A Quick Guide to Hemodialysis
Hemodialysis is used for patients with kidney problems, such as chronic kidney disease (CKD) or kidney failure. It uses a machine that assists the kidneys in filtering the blood when they are unable to function efficiently themselves.
Hemodialysis requires ongoing monitoring by medical professionals to ensure it is working effectively for the patient.
What to expect if undergoing hemodialysis
Hemodialysis is performed on patients whose kidneys are unable to function efficiently themselves. Usually, this is due to kidney disease or kidney failure.
Doctors may initiate hemodialysis when a patient is experiencing the following symptoms, all of which indicate that there is a problem with the kidneys:
- Nausea
- Vomiting
- Edema (swelling)
- Fatigue
- Changes in frequency of urination
Doctors will also calculate the estimated glomerular filtration rate (eGFR) of the kidneys to determine their functionality. The eGFR can be measured by looking at the levels of creatine in the blood, as well as a patient’s age and sex, which are all significant contributing factors.
Depending on the severity of kidney dysfunction, the amount of hemodialysis that the patient requires will vary. In patients with more severe kidney disease or kidney failure, a more intensive hemodialysis treatment plan may be necessary.
Moreover, hemodialysis not only helps to filter out the blood, but can also help to regulate blood pressure, which is a key function of the kidneys. Two key minerals, potassium and sodium, influence the amount of fluid in the blood and therefore influence a person’s blood pressure.
What are the causes of kidney failure?
There are many reasons why somebody might experience kidney failure. Certain medical conditions can affect the function of the kidneys and may eventually lead to kidney failure. Long-term use of certain medications may also impair the kidneys and cause issues further down the line.
The most common causes of kidney failure are:
- High blood pressure (hypertension)
- Diabetes mellitus
- Inflammation of the kidneys (glomerulonephritis)
- Kidney cysts (polycystic kidney disease)
- Familial kidney diseases (inherited kidney disease)
- Long-term use of blood pressure medications, diuretics, and non-steroidal anti-inflammatory drugs
The kidneys can also be affected by trauma after an accident or trauma due to surgical procedures on nearby areas of the body.
Is hemodialysis the preferred treatment option for me?
Hemodialysis isn’t appropriate for every patient. A multidisciplinary team will assess a patient’s condition to determine which treatment option is most suitable for them.
For patients who don’t opt for hemodialysis, long-term management of their condition can be achieved through various medications or lifestyle changes.
For example, if the kidney failure is secondary to diabetes, helping a patient to manage their blood glucose levels and blood insulin levels more effectively may reduce the negative impacts of their health condition on the kidneys.
What happens during hemodialysis?
During hemodialysis, the patient is attached to a filtering machine called a dialyzer. A nurse or doctor will insert two needles into the blood vessels inside the arm and attaches the other side of the needles to the machine.
Blood pumps through the dialyzer, which acts as an artificial kidney and filters the patient’s blood as it passes through the tubes inside the machine. The dialysis machine will also measure the patient’s blood pressure to ensure it stays within a healthy range.
As blood passes through the dialyzer, a dialysis solution passes through the machine in the opposite direction to collect all of the filtration material and waste products from the blood, such as excess water and salt.
The dialysis solution differs depending on the patient’s individual needs. A kidney doctor (nephrologist) will prescribe a specific type of solution that contains the right amount of chemicals and fluid required for the patient.
After hemodialysis, blood tests might be taken to check for the levels of certain components in the blood. If the bloodwork shows unwanted changes in certain blood components, the dialysis solution might be adjusted for the next session of hemodialysis.
How long does hemodialysis take?
Patients usually go to a daycare center or a day ward at a hospital for their hemodialysis, and will usually be called in for the procedure two to three times a week. Some patients choose to have hemodialysis at home but this usually means they need a higher frequency of treatment of up to seven days a week.
A hemodialysis session usually lasts around four hours but it can be shorter than this, depending on the patient's needs. The healthcare team will assess each patient's needs to determine how often they will need hemodialysis and for how long.
Regular blood tests will be taken in between hemodialysis sessions to see if any changes need to be made to the treatment plan. The dialysis team will measure something called the urea reduction ratio (URR), which should be at least 65%, and the Kt/V, which should be at least 1.2.
What are the risks of undergoing hemodialysis?
Hemodialysis carries risks, just like any other medical treatment. Different patients can have a different risk profile based on their health status, the severity of their kidney impairment, and the reason why they require hemodialysis.
Getting hemodialysis can lead to a range of complications, including:
- Hypotension (low blood pressure) or hypertension (high blood pressure)
- Abdominal cramps
- Fatigue
- Itchy skin
- Sleep apnea
- Anemia (low levels of red blood cells)
- Hypokalemia (low blood potassium levels) or hyperkalemia (high blood potassium levels)
- Osteopenia or osteoporosis (low bone density)
- Pericarditis (inflammation around the heart)
- Low mood
Can hemodialysis cure kidney disease?
Hemodiaylsis might only be required for a short period of time, after which the function of the kidneys might improve. However, chronic kidney disease tends to worsen over time, and regular hemodialysis won’t cure the issue.
If dialysis does not work and kidney function continues to get worse, a kidney transplant might be required.
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References
https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis#happens
https://www.mayoclinic.org/tests-procedures/hemodialysis/about/pac-20384824
https://www.kidney.org/atoz/content/hemodialysis