Dialysis: Indications and Complications

Kidney is a bean shaped organ, the size of a fist, present in the back, just below the ribs. The kidneys play an important role in the healthy, normal functioning of the body. They are responsible for maintaining the concentration of different salts in the body, maintaining the blood pressure and removing waste products from the body in the form of urine. Sometimes a disease may reduce the efficiency of the kidneys and lead to build up of waste products and salt in the body, which in turn interfere with the normal functioning of the body. Dialysis is a method to artificially remove the waste products and extra salts from the body. There are two major methods by which this is done:

• Hemodialysis: your blood passes through a machine that removes the waste products and extra salts
• Peritoneal dialysis: a fluid is passed into your abdominal cavity, which accumulates waste products, followed by which it is drained out.

Procedure of Dialysis

The procedure for dialysis depends upon the method that you and your doctor have decided to opt.

• Hemodialysis

For this procedure your doctor will create a small access, generally in the arm, through which a needle can be inserted for the access to blood for filtering by the machine. The machine that acts like an artificial kidney is called a dialyser. There are different ways in which an access can be created:

• Graft: a small tube is placed between an artery and a vein. A needle is inserted into this tube every time you undergo hemodialysis
• Fistula: by a minor surgery, your surgeon connects a vein with an artery to create an access through which blood can enter and leave the body
• Venous catheter: sometimes when there is no time to create a fistula or insert a graft, a catheter is placed in a vein in your neck for access to blood until a graft or fistula can be made.

Too undergo hemodialysis you will have to go to the hospital or a special centre. The frequency of hemodialysis depends upon the severity of kidney damage. It is generally done three times a week and takes about four hours for every cycle.

• Peritoneal dialysis

For this procedure fluid, called dialysate, is passed into the peritoneal cavity with the help of a small tube. Blood flows around the peritoneal cavity. The dialysate present in the cavity accumulates the waste products and salt. It is drained out to remove the waste products from the body. There are two methods by which peritoneal dialysis can be performed:

• Continuous ambulatory peritoneal dialysis (CAPD): for this process you introduce and remove the dialysate from the peritoneal cavity manually. The dialysate stays in the peritoneal cavity for a few hours. The frequency depends on your condition. Generally it is performed four times a day. You may move around while the dialysate is inside your body.
• Continuous cycling peritoneal dialysis (CCPD): a machine is responsible for pumping the fluid into and out of your body. This provides you the advantage of undergoing CCPD during your sleep. It generally takes six to eight hours and is done five times a week.

Indications for Dialysis

Dialysis is indicated for individuals whose kidneys can no longer function efficiently.

• For some individuals, the reduction in kidney function is temporary and they may be able to stop dialysis after the kidneys regain their normal functions.
• Some individuals are advised to undergo dialysis to maintain normal body function while they wait for a kidney transplant.
• Some individuals are not healthy enough to tolerate a major surgery like a kidney transplant; they are advised to undergo dialysis to maintain normal body functioning.

Complications of Dialysis

Dialysis is a relatively safe procedure. Complications seen are:

• Itchy skin and redness at the site of access after a hemodialysis
• Peritonitis, inflammation of the thin membrane surrounding the gut, is a rare complication of peritoneal dialysis.

Dialysis may leave you feeling exhausted and tired. You might have to carefully measure your fluid intake and will have to follow specific dietary instructions.

Resources

• https://www.nhs.uk/conditions/dialysis/
• NIDDK website