Table of contents:
- Definition
- What is hemodialysis?
- What is the function of hemodialysis?
- Procedure
- How is the hemodialysis process?
- Arteriovenous fistula (cimino)
- Arteriovenous graft
- Venous catheter
- What happens when the blood is in the filtering machine?
- Preparation
- What needs to be prepared for hemodialysis?
- Side effects
- What are the side effects of hemodialysis?
- Problematic vascular access
- Low blood pressure (hypotension)
- Abnormal heart rate
- Anemia
- Stroke
- Muscle cramps and stiff joints
- Lifestyle
- Are lifestyle changes necessary during dialysis?
- Treatment options
- Can hemodialysis be done at home?
Definition
What is hemodialysis?
Hemodialysis is a type of dialysis (dialysis). This machine-assisted dialysis method is also a treatment used to help patients with kidney damage.
This dialysis procedure helps you control blood pressure and balance the levels of important minerals, such as potassium and sodium in the blood.
Although it can help relieve symptoms of kidney disease, this procedure is not a cure for kidney failure. Hemodialysis is usually used in conjunction with other medications.
What is the function of hemodialysis?
Hemodialysis functions to clean and filter your blood with the help of a machine. This is done temporarily so that the body is free from toxic waste, salt, and excess fluids.
In addition, sometimes this dialysis procedure is also used to clean the buildup of substances that come from drugs. In short, hemodialysis works to replace kidney function.
Procedure
How is the hemodialysis process?
The hemodialysis process is usually performed using a dialysis machine and a special filter device called an artificial kidney (dialyzer). This artificial kidney will later work to clean the blood in the body.
To allow blood to flow to the artificial kidney, the doctor will perform surgery to create a pathway (vascular access) to your blood vessels. Here are three types of access that doctors usually make when starting the dialysis process.
Arteriovenous fistula (cimino)
Arteriovenous fistula (AV fistula) or cimino is the entrance that vascular surgeons make, from the artery to the vein. Arteries carry blood from the heart to the body, while veins circulate blood from the body back to the heart.
In this process, the surgeon usually makes an access or connection from the artery to the vein and is placed in the forearm or upper arm of a person.
If the veins are enlarged, the entry route for dialysis is also easier. Without AV fistula, hemodialysis may not be possible. The reason is, the uncontrollable veins cannot hold the needle repeatedly entering.
This of course can cause damage to the veins. What's more, doctors recommend AV fistula because of the following advantages.
- Blood drains well.
- Last longer.
- Minimal risk of infection or blood clots.
Even so, cimino is not free from various problems that may arise, such as infection or low blood flow. When this happens, the doctor may suggest other treatments to solve this problem.
Arteriovenous graft
Arteriovenous graft (AV graft) is a circular plastic tube that connects the artery to the vein. In contrast to AV fistulas, AV grafts are more susceptible to infection and blood clots.
When this happens, the blood clot can block blood flow through the damaged blood vessel. However, when the placement of the AV graft is done properly, this access can last for several years.
Venous catheter
A venous catheter is a tube inserted into a vein in the neck, chest, or leg near the groin. This vascular access is usually only performed for short-term hemodialysis.
This pipe is usually divided into two tubes that exit the body. Both have an upper part that acts as a pathway that carries blood from the body to the dialyzer and vice versa.
Unfortunately, venous catheters are not ideal for long-term use. The reason is, this tube is at risk of blood clots, infection, or injury to the veins. As a result, the veins become narrower.
However, patients who need to immediately undergo dialysis washing will usually use a venous catheter for several weeks. This tube will continue to be used until the doctor performs surgery for the AV fistula or AV graft for the long term.
If one of the several vascular accesses is successfully inserted, the dialysis machine will start pumping blood. During this process, the machine will also check blood pressure and control how fast blood flows and fluids are removed from the body.
What happens when the blood is in the filtering machine?
When blood enters one end of the filter, the tool will be forced to turn into more hollow fibers which are quite thin. After the blood passes through the fiber, the dialysis solution will flow in the opposite direction on the outside of the fiber.
Then, the waste from the blood will be transferred to the dialysis solution. Meanwhile, the filtered blood stays in the hollow fibers and returns to your body.
Usually, the nephrologist will prescribe a dialysis solution to meet your needs. This solution contains water and chemicals added to remove wastes, salts, and fluids from the blood.
In addition, doctors can also adjust the balance of chemical compounds in the solution due to several factors, such as:
- Blood test results show that the blood contains too much or too little potassium and calcium
- Have problems, such as low blood pressure or muscle cramps during hemodialysis
Treatment for kidney disease usually lasts 2 to 4.5 hours. During the procedure, your healthcare provider will check your blood pressure and adjust the machine to determine the amount of fluid that is being drained from your body.
Apart from that, you can also read, watch, sleep, or do other work during dialysis.
Preparation
What needs to be prepared for hemodialysis?
Most patients with chronic renal failure may require certain treatments before undergoing hemodialysis. The decision to start dialysis procedures depends on the condition and disease of the kidneys.
In addition, the doctor will also consider the need for this method based on the results of a kidney examination. Prior to that, you may be asked to consult with someone about dialysis treatment options.
If you choose hemodialysis, you will be given time to understand and prepare. After that, the doctor will insert the designated vascular access through surgery to gain access to the bloodstream. This surgery is usually quick and does not require hospitalization.
If you have started the dialysis procedure, it is best to wear comfortable and loose clothing during the treatment. Don't forget to follow your doctor's instructions, including fasting a certain amount of time before treatment.
Side effects
What are the side effects of hemodialysis?
In general, patients undergoing hemodialysis will be monitored around the clock and performed by trained health professionals. Therefore, this dialysis procedure is quite safe.
However, there are some risks of disease and side effects that can occur when you are on dialysis.
This can occur in patients whose conditions are quite severe and have other health problems. Some of the risks of undergoing hemodialysis include the following.
Problematic vascular access
The vascular access is the entrance that connects the blood flow from the body to the dialysis machine. It is not impossible that this tube or pipe can experience problems, such as:
- having an infection, and
- blood clots or clots occur.
If this is allowed, the treatment for kidney failure will not be successful. You may need more procedures to fix the access in order to function properly.
Low blood pressure (hypotension)
You can also experience a sudden drop in blood pressure while undergoing the hemodialysis process. The risk of hypotension is quite high in patients with severe and life-threatening conditions.
In some cases, this condition can also be a reason for someone to stop undergoing dialysis or stop it early.
For patients who are already critical, the risk of death from hypotension may outweigh the benefits of dialysis.
Abnormal heart rate
Some of you who are undergoing hemodialysis may feel an abnormal heart rhythm. This can occur due to increased levels of potassium in the blood (hyperkalemia) because it is not wasted properly.
If not treated immediately, disturbances in heart rate can lead to more severe conditions. Therefore, this condition needs special treatment so that the heart rhythm returns to normal.
Anemia
Anemia is one of the most common side effects in kidney failure patients undergoing hemodialysis.
The reason is, the kidneys cannot produce the hormone erythropoietin to produce red blood cells. As a result, the body also lacks red blood cells which causes anemia.
Stroke
According to research from the journalBlood Purification, end-stage renal failure patients undergoing dialysis have an 8-10 greater risk of stroke than others. In fact, the prevalence of bleeding stroke (hemorrhagic stroke) is also higher than that of the general population.
This condition may occur because the treatment of kidney failure uses anticoagulants (blood clotting inhibitors) routinely. Anticoagulants are used to maintain blood circuits so that the dialysis process runs smoothly.
However, the use of this drug also has the risk of causing the patient to bleed when the blood does not clot enough. As a result, the risk of excessive bleeding occurs.
Muscle cramps and stiff joints
Patients who have undergone hemodialysis for several years may experience muscle cramps and stiff joints. Both of these conditions can occur due to drastic changes in body fluids that interfere with chemicals during treatment.
For example, the build-up of uric acid crystals in the blood can cause stiffness and pain in the joints.
When this happens, the doctor will usually change the dialysis solution to reduce the risk of the condition getting worse.
Apart from some of the conditions mentioned, there are other side effects that may occur during dialysis, such as:
- sleep disorders, such as restless leg syndrome, sleep apnea, and insomnia,
- dry and itchy skin,
- inflammation of the lining of the heart, as well
- depression.
If you experience any of the problems mentioned, consult a doctor immediately.
Lifestyle
Are lifestyle changes necessary during dialysis?
If you have started hemodialysis treatment to relieve symptoms of kidney failure, this means that your lifestyle has also changed. You need to adjust your lifestyle to adapt to dialysis procedures.
If you are on dialysis in a hospital or certain place, you may need to rest after each treatment. The reason is, adjusting the impact of kidney failure and the time spent during dialysis may be difficult.
Here are some things that need to be considered while living together with the dialysis process.
- Reduce activity and strenuous work.
- Keep the vascular access clean with soap and warm water.
- Follow the kidney failure diet recommendations from nutritionists and doctors.
- Take medications and vitamins according to doctor's instructions.
- Perform regular consultations with a doctor.
Treatment options
Can hemodialysis be done at home?
Hemodialysis is usually done routinely in the hospital for at least 2-3 a week. Even so, going back and forth to the hospital in a body condition that is not fit can certainly be tiring considering that each session can last 4 hours.
You don't need to worry because this dialysis process can actually be done at home. However, this procedure certainly cannot be done haphazardly.
Unlike the CAPD (Continuous Ambulatory Peritoneal Dialysis), hemodialysis performed at home is still using machine assistance.
The CAPD procedure is not completely machine-driven, but uses the peritoneal membrane in the lining of the stomach to filter blood. However, dialysis that is done at home is also effective depending on the condition of each patient.
Here are some types of hemodialysis that can be done at home.
- Conventional hemodialysis (3 times a week for 3-4 hours).
- Daily short hemodialysis (5-7 times a week for two hours).
- Nocturnal hemodialysis (2-6 times a week at night for up to 8 hours).
If you decide to have a home dialysis procedure, your doctor will likely look at your condition first. Then, he will recommend several types above according to your health condition.