• Hemodialysis

    Definition

    Dialysis is a treatment that takes over the job of your kidneys if they fail. The kidneys have many functions that help your body stay healthy. They help clear toxins out of your blood and help your body balance salt levels. Most patients begin dialysis when their kidneys have lost 85%-90% of their ability. You may be on dialysis for a short time, or you may need it for the rest of your life (or until you receive a kidney transplant). It depends on the reason for your kidney failure.
    If you have kidneys that are not working and the damage is not reversible, you have end stage renal disease (ESRD). ESRD is caused by conditions such as diabetes, kidney cancer, drug use, high blood pressure, or other kidney problems. Dialysis is not a cure for ESRD, but it does help you feel better and live longer.
    There are two types of dialysis: hemodialysis and peritoneal dialysis. This fact sheet will focus on hemodialysis.

    Reasons for Procedure

    The main functions of hemodialysis are to:
    • Remove waste and excess fluid from your blood
    • Control blood pressure
    • Keep a safe level of salts in the body, such as potassium, sodium, and chloride
    It may also be done to remove toxins from the bloodstream quickly. It can be used in cases of poisoning or drug overdose.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have hemodialysis, your doctor will review a list of possible complications. These may include:
    • Lowering your red blood cell count and causing anemia
    • A drop in blood pressure during hemodialysis
    • Muscle cramps
    • Nausea, vomiting
    • Headaches
    • Infection
    • Feeling hot, sweaty, weak, and/or dizzy
    • Inflammation of the heart sac (pericarditis)
    • Neurologic problems
    • Disruption of calcium and phosphorus balance, resulting in weakened bones
    If you have heart problems, this may increase your risk of complications from hemodialysis.

    What to Expect

    Prior to Procedure

    Usually, before your first hemodialysis, you will have some sort of tubing attached to a large vein. The tubing will make blood flow from your body to the machine and back more easily. If you will be on hemodialysis for a long time, you may have had surgery to create a shunt or a fistula, which makes access to a large vein easier. Fistulas may need as long as 2–3 months to fully heal before they can be used. They are not used if the treatment is temporary. They are typically created many months before hemodialysis begins.
    Before your hemodialysis, you will:
    • Have your weight, blood pressure, and temperature taken
    • Be given heparin to prevent blood clotting.

    Anesthesia

    You will be given a topical anesthetic (a pain-numbing medicine) that is usually applied to the area of needle insertion, if needle insertion is needed.

    Description of the Procedure

    Hemodialysis is done at a dialysis center or hospital. It may be done at home with assistance.
    During the procedure, blood is filtered through an artificial kidney machine, called a dialyzer. The blood travels from your body to the machine through tubes inserted into a large vein in your body. After the blood is filtered in the machine, it travels back into your body through another tube.
    Hemodialysis
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    Copyright © Nucleus Medical Media, Inc.

    How Long Will It Take?

    Hemodialysis is usually done three times a week. Each treatment can last 2-4 hours. The specific time needed depends on:
    • How much kidney function remains
    • How much fluid weight gain has occurred since the last treatment
    • The amount of waste in the body
    • Body size
    • The level of salts in your body, such as sodium, potassium, and chloride

    Will It Hurt?

    In general, hemodialysis does not cause pain. You will not feel the blood exchange. There may be some temporary discomfort inserting the needle or tube.

    Post-procedure Care

    At the Care Center
    Your blood pressure will be monitored. After the procedure is complete and blood pressure is stable, you can continue daily activities.
    At Home
    Be sure to follow your doctor’s instructions. There are some special considerations:
    Be sure to follow your doctor’s instructions. There are some special considerations:
    Dietary Guidelines
    Certain dietary guidelines should be followed. This will help maintain overall health and optimize treatment effects. Talk to your doctor about your specific dietary needs.
    Medications
    Your doctor may give you various medicines. These include, but are not limited to:
    • Blood pressure medicines
    • Calcium supplements or multivitamins
    • Phosphorus binders—to lower phosphorus levels in the blood
    • Diuretics—to remove excess fluid
    • Stool softeners or laxatives—to prevent or treat constipation, which can be caused by decreased fluid intake
    • Iron supplements—to increase iron intake, which is important to make red blood cells
    • Medicines to stimulate the body to produce more red blood cells

    Call Your Doctor

    Contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, warmth, increasing pain, excessive bleeding, or discharge at the catheter or tube insertion site
    • Nausea or vomiting
    • Abdominal pain
    • Dizziness or weakness
    In case of an emergency, call for medical help right away.

    RESOURCES

    The Kidney Dialysis Foundation http://www.kdf.org

    National Kidney Foundation http://www.kidney.org/

    National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) http://kidney.niddk.nih.gov/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Kidney Foundation of Canada: British Columbia Branch http://www.kidney.ca/

    References

    Dialysis. National Kidney Foundation website. Available at: http://www.kidney.org/atoz/atozTopic%5FDialysis.cfm . Accessed October 18, 2012.

    Dialysis for chronic kidney disease. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated September 28, 2012. Accessed October 18, 2012.

    Peritoneal Dialysis Dose and Adequacy. National Diabetes Information Clearinghouse (NDIC) website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/peritonealdose/index.aspx . Updated September 2, 2010. Accessed October 18, 2012.

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