Dialysis

Types of Dialysis:

• Hemodialysis: In hemodialysis, blood is circulated outside the body through a dialysis machine that filters waste products and excess fluids before returning the purified blood to the body. This process typically takes place at a dialysis center several times a week and lasts for several hours per session.
• Peritoneal Dialysis: In peritoneal dialysis, a special fluid called dialysate is introduced into the abdominal cavity through a catheter. The peritoneal membrane lining the abdomen acts as a natural filter, allowing waste products and excess fluids to pass from the blood vessels into the dialysate. After a dwell time, the used dialysate is drained from the abdomen and replaced with fresh dialysate. Peritoneal dialysis can be performed at home, allowing for greater flexibility and independence.
• Continuous Renal Replacement Therapy (CRRT): CRRT is a form of dialysis used in critically ill patients with AKI. It involves continuous removal of waste products and excess fluids from the blood over an extended period, typically 24 hours a day, using a specialized machine in the intensive care unit (ICU).

Indications for Dialysis:

• End-Stage Renal Disease (ESRD): Dialysis is the primary treatment for individuals with ESRD, a stage of kidney disease where the kidneys have permanently lost their ability to function. Without dialysis or kidney transplantation, ESRD is fatal.
• Acute Kidney Injury (AKI): Dialysis may be used as a temporary measure to support kidney function in patients with severe AKI, particularly those with complications such as fluid overload, electrolyte imbalances, or uremia (buildup of waste products in the blood).

Purpose and Benefits:

• Removal of Waste Products: Dialysis filters waste products such as urea, creatinine, and excess electrolytes from the blood, helping to maintain a healthy balance of these substances in the body.
• Fluid Removal: Dialysis helps remove excess fluid from the body, preventing fluid overload and reducing the risk of complications such as pulmonary edema and hypertension.
• Acid-Base Balance: Dialysis helps regulate the body’s acid-base balance by removing excess acids or bases from the blood.
• Symptom Relief: Dialysis can alleviate symptoms associated with kidney failure, such as fatigue, nausea, vomiting, itching, and shortness of breath, improving the patient’s quality of life.

Complications and Considerations:

• Complications of dialysis may include hypotension (low blood pressure), muscle cramps, infection at the catheter site (in peritoneal dialysis), vascular access issues (in hemodialysis), anemia, bone disease, and cardiovascular events.
• Dialysis requires careful monitoring of fluid and electrolyte balance, blood pressure, and nutritional status to optimize treatment efficacy and minimize complications.
• Long-term dialysis may have a significant impact on a patient’s lifestyle, requiring regular visits to the dialysis center, dietary restrictions, and adherence to medication regimens.

Kidney Transplantation:

• Kidney transplantation is considered the best treatment option for eligible candidates with ESRD, offering improved quality of life and long-term survival compared to dialysis.
• However, not all patients are suitable candidates for transplantation due to medical comorbidities, immunological factors, or social considerations.
• Dialysis may be used as a bridge to transplantation while awaiting a suitable donor organ.