Table of Contents

How does dialysis work?

Dialysis removes waste products and fluids from the body that your kidneys are unable to remove. The goal of dialysis is also to keep the body in balance by adjusting the levels of various toxic substances in the blood. Without dialysis, all patients with failed kidneys would die from the accumulation of toxins in the body.

Principles of Dialysis

There are two main types of dialysis: peritoneal dialysis and hemodialysis. Whichever treatment option is chosen, the goals of dialysis are very similar: dialysis is designed to replace basic kidney functions. The goals of therapy are to remove metabolic products, remove excess fluid and maintain a balanced amount of chemical compounds (electrolytes) and other substances in the body. Effective dialysis requires: a semi-permeable membrane, a blood supply, a dialysis solution, and a method for removing excess fluid.

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How does dialysis work?

 

 

Semipermeable membrane

During dialysis, a semi-permeable membrane separates the blood from the dialysis solution. This membrane allows only certain substances to pass through. It allows waste products, water, electrolytes and other substances to be removed from the blood into the dialysis solution (and sometimes in the other direction) through a process called diffusion. The movement of waste products and other substances depends on the permeability of the membrane, the size and structure of various substances, the composition of the dialysis solution, and the blood supply to the membrane.

blood supply

The more efficient the blood supply to the membrane, the higher the quality of dialysis therapy. In hemodialysis, the blood supply can be controlled by the dialysis machine.

dialysis solution

In the case of using either of the two methods of dialysis, the dialysis solution ensures the removal of metabolic products from the blood. In addition, it contains certain substances that help correct the imbalance resulting from kidney failure.

Fluid removal

Fluid removal in hemodialysis is achieved by very different processes (unlike peritoneal dialysis). In hemodialysis, the dialysis machine uses pressure differences to force fluid out of the blood through the membrane into the dialysis solution. In peritoneal dialysis, glucose is used in the dialysis solution. This has the effect of stimulating the movement of excess fluid from the blood into the dialysis solution, which is drained periodically. Purpose of dialysis

Purpose of dialysis

Whichever method of dialysis is used, it has the following goals: removal of metabolic products, removal of excess fluid, correction of electrolyte imbalance and adjustment of the pH level of the body.

When the kidneys stop functioning, patients begin dialysis. Hemodialysis is a life-saving kidney replacement therapy for people with severe kidney failure and is an artificial blood purification process outside the body using a special artificial kidney machine, in which toxic waste and excess water are removed from the body and the purified blood is returned back.

How does dialysis help people with severe kidney failure?

Dialysis helps the body by performing the following functions of affected kidneys:

  • Cleansing the blood by removing waste products such as creatinine, urea, etc.
  • Removing excess fluid and maintaining the right amount of water in the body.
  • Correction of imbalances of essential chemicals such as sodium, potassium and bicarbonate.

However, an artificial kidney cannot perform the functions of healthy kidneys associated with maintaining proper hemoglobin levels, as well as maintaining healthy bones, but special drugs are additionally used for this.

When is dialysis needed?

When kidney function decreases by 85-90% (end-stage kidney disease), the kidneys no longer remove enough waste and fluid from the body, leading to symptoms such as nausea, vomiting, fatigue, swelling, and shortness of breath. At this stage, CP response to drugs is poor and the patient needs dialysis. A person with CKD usually requires dialysis when a blood test shows a creatinine level of 700 µmol/L or more in a patient weighing about 70 kg.

Dialysis is a fast and effective treatment for symptomatic improvement in patients with severe renal insufficiency.

Can dialysis cure chronic kidney disease?

No. Chronic kidney disease is incurable, and a patient with end-stage renal disease needs lifelong dialysis treatments until a kidney transplant is performed. Only in case of acute kidney failure is dialysis necessary for a short period of time until the kidneys recover.

What are the types of dialysis?

There are two main types of dialysis – hemodialysis and peritoneal dialysis.

Hemodialysis: Hemodialysis (HD) is the most common method used to treat end-stage kidney disease. This is the process of removing waste and excess fluid from the blood using an artificial kidney machine.

Peritoneal dialysis: Peritoneal dialysis (PD) is an effective treatment for end stage kidney disease. A soft tube called a catheter is placed in the abdomen for this type of dialysis. Using a catheter, dialysis solution from plastic disposable bags is poured into the abdominal cavity, which removes toxins and excess fluid from the body. PD is performed at home and usually without a special machine.

Dialysis cannot cure kidney failure, but it helps patients live comfortably despite their kidney failure.

What factors determine the choice of dialysis in patients?

Hemodialysis and peritoneal dialysis are effective methods for the treatment of patients with end-stage kidney disease. There is no specific method that suits everyone equally well. After considering the advantages and disadvantages of each method, the choice between HD or PD is made in consultation with the patient, family members, and nephrologist. The main factors influencing this choice are the cost of treatment, age, comorbidities, the presence of residual kidney function, the remoteness of the place of residence from the dialysis center, the level of education, the patient’s mobility, and lifestyle.

Should dialysis patients follow a special diet?

Yes. General nutritional advice for dialysis patients is to limit sodium, potassium, phosphorus, and fluid intake. Dialysis patients should follow these dietary guidelines, but dietary restrictions are lessened once dialysis is started. Most people on dialysis are advised to eat a diet high in protein, high in calories, vitamins and minerals.

What is “dry weight”?

The word “dry weight” is commonly used in relation to dialysis patients. This is the weight of a person after all excess fluid has been removed by dialysis. The “dry weight” value should be adjusted from time to time, according to the actual weight of the person.

Even after starting dialysis, dietary restrictions should be continued.

Hemodialysis

Hemodialysis

Hemodialysis (HD) is the most popular treatment for end stage kidney disease. During hemodialysis, the blood is purified using dialysis and a dialyzer.

How is hemodialysis performed?

Most often, hemodialysis is performed in dialysis centers under the supervision of doctors, nurses, and dialysis technicians.

  • The pump of the dialysis machine at a rate of 300-400 ml per minute pumps blood from the body into the dialyzer (a plastic cylinder with a semi-permeable membrane) through flexible hoses. Heparin is constantly injected into the system to prevent blood clotting.
  • A dialyzer is a special filter that removes excess fluid and toxins. The dialyzer cleans the blood with a special solution called dialysate. It is prepared using an artificial kidney machine.
  • After the blood is cleansed, the machine returns it back to the body.
  • Hemodialysis is usually carried out three times a week, and each blood purification session lasts from four hours.

How is blood collected for purification and returned back to the body during hemodialysis?

There are three most common types of vascular access for hemodialysis: central venous catheters, native arteriovenous fistulas (AVFs), and synthetic vascular prostheses.

Hemodialysis is performed regularly three times a week throughout life in end-stage kidney disease.

Central venous catheters

 

1. Central venous catheters

  • For immediate initiation of hemodialysis treatment, a central venous catheter is placed. This method is the most common and effective.
  • This vascular access method is ideal for short-term use prior to the formation of an AVF or vascular prosthesis.
  • For hemodialysis, a catheter is placed in a large vein in the neck, chest, or leg in the groin area (internal jugular, subclavian, and femoral veins, respectively). With the help of such a catheter, blood at a rate of about 300 ml min can be taken during dialysis.
  • Catheters are flexible hollow tubes with two lumens. Blood is taken from the body through one end. The blood then enters the dialysis circuit and returns to the body from the other end.
  • Venous catheters are usually used for temporary access due to the risk of infection and clotting.
  • Two types of venous catheters are available: tunneled, cuffed, or indwelling (used for several months) and temporary (used for several weeks).

AV fistulas

2. AV fistula

 

  • An arteriovenous or AV fistula is the most common and best vascular access option for long-term hemodialysis because they last longer and are less susceptible to infection and thrombosis.
  • In an AV fistula, the artery and vein are surgically connected to each other. The fistula is usually formed in the forearm at the wrist (radial artery and cephalic vein are connected).
  • A large amount of blood from the artery enters the vein under high pressure. After a few weeks or months, the vein expands and pumps more blood through it, a process called maturation. Since the fistula takes time to mature, the fistula cannot be

used for hemodialysis immediately after its formation.

  • For hemodialysis, two large-diameter needles are inserted into the fistula – one to deliver blood to the dialyzer, and the other to return purified blood to the body.
  • An AV fistula works for many years if it is well looked after. All normal, daily activities can easily be performed by the hand with an AV fistula.

Why does a fistula need special care?

  • The life of a person with end-stage CKD depends on regular and adequate hemodialysis. The availability of sufficient blood from the AV fistula is essential for adequate hemodialysis, which is why the AV fistula is called the “Lifeline” for a person on hemodialysis. Special fistula care ensures adequate blood flow for a long period of time.
  • A large volume of blood under high pressure flows through the veins of the fistula. Accidental injury to these dilated veins can lead to profuse bleeding and sudden massive blood loss, which can be life-threatening. Therefore, reasonable consideration should be given to protecting the AV fistula.
AV fistula is the “lifeline” in CKD patients. Without it, long-term hemodialysis is not possible.

Fistula care

Proper regular fistula care and protection ensures adequate blood flow for many years. Important precautions to keep the fistula healthy and working for a long period of time are as follows:

Prevent infection

  • Always keep the side where the fistula is located clean, wash the vascular access arm daily and before each dialysis.

AV fistula protection

  • Use the fistulous side of the arm for dialysis only. Do not allow anyone to inject into it, draw blood, or measure blood pressure on a fistulous arm.
  • Avoid injury to the fistula. Do not wear jewelry, tight clothing, or wristwatches on a vascular access arm. Accidental injury to the fistula can lead to sudden heavy bleeding, which can be life-threatening. To stop bleeding, you must immediately press hard on the bleeding site with your other hand or use a tight bandage. Seek medical attention after the bleeding has stopped. It is reasonable to start fighting the bleeding on your own without delay, after which you can go to the hospital.
  • Do not lift heavy objects with an accessible hand. Avoid putting pressure on your hand. Be careful not to sleep on the arm with an AV fistula. Do not carry out dangerous work that can injure the fistula (for example, repair a car yourself)
To ensure adequate blood flow and effective long-term operation of the fistula, special care is very important for it.

Ensuring the operation of the AV fistula

  • Regularly check blood flow through the fistula. When the fistula is working properly, you feel a vibration when you touch it with your hand (fistula noise). This must be done three times a day (before breakfast, lunch and dinner). If there is no vibration, contact your doctor or dialysis center immediately. Early detection of a stopped fistula and timely resolution of the problem of dissolution or removal of the thrombus may save the AV fistula.
  • Low blood pressure entails the risk of fistula thrombosis and therefore must be controlled.

Regular exercise

  • Regular exercise can improve fistula maturation. Even after the start of hemodialysis, regular exercise of the access arm helps to strengthen the AV fistula.

Vascular prosthesis

  • A vascular prosthesis is another form of long-term dialysis access that can be used when the patient’s veins are not well enough to form a fistula or the AV fistula has stopped working.
  • In a vascular prosthesis, an artery is surgically connected to a vein with a short piece of synthetic soft tube that is implanted under the skin. During the hemodialysis procedure, needles are inserted into this prosthesis.
  • Compared to an AV fistula, the prosthesis has a higher risk of thrombosis, infection, and generally does not last as long as an AV fistula.
The hemodialysis machine cleans the blood and maintains the balance of fluid, electrolytes and acids with the help of a dialysis filter.

What are the functions of a hemodialysis machine?

Important functions of the dialysis machine are:

  • The dialysis machine pumps blood and monitors the flow of blood from the body to the dialyzer for cleaning.
  • The machine prepares a special dialysis solution (dialysate) that is fed into the dialyzer to purify the blood. The machine carefully regulates and controls the concentration of electrolytes, temperature, volume and pressure of the dialysate. These parameters can be changed according to the needs of the patient. This solution removes waste and excess water from the body through the dialyzer.
  • The machine has various safety devices to ensure patient safety, such as a dialyzer blood leak detection sensor or the presence of air in the blood circuit.
  • The computer model of the hemodialysis machine with the display of various parameters on the front panel of the screen and various alarms ensure the convenience, accuracy and safety of the dialysis procedure.
  • During hemodialysis, blood passes through a dialyzer (artificial kidney) where the blood is purified.
  • The dialyzer is approximately 20 cm long and 5 cm wide. It is a plastic cylinder, inside of which there are thousands of filiform hollow fibers, each of which is a synthetic semi-permeable membrane.
In the process of hemodialysis, the dialyzer acts as a filter, where the process of blood purification takes place.

 

  • These hollow fibers are connected to each other at the top and bottom of the cylinder and form the “blood compartment”. Blood enters the “blood compartment” through the hollow fibers from the orifice or blood port at one end and exits at the other end after being cleaned.
  • Dialysis fluid enters from one end of the dialyzer, flows along the outside of the fibers (“dialysate compartment”), and exits at the other end.

Purification of blood in the dialyzer

  • In hemodialysis, blood is pumped by a machine and enters the dialyzer through one end, then distributed into thousands of capillary-like hollow fibers. The dialysate enters the other end of the dialyzer and travels along the outside of the fibers through the “dialysate compartment”.

The process of hemodialysis

  • Every minute, about 300 ml of blood and 600 ml of dialysis solution continuously flow in the opposite direction in the dialyzer during hemodialysis. Semi-permeable hollow fiber membrane that separates blood and dialysate, allows waste to be removed and
excess fluid, moving them from the blood space to the dialysis solution space.

  • Blood exits from the other end of the dialyzer after cleaning. Dialysis fluid with toxic substances and excess fluid that is removed from the blood exits the end of the dialyzer into which the blood enters.
  • During hemodialysis, all of the patient’s blood passes through the machine about 12 times. After four hours of hemodialysis, blood urea and creatinine levels are greatly reduced, excess fluid is removed from the body, and electrolyte disturbances are corrected.

What is dialysate and what are its functions in hemodialysis?

  • Dialysate (dialysis solution) is a special fluid used in hemodialysis to remove waste and excess fluid from the blood.
  • The composition of the standard dialysate resembles normal extracellular fluid, but its composition can be changed according to the needs of the patient.

  • Dialysate prepares the machine by mixing 30 parts of highly purified water with one part of dialysis concentrate.
  • Dialysis concentrate is a special fluid that contains high concentrations of electrolytes, minerals and bicarbonate. It is sold, as a rule, in a canister, or diluted in a dialysis center from a dry powder.
  • To prepare a dialysate solution, network water is purified by a series of sequential actions, such as cleaning through a sand filter, a carbon filter. The water is softened, passed through a reverse osmosis apparatus, sometimes deionized and treated with ultraviolet light.
  • Water purified in this way becomes free from dirt, suspended and chemical impurities, minerals, bacteria and endotoxins.
  • Ultrapure water is essential for safe hemodialysis, as the patient is exposed to approximately 150 liters of water during each hemodialysis session.
  • To protect patients, hemodialysis water is carefully purified. Water quality control is very important.

Where is hemodialysis performed?

Hemodialysis is usually performed in a hospital or specialized center by trained staff under the supervision of a doctor. Very few patients receive hemodialysis at home. Home hemodialysis is carried out in stable patients, as it requires appropriate training, family support, sufficient space and finances.

Dialysate corrects electrolyte imbalances and removes waste during dialysis.

Does hemodialysis hurt? What does a patient do during dialysis?

No. Hemodialysis is not painful, except for the pain during needle insertion. A hemodialysis patient visits the hospital for dialysis and returns home after the procedure is over. Patients typically spend four hours of dialysis resting. Sleep, read, listen to music or watch TV. During dialysis, patients prefer light snacks and hot or cold drinks.

What are the most common problems during hemodialysis?

Common problems during hemodialysis are low blood pressure (hypotension), nausea/vomiting, muscle cramps, weakness, and headache.

What are the advantages and disadvantages of hemodialysis? Benefits of hemodialysis:

  • Hemodialysis is performed by trained nurses or specialists, so it is safe, less stressful, and more comfortable for patients.
  • Hemodialysis is a faster and more effective method, it takes much less time than peritoneal dialysis.
  • The hemodialysis center provides a platform to meet and interact with other patients with similar problems. This interaction reduces stress and the patient can socialize in the company of other patients.
The main advantages of hemodialysis are safety, efficiency and comfort.

  • More free time, because hemodialysis is carried out only three days a week.
  • Small risk of infection.
  • Hemodialysis is less expensive than peritoneal dialysis in most countries and centers.

Disadvantages of hemodialysis:

  • Regular trips to a hemodialysis center can be inconvenient and time consuming, especially when the dialysis center is far away.
  • On hemodialysis, you need to follow a regular schedule. The patient should plan all his actions taking into account hemodialysis procedures.
  • The insertion of a hemodialysis needle is painful for some patients.
  • Less freedom in diet. A patient on hemodialysis needs to adhere to restrictions on the intake of fluid, salt and potassium, as well as foods rich in phosphorus.
  • Higher risk of contracting viruses and, in particular, hepatitis.
The main disadvantage of hemodialysis is the need to regularly visit a hospital or specialized center three times a week.

Do’s and Don’ts for Hemodialysis Patients

  • Patients with end-stage kidney disease who are on dialysis should visit hemodialysis regularly, three times a week. Regular dialysis is important for long-term health. Skipped treatments, irregular or insufficient hemodialysis can be harmful and sometimes fatal.
  • Fluid and salt restriction are very important to control weight gain between two dialysis sessions. Limit foods rich in potassium and phosphorus. Increasing your protein intake is very important.
  • Malnutrition is a common problem among dialysis patients and leads to poor outcomes. The lack of dietary protein and the loss of protein during dialysis leads to malnutrition. Thus, a diet high in protein and high in calories is recommended for dialysis patients.
  • Water-soluble vitamins, including B and C vitamins, may be added to dialysis patients by a doctor’s prescription. Avoid over-the-counter multivitamins, because they may not contain all the necessary vitamins and vitamins may not be adequate for dialysis patients. They may also contain vitamins A, E, and K, or minerals that may be harmful to dialysis patients.
  • Calcium and vitamin D may be prescribed depending on calcium, phosphorus, and parathyroid hormone levels.
In hemodialysis patients, fluid restriction is essential to control weight gain between two dialysis sessions.

  • Maintain a healthy lifestyle and follow general activities such as quitting smoking, maintaining a healthy weight, exercising regularly, limiting alcohol consumption, etc.

When should a person on hemodialysis contact a dialysis doctor or nurse?

A patient on hemodialysis should contact their dialysis doctor or nurse immediately if:

  • Started bleeding from an AV fistula or catheter.
  • The fistula no longer makes noise or vibrates.
  • Sudden weight gain, swelling or shortness of breath.
  • Chest pain, very slow or fast heart rate.
  • High or low blood pressure.
  • The patient’s consciousness is confused, the patient is drowsy, unconscious, or convulsions develop.
  • Fever, chills, severe vomiting, blood in vomit, or severe weakness.
Hemodialysis patients should stop smoking, maintain a healthy weight, and exercise regularly.

Peritoneal dialysis

Peritoneal dialysis

Peritoneal dialysis is another form of dialysis for patients with end-stage kidney disease that is widely recognized and effective. This is the most common way to perform dialysis at home.

What is peritoneal dialysis?

  • The peritoneum is a thin membrane that lines the abdominal cavity and supports the intestines and other abdominal organs.
  • The peritoneal membrane is a natural semi-permeable membrane that allows toxins to be removed from the blood through it.
  • Peritoneal dialysis is the process of cleaning blood through the peritoneum.

What are the types of peritoneal dialysis?

Types of peritoneal dialysis:

  1. Intermittent peritoneal dialysis (PPD)
  2. Permanent ambulatory peritoneal dialysis (CAPD)
  3. Continuous automated (cyclic) peritoneal dialysis (APD).

1. Iodine peritoneal dialysis (PPD)

  • Intermittent peritoneal dialysis (PPD) is a valuable and effective option for short-term dialysis in hospitalized patients. DAA is widely used in acute renal failure, in children, in emergency cases in end-stage kidney disease.
  • In PPD, a special plastic catheter with multiple holes is placed in the patient’s abdominal cavity and dialysis is performed using a special solution – dialysate.
  • PPD lasts for 24-36 hours and uses 30 to 40 liters of dialysate solution during treatment.
  • PPD is repeated at short intervals of 1 to 3 days, according to the needs of the patient.
CAPD is a type of dialysis that can be performed by patients at home with a specialized fluid.

Permanent ambulatory peritoneal dialysis (CAPD)

2. Permanent ambulatory peritoneal dialysis (CAPD)

What is PAPD?

CAPD stands for: P – permanent means continuous process (treatment without stopping for 24 hours a day, 7 days a week).

A – ambulatory means that the patient can walk and perform normal activities.

P – the peritoneal membrane in the abdomen acts as a filter.

D – dialysis is a way to purify the blood. Continuous ambulatory peritoneal dialysis (CAPD) is a form of dialysis that can be performed by a person at home without the use of a machine. Since CAPD provides convenience and independence, it is a popular form of dialysis in developed countries.

The PAPD process

CAPD catheter: Continuous ambulatory peritoneal dialysis (CAPD) uses a soft, thin, flexible silicone tube with numerous side holes. It’s called a CAPD catheter. The catheter is surgically implanted into the patient’s abdomen as a permanent access for peritoneal dialysis. The catheter is usually implanted through the patient’s abdominal wall about an inch below the navel. The CAPD catheter is placed 10-14 days before the start of dialysis. Like a fistula in hemodialysis, a PD catheter is the lifeline for CAPD patients.

CAPD must be done carefully every day at the set time without any days off.

Permanent ambulatory peritoneal dialysis (CAPD) technique:

The CAPD method consists of three steps: Fill, hold, empty.

 

Fill: Through the catheter, two liters of peritoneal dialysis fluid from the bag is poured through a sterile plastic tube into the abdominal cavity by gravity, where it contacts the peritoneum. After the liquid passes into the body, the empty solution bag is rolled up and stored until the next treatment.

Endure: PD fluid (dialysate) remains in the abdomen for about 4-6 hours during the day and about 6-8 hours at night. The time that PD fluid remains in the abdominal cavity is called the holding time. At this time, the cleaning process takes place.

The PAPD process

The peritoneum acts as a filter that allows waste and excess fluid to pass from the blood into the PD fluid. During this period, the patient can walk freely.

Empty: After the dwell time, the PD fluid with waste products is drained through the catheter into an empty bag (which has been rolled up and stored). The liquid bag is weighed and then discarded. The released liquid should be clear.

Emptying the PD fluid from the abdominal cavity and replacing it with a fresh solution takes approximately 30-40 minutes. This process of filling and emptying is called exchange. The exchange can be made 3 to 5 times during the day, and once per night. The exchange at night is done right before going to bed, and the solution remains in the abdominal cavity all night. The CAPD process is carried out strictly in accordance with the requirements of asepsis and precautions.

Continuous cyclic peritoneal dialysis is performed at home using an automated machine.

Continuous automated (cyclic) peritoneal dialysis (APD)

3. APD or continuous cyclic peritoneal dialysis (NCPD)

Automated peritoneal dialysis (APD) or continuous cyclic peritoneal dialysis (CCPD) is a continuous method of dialysis performed at home every day with the help of a special machine. During APD, the machine automatically fills the PD solution into and empties the abdominal cavity. Each cycle usually lasts 1-2 hours and the exchange is carried out four to five times. APD lasts 8 – 10 hours during the night when the person is sleeping. In the morning, when the machine is turned off, 2-3 liters of PD fluid is usually left in the abdomen. The solution remains in the abdominal cavity during the daytime and is drained in the evening or at night when the device is connected. The main advantages of the ADF are the freedom for day-to-day activities, as the process consists of only one connection and disconnection to the machine within 24 hours. This provides comfort and reduces the risk of peritonitis. The main disadvantages of ADF are cost and complexity.

The main disadvantages of ADF are cost and complexity.

What is PD fluid used in CAPD?

PD fluid (dialysate) is a sterile solution rich in minerals and glucose. It is used during peritoneal dialysis. Three different concentration solutions are available depending on the glucose content (1.5%, 2.5% and 4.5%). Glucose in solution allows you to remove fluid from the body. Depending on the volume of fluid to be removed, solutions of different concentrations are available to the patient. For greater liquid removal, a solution with a high concentration is used. New PD solutions are now available that contain icodextrin instead of glucose. The advantage of the new formula is that it removes fluid from the body slowly. The new solution is recommended for diabetic or overweight patients as its use is limited to one cycle per day. PD solution bags are available in different sizes,

What are the most common problems with CAPD?

The main complications of continuous ambulatory peritoneal dialysis are:

Infections:The most common serious problem in a person on CAPD is peritonitis, an infection of the peritoneum. Abdominal pain, fever, chills, and cloudy fluid coming out of the abdomen are the most common symptoms of peritonitis. To avoid this problem, the CAPD procedure must be carried out strictly in accordance with the requirements of asepsis and precautions. Treatment of peritonitis includes the use of broad-spectrum antibiotics, microflora culture (which allows for an accurate choice of antibiotic), removal of the atheter may be necessary for some patients. An infection may also develop at the site of the catheter entry. Other problems: bloating, weakening of the abdominal muscles causing a hernia, fluid overload, swelling of the scrotum, constipation, back pain, poor drainage,

Precautions to prevent infection are essential in CAPD patients.

Benefits of CAPD

  • Fewer dietary and fluid restrictions.
  • More freedom. Dialysis can be done at home, at work, or on the road. You can carry on with your normal activities while dialysis is in progress. The patient can do CAPD on their own – no need for a machine, hospital staff or family members.
  • There is no attachment to a fixed schedule of dialysis three times a week and painful needle sticks.
  • Better control of hypertension and anemia.
  • Easier to carry, tk. the blood is cleared continuously, unlike hemodialysis – there are no sharp fluctuations three times a week or discomfort.

Disadvantages of CAPD

  • Risk of infection of the peritoneum and the exit site of the catheter.
  • A person must carefully perform 3-5 exchanges per day, 365 days a year without days off. Adhering to all the instructions and strictly maintaining the appropriate level of cleanliness is quite difficult.
The main benefits of CAPD are freedom of movement, ease of scheduling, and fewer dietary restrictions.

  • A permanent catheter and fluid in the abdomen can cause discomfort, and the change in appearance may not be acceptable to everyone.
  • Sugar in dialysis fluid can lead to weight gain and hypertriglyceridemia.
  • Keeping a reserve of heavy PD bags at home is very difficult.

What dietary changes are recommended for a person on CAPD?

The diet for people on CAPD is very important and is slightly different from the diet for people on hemodialysis.

  • A high protein diet is essential to avoid protein malnutrition due to the constant loss of protein during peritoneal dialysis.
  • Reduce calories to avoid weight gain. The solution for PD has glucose, which constantly provides carbohydrates to a person on CAPD.
  • Restrictions on salt and fluid intake are less stringent than on hemodialysis.
  • Foods rich in potassium and phosphorus are limited.
  • Increase fiber-rich foods to prevent constipation.
Patients on CAPD should eat a high protein diet to avoid malnutrition and reduce the risk of infections.

When should a person on CAPD see a dialysis nurse or doctor?

A CAPD patient should contact a dialysis nurse or doctor immediately if they have:

  • Abdominal pain, fever or chills.
  • Fluid after PD is cloudy or contains blood.
  • Pain, pus, redness, swelling, or warmer skin near the exit of the catheter.
  • The flow of PD solution is blocked at the entrance or exit from the abdominal cavity, or constipation has begun.
  • Unexpected weight gain, significant edema, shortness of breath and development of severe hypertension (presumably due to fluid overload). Low blood pressure, weight loss, seizures and dizziness (presumably due to fluid deficiency).

Are dialysis patients immunocompromised?

Dialysis patients do have a weakened immune system and are considered to be more susceptible to infection.  Patients who are on dialysis have some level of lymphocyte activation/exhaustion which predisposes them to increased rates of infections

Are dialysis patients considered disabled?

Patients who are undergoing dialysis are considered disabled with regard to qualifying for social security benefits( Reference)

Are dialysis centers open on holidays?

Dialysis centers are generally closed on Christmas, new years and thanksgiving but some may be open and you will need to contact your local dialysis center for their schedule.

Is dialysis painful?

Dialysis treatment itself is not painful including hemodlysis through a catheter (Permcath) or an AV fistula or through peritoneal dialysis. There may however be some pain involved with hemodialysis when using an AV fistula because the fistula needs to be accessed with 2 needles which are put into the graft/fistula through the skin.  Peritoneal dialysis does not require any blood, so there are no needle sticks  and fluid is simply enters the abdomen through the PD catheter and is left in the abdomen for a while and then drained back out.  This process is generally considered completely painless and many patients undergo peritoneal dialysis at night while they sleep.

Are dialysis ports MRI safe?

Dialysis catheters and the external ports of the dialysis catheters (tunneled hemodialysis catheters also known and Permcath/Permacath and non tunneled hemodialysis catheters known as vascaths/Quintons) do not generally have any metal and are MRI safe.  Peritoneal dialysis catheters are also generally safe for MRI although some of the PD catheters do contain a metallic tip which can cause artifact nearby on an MRI.  It should be noted that ports/chemo ports are completely different devices which are specifically used in cancer patients or patients requiring long term vascular access and are implantable devices for vascular access and chemotherapy.  These ports/chemo ports are not the same thing as dialysis catheters with ports and cannot be used for dialysis as they are generally much smaller devices that would not allow for the blood flow needed for dialysis.

Are dialysis machines portable and can dialysis be done at home?

Both hemodialysis and peritoneal dialysis machines can be portable and can be used at home or on trips.  A portable hemodialysis machine can measure 20 x 40 inches and can be considered a medically necessary assistive devices under the air carrier access act and can be taken on a plane.

Can dialysis be temporary?

Dialysis can absolutely be temporary.  Acute kidney injury can require immediate treatment in the form of dialysis however the acute kidney injury can often be reversed and the kidneys can begin recovering and can even return to normal function within weeks.

Can dialysis improve kidney function?/can dialysis cure kidney failure?

In some settings dialysis can help the kidney recover its function.  for example if the cause for acute renal failure is a medication, antibiotic or contrast its possible that stopping the medication causing the renal dysfunction in conjunction with dialysis helping clear some of the inciting medication that the kidney function may improve.

Can dialysis stop working?

Its possible for peritoneal dialysis to stop working especially over the long term however hemodialysis which can be done through catheters or an AV fistula will generally not stop working.  Its possible for catheters and AV fistulas to stop working however a new catheter can be placed and generally a new AV fistula or graft can be created.

Can dialysis cause diarrhea?

Yes diarrhea is one of the symptoms which can be seen in patients who start hemodialysis.  Applesauce however is suggested as a treatment for dialysis in chronic kidney disease.

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