Everything You Need To Know About Dialysis

Renal Failure is also called as end-stage renal disease. Kidney disease can get worse over time and may lead to kidney failure. If less than 15% of your kidney is working normally, that is considered kidney failure. You may have symptoms from the buildup of waste products Kidneys are said to be in failure when they are unable to filter waste products from your blood. When kidneys lose their ability to filter waste out of the body, dangerous levels of these waste accumulate leading to an imbalance of blood's chemical composition.

Renal Failure: Two Types

1. Acute Renal Failure:

This involves a rapid and sudden decline in kidney functions over hours to days. It is most common in people who are already hospitalized. Causes of ARF could be diseases causing reduces blood flow to the kidneys, diseases causing direct injury to the renal tissue and diseases associated with urinary tract obstruction. It is a reversible process

2. Chronic Renal Failure or Chronic Kidney Disease:

This encompasses a spectrum of different pathophysiological causes leading to abnormal kidney function and a progressive decline in the function to filter out waste products from the blood. It is an irreversible process if the causes are eliminated from the system.

What is Dialysis

It is a process by which the waste collected in the body because of renal failure is removed. It may be required for the treatment of either acute or chronic kidney disease. With the widespread availability of dialysis, the lives of hundreds of thousands of patients with end-stage renal disease have been prolonged. In India alone, as per 2011 census, the population of India is 121 billion which takes the total ESRD patients' number to 3.7 million (incidence rate is taken as 0.304%). However, the fact is that only 30% of the patients are actually aware that they are suffering from ESRD. Also, only 10% of these actually undergo dialysis.

Types of Dialysis:

1. Hemodialysis:

It is a form of dialysis where the blood is continuously removed and passed through an artificial kidney which cleans it. The treatment is an intermittent treatment and is performed ranging from three hours thrice weekly to eight or nine hours 6-7 times a week. For this method of removing the blood from the body and returning it requires a convenient mechanism which involves passing the blood through an artificial kidney. For this, an "access" is created. An arteriovenous fistula is the best form of access. A small surgery is required for this to be done. The fistula is ready for dialysis within a few weeks of the surgery.

2. Peritoneal Dialysis:

It is a type of dialysis where a special fluid (1.5-3L of dextrose containing) is infused into the peritoneal cavity-a container in the stomach which is surrounded by arteries and veins through which blood flows and allowed to dwell for a set period of time. The excess wastes from these blood vessels diffuse into the fluid through a semi-permeable membrane that encloses the peritoneal cavity. The rate of peritoneal solute transport varies from patient to patient and may be altered by the presence of infection (peritonitis), drugs and physical factors such as position and exercise. It can be carried out as:

1. Continuous ambulatory peritoneal dialysis (CAPD)- dialysis solution is manually infused into the peritoneal cavity during the day and exchanged 3-5 times daily. A nighttime dwell is frequently instilled at bedtime and remains in the peritoneal cavity through the night.
2. Continuous cyclic peritoneal dialysis (CCPD)-exchanges are performed in an automated fashion, usually at night; the patient is connected to an automated cycler that performs a series of exchange cycles while the patient sleeps.

Peritoneal Dialysis (PD) vs Hemodialysis (HD)

1. Diet & fluid restriction:

With PD, there are generally fewer diet and fluid restrictions as compared to HD.

2. Travel:

It is generally easier to travel with PD as you can carry the supplies with you. With HD, travel is possible, but you can travel for short periods and then come back in time for your next session.

3. Treatment process:

PD is considered to be less risky as a process because there is no blood going out of your system as it does in HD. Also, PD offers continuous dialysis as compared to HD which is intermittent.

4. Cost:

PD is slightly cheaper than HD.

5. Accessories:

In PD, you would need to have a catheter(tube) inside your stomach, the outer part of which will be outside your body. This tube is usually wrapped in a small pouch that is fastened around your stomach. With HD, you will need to get a fistula which may look like a swelling on your arm or wherever the fistula is made.

6. Infection:

The chances of catching infection areit high on PD, the reason why HD is considered over it. In HD, is it possible that you may catch infections if the proper washing procedures are not followed especially during reprocessing of the dialyzer and tubes.