later.

What Are Dialysis Options?

There are two forms of dialysis: Hemodialysis and Peritoneal.

Hemodialysis

Uses an artificial kidney (dialyzer) and a machine to remove water and waste products from the blood stream. An access site is usually created in the arm or leg, months before dialysis is needed. Blood is taken from the access through a needle inserted in the arterial end of the access. Blood is pumped out through the needle into plastic tubing, which is connected to the dialyzer (bundle of hollow fibers made up of semi-permeable membrane) where it is cleansed. Blood is then returned to the body through a tube and needle, which is inserted into the venous end of the access. The treatment is usually for 4 hours and performed 3 to 4 times a week.

Advantages

Staff performs treatment in the dialysis centre
Permanent internal access required
Three treatments per week in the dialysis centre
Regular contact with people in the centre

Disadvantages

Requires travel to a dialysis centre
Two needle sticks per treatment; connected to a machine, cannot move about during treatment
Fixed treatment schedule
Diet and fluid intake restriction

Peritoneal Dialysis

This form of dialysis occurs inside the body. Dialysis solution flows into the peritoneal (abdominal) cavity through a silastic catheter. The peritoneal membrane (peritoneum) acts as a filter. Waste products and excess water pass from the body through the membrane into the dialysis solution. When the filtering process is completed, the waste filled solution is drained from the peritoneal cavity into a bag and then discarded. Fresh dialysis solution is drained into the abdominal cavity through the catheter again. Each exchange takes about 45 minutes and is performed, on average of, 4 times per day.

There are two forms of peritoneal dialysis:

CAPD or Continuous Ambulatory Peritoneal Dialysis - The patient will perform four exchanges during the day
APD or Automated Peritoneal Dialysis - The exchanges are performed by the machine during the night while the patient is asleep.

Advantages

Patient's involvement in self-care
Control over schedule
Less diet & fluid restriction
More steady physical condition as it provides slow, continuous therapy
Most similar to original kidneys
Provide less severe cardiovascular instabilities in patients with underlying heart disease
Can be done in the night as in automated peritoneal dialysis

Disadvantages

Potential weight gain
Some risks of infection
Change of body image
If on automated peritoneal dialysis, patient will be tied to a machine at night
Storage space is needed for supplies
Four exchanges per day
Permanent external catheter

How Can I Prepare Myself For Dialysis?

Your doctor will schedule an operation to create an AV fistula or AV graft. This should be done in advance of its anticipated use. However, if the fistula is not ready for use, a temporary catheter is inserted in the neck vein for blood access so that you can start your hemodialysis. This is not ideal as infection from the catheter is a common complication, which you hope to avoid. You should go for your fistula creation early and avoid using a temporary catheter.

How Do I Care For My Access (arterio-venous fistulas or graft)?

Immediately after insertion operation

Keep the fistula arm raised on a pillow to reduce swelling.
The dressing should remain intact and dry at all times. If the dressing is dirty or blood stained, it should be changed. Observe suture line for signs of infection. Report to doctor-in-charge or nurse if any of these following symptoms are present:
- Pronounced redness
- Warmth
- Fever
- Bleeding or discharge
- Increase pain
- Tenderness
After the sutures are removed, the fistula arm may be cleansed with soap and water in the usual manner.
As soon as postoperative pain has subsided, start arm exercises by squeezing a rubber ball or using a rolled up washcloth for 5 minutes, alternating squeezing and relaxing the hand. Do up to 6 times a day. This helps to develop the fistula.
Do not allow blood pressure, blood taking or intravenous administration on the fistula arm.
Do not wear constrictive clothing, bangle, watch or hang a bag over the arm or carry heavy objects on the extremity of the fistula arm.
The doctor-in-charge will inform you when the fistula is ready for use.

In General

Keep fistula or graft site clean and dry.
Feel for thrill or buzzing sensation at both ends of the fistula or graft in the morning when you wake up and at night before you go to sleep. Seek advice from your doctor or nurse if the thrill or buzzing sensation is absent.
Inspect fistula for redness, swelling, tenderness or warm to touch to detect infection. Report to the doctor or nurse if any of these symptoms are present.
Avoid constrictive clothing, bangle, watch or hang a bag over the arm or carry heavy objects on the extremity of the fistula arm, which may block off the fistula.
Remember that no taking of blood pressure, blood taking or intravenous administration should be done on the fistula arm. Take measures to prevent sleeping on the fistula arm.
Continue arm exercises if the fistula is still not well developed.
Wear an arm guard to protect the fistula if participating in contact sport or labor work.
Wash the fistula arm thoroughly with antiseptic solution before dialysis.
Avoid excessive pressure on the puncture sites after dialysis. Apply digital pressure so as to prevent bleeding.
Rotate needling sites to prevent aneurysm and pseudo-aneurysm and also to allow healing of the puncture sites.
After dialysis, the dressings should remain intact for about 6 hours. Ensure that the thrill or buzzing sensation is still present on the fistula.
If injury or profuse bleeding occurs at fistula site, apply pressure over the bleeding area to stop bleeding and seek immediate medical attention at the nearest A&E department.

Kidney Transplant

A kidney transplant is an alternative to dialysis in treating kidney failure. In transplantation, a kidney from a compatible living or deceased donor is removed and surgically placed into the kidney failure patient. The patient's own kidneys do not have to be removed. Living donors have to undergo extensive testing before donation, to assess their suitability and fitness.

Not all kidney failure patients are fit to undergo transplantation. They should check with their doctors to see if they are a good candidate for a kidney transplant. The medication that is prescribed for transplantation may deteriorate their general health. Patients who have had a transplant will need to remain on medications, which suppress immunity so that the 'new' kidney will not be rejected by the body's immune system.

Advantages

Absence of need for frequent dialysis treatment
Better quality of life
Better health
Reduced medical costs after first year
No diet and fluid intake restriction

Disadvantages

Risk of transplant rejection
Prone to infections
On lifelong medications
Need for frequent physician visits
Pain, discomfort of surgery

What Are The Options For Kidney Donations?

Living Donor Brochure

If you have any questions, call Kidney Foundation of Greater Cincinnati at 513.961.8105.