Dialysis is a process that substitutes for kidney function when the kidneys are functioning less than 10%. In a healthy body, the kidneys serve to regulate fluid levels in the body and filter waste products. Dialysis performs these functions when the kidneys are unable to remove fluid or toxins from the body.
There are two major types of dialysis: Hemodialysis and Peritoneal Dialysis
What is Hemodialysis (HD)
This is a procedure in which a dialysis machine is used to filter toxins, electrolytes and excess fluid from the blood. Hemodialysis is administered by health care professionals in a hospital or at an outpatient dialysis centre or it can be done at home by the patient with proper training. Most hemodialysis patients get their treatments 3 days per week, but some patients choose to do more frequent treatments at home.
Peritoneal Dialysis (PD)
In this process, the body's own tissues are used to flush waste from the body with sterile fluid instilled into the abdominal cavity. Peritoneal dialysis is self-administered by the patient through a catheter in the abdomen. Exchanges of fluid ("drain" and "fill") may be performed in any clean location in the home or during travel. It may also be possible for peritoneal dialysis to be administered during sleep via a fluid cycler machine. Unlike hemodialysis, peritoneal dialysis does not require needles, but PD exchanges typically do need to be performed multiple times every day or night.
During hemodialysis, blood is removed from a vein (either a dialysis catheter or an AV Fistula) circulated through a filtering machine and returned to the body. Blood is pumped at the rate of 250 – 400 ml/min for hours through the machine. A filter (that mimics the kidney) which has a filtering membrane is used and called the dialyser. A single dialysis session can clean about 60 to 100 litres of the patient’s blood. An adult has about 5 litres of blood which is run over and over again, just like in our kidneys. Toxins and excess fluids are removed over this session.
Since veins tend to have weak blood flow, one of the patient's arteries are connected to the vein in a minor surgical procedure. This increases blood flow to the vein. This artery-to vein connection can be created either through the use of synthetic material known as a AV Graft, or through a direct surgical connection of one blood vessel to the other, which is known as an AV fistula.
In cases where creating a fistula or graft is not possible, or in emergency situations, a hemodialysis catheter may be inserted into a vein in the neck or thigh in order to perform dialysis. These catheters are similar to large IV's, with 2 ports visible outside the body. One port is used to pull blood from the body to the machine, and the other port is used to return blood to the patient from the machine. Catheters can be temporary double lumen catheters (for use not more than a week) or tunnelled under the skin called Permacaths which can be used for months or even years. Unlike fistulas and grafts, catheters do not require needle sticks to access the patient's blood, but catheters are associated with higher risks of serious infection.
After the fistula is created, the vein thickens and strengthens in response to the higher blood flow from the artery, but this maturation process typically takes 2-3 months for the vein to becomestrong enough to withstand the needle sticks required to access the bloodstream and move blood to & from the dialysis machine. So, ideally an AV Fistula should be created a few months before dialysis is required, usually after the serum creatinine crosses 4.0 mg/dl.
Grafts, on the other hand, are synthetic material used to connect the artery to the vein. The graft material can be accessed with needle sticks immediately if needed because no maturation process is needed, but patients often wait until post-operative swelling has improved before using the graft for dialysis. Grafts usually work well, but fistulas generally are the preferred option because of better long-term performance and lower infection risk.
While dialysis is generally a safe procedure, there are potential complications and risks associated with it. Infection can occur at the site of the dialysis access or in the bloodstream. Patients also may develop cramps or low blood pressure because fluid may need to be removed during the dialysis procedure. Other complications include irregular heart rate, blood loss, allergic reactions, and others. Hemodialysis and peritoneal dialysis can have different types of complications, so be sure to communicate with your healthcare providers to get more information.
Yes. It is extremely important for the patient and health care professionals involved to avoid possible infection by hand washing, the use of surgical masks and antiseptic wipes. Patients should maintain a diet that is high in protein and low in potassium and phosphorous, and to monitor fluid intake carefully to avoid excessive weight gains.
The only effective treatment for kidney failure other than hemodialysis or peritoneal dialysis is for the patient to receive a Kidney Transplant.
While dialysis is a life-saving treatment, it does only about 10 percent of the work that a functioning kidney does. Because of its inability to replace full kidney function, toxins accumulate and decreased life on dialysis (compared to a transplant). Patients typically live 10 to 15 years longer with a kidney transplant than if they stayed on dialysis. And most people report that in comparison, transplantation offers them a much better quality of life.
You will need a thorough evaluation by the Transplant team to determine if you are fit for a transplant. Being a good candidate for transplant depends upon your physical health, emotional well-being, and ability to manage medication and care plans.
If possible, it is best to have a transplant before you need to start dialysis or spend a long time on dialysis. Patients who have a living kidney donor have the best chance of avoiding dialysis or being on dialysis for lesser time than if they had to wait for a deceased donor kidney. If you have a living donor, it may be possible for you to undergo a "pre-emptive transplant"; that is, before you ever need dialysis. Studies show that a transplanted kidney from a living donor functions longer, and the recipient lives longer, compared to those patients who have had dialysis prior to transplant.
However, no matter how long someone has been on dialysis, a transplant from a live donor should still be considered. Living donation can also be scheduled at the convenience of both donor and recipient, and is performed at a pre-determined time, rather than as an urgent operation when a deceased donor kidney becomes available.
In India kidney transplants are governed by the THOA Act. Accordingly, the patient’s parents, siblings, spouse or children can donate as first preference (1st degree relatives). If for some reason the 1st degree relatives cannot donate, the 2nd degree relatives (unless, aunts, cousins etc) can donate with permission from the State Authorization Committee. Unrelated persons, who have an emotional attachment with the patient can donate with similar permission from the State Authorization Committee. Registering for a deceased donor kidney (also called as a cadaver kidney) through your Nephrologist onto your state’s registration portal (Jeevandan in AP, Telangana, Jeevasarthkathe in Karnataka, TRANSTAN in Tamil Nadu etc) can help you get a kidney if you have no living donor to donate.
Typically, the wait for a deceased donor kidney is long, about 3 – 4 years, depending on the blood group in most states in India now. And there is no guarantee when a deceased donor kidney will become available. Patients could wait several years for a deceased donor kidney, during which time their health may decline. For this reason, we strongly advise patients to consider talking to family members, friends and others about living kidney donation. Patients who have a living kidney donor may be able to avoid dialysis or may spend less time on dialysis than if they had to wait for a deceased donor kidney. This has a number of health benefits for the transplant patient.
Not really. Its usually a normal diet that’s balanced for proteins, fats, carbohydrates and fats. Salt restriction if BP continues, diabetic diet if diabetic and certain targeted diets in rare conditions like if the potassium is high or phosphorus is low.
Yes! It will take time to regain strength and endurance after a transplant, but eventually you can resume normal activity. Walking and stair climbing are excellent exercises for maintaining muscle tone and strength. You should consider walking 5 to 10 minutes a day when you first arrive home following surgery and then slowly increase the time you walk each week to target 10 – 15 thousand steps every day. Do not begin strenuous exercises, such as contact sports, jogging, tennis and weightlifting, for at least two months after the operation. It is normal to tire easily so you should rest when tired.
Any healthy person over age 18 up to almost 65 or even more, who has a compatible HLA tissue typing may be considered as a possible donor. Most healthy individuals would be fit to donate. A person is deemed unfit to donate if they have major medical conditions like psychiatric, cardiac issues, cancers etc. The transplant team will decide on the fitness to donate.
The decision to donate a kidney is entirely voluntary and should not have any financial or commercial considerations. Potential donors undergo a thorough evaluation to determine their general health and condition of kidneys.
Most patients who donate a kidney qualify for laparoscopic donor nephrectomy, which uses minimally invasive procedures to remove the kidney. Surgeons insert a small scope connected to a video camera into the donor's abdomen. The kidney is detached using additional instruments inserted through very small holes. The kidney is removed through a 2 to 3-inch incision in the lower part of the abdomen. Patients typically experience less postoperative pain, and quicker recovery, without harming the function of the donor kidney. A donor starts walking on the day after surgery and is discharged home on the 3rd day after surgery.
Most living donors return to work about four weeks after surgery. If you have a job that requires little or no strenuous physical activity (like a desk job), you might be able to return to work in less than four weeks. If you have a more strenuous or physically demanding job (like farming or construction), it might take you longer than four weeks before you can return to work.
Living donors are normal people and do not require lifelong medications.
After recovery from surgery, donors can live a normal life without limitations on their activity.
Female donors will be able to have healthy pregnancies after donation. It is recommended that pregnancy be postponed for 1 year after donation.