Hemodialysis is basically a machine which filters wastes including fluid & salts from blood when kidneys are no longer healthy enough to adequately perform this work. As one of the most common ways to treat advanced kidney failure, this procedure can help patients carry active lives despite failing kidneys. However, hemodialysis requires that patients follow a strict treatment schedule which includes that they regularly take medications & usually make necessary changes in diet. Hemodialysis is in fact a serious responsibility, but nevertheless they do not have to bear it alone. They will closely work with the healthcare team including nephrologists or kidney specialists & other professionals having experience in managing hemodialysis. Patients may also be able to undergo hemodialysis at home.
Why Undergo Hemodialysis?
Doctors will eventually help determine as to when patients should start hemodialysis based upon several factors like kidney function, quality of life, overall health, signs & symptoms & personal preferences of patients. Signs & symptoms of uremia or kidney failure which patients generally experience include nausea, fatigue, vomiting or swelling. Doctors normally use estimated glomerular filtration rate (eGFR) so as to measure level of kidney function in patients. eGFR is typically calculated using blood Creatinine test results, age, sex & other factors. Normal value of eGFR however varies according to age. This measurement of kidney function usually help doctors plant treatment for patients, including the ideal time which is best suited to start hemodialysis. Hemodialysis can effectively help patients control blood pressure & maintain proper balance of fluids & other minerals like sodium & potassium in the body. Hemodialysis often begins much before kidneys have shut down to the point where they can cause life threatening complications in patients.
Common Causes of Kidney Failure
Common causes of kidney failure include the following.
Kidneys may however shut down suddenly due to acute kidney injury after sever illness, heart attack, complicated surgery or any other serious problem. Moreover, certain medications may also cause injury to kidneys. Many people with chronic or severe long-standing kidney failure may choose a different course like maximal medical therapy, which is also called maximum conservative management, in place of dialysis. Maximal medical therapy involves active management of complications of advanced chronic kidney diseases like anemia, high blood pressure & fluid overload with focus on supportive management of symptoms which affect the quality of life of patients. Patients must therefore, ask their healthcare team for more information about various other options, since this is an individualized decision as benefits of dialysis may vary depending upon particular health issues of patients.
Preparing for Hemodialysis
Preparing for hemodialysis begins several weeks or months prior to the first procedure so as to allow easy access to bloodstream for which surgeons will create a vascular approach. This access is meant to provide a mechanism for safe removal of small amount of blood from circulation & for returning the same to the patient for hemodialysis procedure to work. This surgical access however needs time to heal before commencing hemodialysis treatment.
Three Basic Types of Access for Hemodialysis
- AV or Arteriovenous Fistula – This is a surgically created AV fistula which is basically a connection between a vein & an artery. This is usually made in the art which patients use less often. It is a preferred type of access simply because of safety & effectiveness.
- AV Graft – When blood vessels of patients are too small so as to form an AV fistula, surgeons may instead create a path between a vein & artery by using a flexible synthetic tube called graft.
- Central Venous Catheter – A plastic tube catheter may be inserted into large vein in patient’s neck or near groin in case of emergency hemodialysis. However, this catheter is a temporary arrangement.
Nevertheless, it is extremely important that patients take due care of access so as to reduce possibility of infection & other associated complications. They should strictly follow healthcare team’s instructions about taking care of access.
Risks & Complications Associated with Hemodialysis
Most people needing hemodialysis also have a variety of other health issues. However, hemodialysis prolongs life for many patients, but life expectancy for many patients requiring this procedure is still less than that of the general population. Although hemodialysis treatment is efficient at replacing some lost functions of the kidneys, some patients may however experience related conditions listed below, even when not everyone will experience these problems. Nevertheless, the dialysis healthcare team will help patients deal with these issues.
- Hypotension – Low Blood Pressure – Drop in blood pressure is one of the most common side effects of hemodialysis. This is particularly so for patients having diabetes. Hypotension is also usually accompanied by muscle cramps, abdominal cramps, nausea, vomiting & shortness of breath.
- Muscle Cramps – Muscle cramps during hemodialysis are common even though the cause is yet unclear. Quite often cramps can be eased by adjusting the prescription for hemodialysis. Adjustments in fluid & sodium intake in between hemodialysis treatment sessions can also help prevent muscle cramps symptoms during treatments.
- Itching – Many patients undergoing hemodialysis have itchiness in skin which is most often worse during or immediately after the procedure.
- Problems with Sleep – Patients undergoing hemodialysis usually have trouble with sleep. This is sometimes because of sleep apnea or due to breaks in breathing during sleep or due to aching & restless or uncomfortable legs.
- Anemia – Having insufficient red blood cells in blood or anemia is a common complication of hemodialysis & kidney failure. Failing kidneys invariably reduce production of hormone called erythropoietin & which effectively stimulate formation of red blood cells. Frequent blood tests, poor absorption of iron, diet restrictions and/or removal of iron & vitamins through hemodialysis may also be a contributing factor to anemia.
- Bone Diseases – When damaged kidneys are no longer able to process vitamin D, which is essential for patients to absorb calcium, will eventually weaken their bones. Additionally, overproduction of parathyroid hormone, which is a common complication associated with kidney failure, will eventually release calcium from bones.
- Hypertension – High Blood Pressure – When hemodialysis patients drink too much fluid or consume too much salt, it is most likely to cause high blood pressure which can get worse & lead to strokes or problems of the heart.
- Fluid Overload – As fluid is removed from the patient’s body during the hemodialysis procedure, consuming more fluids than what is recommended during hemodialysis treatment sessions may cause life-threatening complications like pulmonary edema, which is fluid accumulation in lungs, or heart failure.
- Pericarditis – Inflammation of Membrane Surrounding Heart – This is due to insufficient hemodialysis which can lead to inflammation of the membrane surrounding heart. This will subsequently interfere with the heart’s ability to pump blood throughout the patient’s body.
- Hyperkalemia – High Levels of Potassium – Mineral potassium is normally removed by the kidneys from the body. When hemodialysis patients eat more potassium than recommended, level of potassium within their bodies may become too high. In such severe cases, excessive potassium can cause patient’s heart to stop functioning.
- Access Site Complications – These potentially dangerous complications include infection, aneurysm – which is narrowing or ballooning of blood vessel, or blockage which can impact the quality of hemodialysis. Patients must therefore strictly follow the dialysis healthcare team’s instructions as to how they must check for changes in access which may indicate any problem.
- Amyloidosis – This dialysis-related Amyloidosis develops especially when proteins within blood are deposited on tendons & joints so as to cause stiffness, pain & fluid inside joints. However, this condition is more common in patients who have continuously undergone hemodialysis for more than 5 years of time.
- Depression – Changes in mood are quite common among patients with kidney failure. Therefore, patients who experience anxiety or depression after starting hemodialysis must talk to their dialysis healthcare team about effective treatment options.
Frequency of a patient receiving hemodialysis at home, at a dialysis clinic or in a hospital will invariably depend upon his/her individual health & situation of kidney failure.
- In-Clinic Hemodialysis – Several kidney failure patients undergo hemodialysis thrice a week at clinics or hospitals in sessions which last between 3 – 5 hours each.
- Daily Hemodialysis – This involves a more frequent but shorter sessions which are usually performed at home for kidney failure patients. Lasting between 2 – 3 hours each, these hemodialysis treatments are given for 6 – 7 days every week.
Simpler machines for hemodialysis have made performing this procedure at home less cumbersome. This is accomplished along with special training programs & someone to help patients so as to be able to undergo hemodialysis procedure at home. Patients may also be able to undergo this procedure at night while they are asleep. Moreover, there are dialysis centers located throughout the metropolitan cities of India so patients can travel to many areas & receive hemodialysis on schedule. Dialysis teams at these clinics can help patients make appointments at these centers or patients can directly contact the dialysis center at which they intend to undergo hemodialysis procedure. However, patients are required to plan ahead in order to make sure that space is available & proper arrangements can be ensured.
Actual Procedure for Hemodialysis
Patients will either sit or recline within a chair while their blood flows through a dialyzer during hemodialysis treatment. Dialyzer is a filter which acts like an artificial kidney so as to clean blood. Patients can however utilize the time watching television or a movie, or nap, read or even talk to neighboring patients undergoing treatment at the center. Patients receiving the procedure at night can also sleep during hemodialysis.
- Preparing for Hemodialysis – Patient’s body weight, pulse, blood pressure & temperature are checked prior to starting the hemodialysis procedure. Skin covering the access site, which is the point from where blood leaves the body into the machine & then reenters the body in hemodialysis procedure is first cleaned as preparation.
- Starting of Hemodialysis Procedure – Two needles are inserted into arm through access points during hemodialysis procedure. These are subsequently taped into place so as to remain secure. Each needle is then attached to flexible plastic tubes which connect them to the dialyzer. The dialyzer filters patient’s blood, just a few ounces at a time, through one tube while allowing extra fluids & wastes to pass from blood into a cleansing fluid known as dialysate. Filtered blood eventually returns to the patient’s body through the second tube.
- Symptoms During Hemodialysis – Patients may experience abdominal cramps & nausea as excessive fluids are pulled from their bodies. This is especially true when they are having hemodialysis only for about three time a week, rather than having more frequently. In case patients feel uncomfortable during the hemodialysis procedure, they should ask their healthcare team about minimizing side effects by adopting measures like adjusting speed of hemodialysis, hemodialysis fluids and/or medications.
- Monitoring During Hemodialysis Procedure – Since heart rate & blood pressure can fluctuate as excessive fluids are drawn out from the patient’s body, both blood pressure & heart rate will be required to be checked several times during each hemodialysis treatment session.
- Finishing Hemodialysis Treatment Session – At the completion of hemodialysis procedure, needles are removed from access points & a pressure dressing applied so as to prevent bleeding. Patient’s weight may be recorded again after which they are free to go about their usual activities until the start of the next hemodialysis treatment session.
Results of Hemodialysis Treatment
People having a sudden or acute kidney injury may need hemodialysis only for a short time long as their kidneys recover. In case they had reduced kidney function prior to sudden injury to kidneys, chances of full recovery back to being independent from hemodialysis are quite less. Hemodialysis however is started as an emergency & subsequently at a later stage is determined whether patients will need dialysis for the rest of their lives. Dialysis team will also explain other types of dialysis procedures to patients so that they can learn & understand which option would be most suitable to achieve goals in their case. Nevertheless, in-clinic 3 times a week hemodialysis is found to be more commonly accepted by dialysis patients.
Home Dialysis is Generally Linked to the Following Factors
- Increased well being
- Achieving better quality of life
- Reduction in symptoms like headaches, less cramping & shortness of breath
- Improvement in energy level, sleeping patterns, appetite & ability to concentrate
Hemodialysis healthcare team will effectively monitor treatment in order to make sure that patients are getting the right amount of hemodialysis treatment so as to remove enough quantity of wastes from blood. Patient’s blood pressure & weight are also very closely monitored before, during & after hemodialysis treatment.
Hemodialysis patients also receive the following tests about once every month.
- URR – blood tests designed to measure Urea Reduction Ratio & KtV – Total Urea Clearance test so as to see how well hemodialysis treatment is removing waste from their bodies.
- Assessment of blood counts & blood chemistry evaluation tests.
- Measurement of amount of blood flowing through access point during hemodialysis procedure.
Dialysis healthcare team may also adjust the intensity & frequency of hemodialysis which is in part based upon the above test results.
Caring Between Hemodialysis Treatment Sessions
Patients can help achieve best possible results of treatment between hemodialysis sessions by taking the following steps.
- Consuming the Right Foods – Eating a proper diet which is beneficial & can be helpful in improving hemodialysis results for overall health of patients will go a long way. Dialysis patients will also need to carefully monitor intake of phosphorous, potassium, sodium, protein & fluids while receiving hemodialysis treatment. Dieticians can help hemodialysis patients develop customized meal plans based upon their personal preferences, body weight, remaining function of kidneys & other associated medical conditions like high blood pressure & diabetes.
- Taking Medications as Prescribed – Hemodialysis patients must strictly follow instructions & medications prescribed by the dialysis healthcare team.
- Discussing Concerns – Allowing the dialysis healthcare team to assist in sorting out concerns can be helpful to patients. Hemodialysis healthcare team can enable patients deal with all types of concerns.
Affordable Hemodialysis Treatment Sessions with IndianMedTrip
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