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Dialysis

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Kidney dialysis is a medical procedure that is a substitute for many of the normal functions of the kidneys. With the increasing rate of kidney failure each year (about 5-6%), many patients now rely on Kidney dialysis. By the year 2020, it is said that 700,000 people in the United States will suffer from renal failure, also known as Kidney failure. Medical advances however have allowed patients to live a normal and healthy life.

There are two types of dialysis: hemodialysis and peritoneal Dialysis. Both forms of dialysis clean the blood and benefit the patient. Hemodialysis involves a dialysis machine, that takes the blood out of the body and filters it through the machine. This treatment takes 2-4 hours, 3 or 4 times a week. Peritoneal Dialysis uses the body to filter out the blood. In the peritoneal cavity, located in the abdominal area, blood is filtered through the membrane by the means of osmosis. Dialysis solution dwells in the Peritoneal cavity, and then osmosis is used to attract and collect the toxins. The fluid containing all the toxins are then drained. This type of treatment occurs everyday, all day. Although the two types of dialysis may differ in some ways, they both allow the patient to function normally until they are able to receive a kidney transplant.

Purpose

Kidneys

Dialysis is required once a person's kidneys no longer function properly. The kidneys perform many essential functions for the body. They are found below the rib cage, and the two are separated by the spine. Everyday, the kidneys filter 120 to 150 quarts of blood to produce 1 to 2 quarts of urine, which is made up of wastes and excess fluid. The kidneys also make hormones that keeps our bones strong, regulate blood pressure, and make red blood cells. They also keep levels of electrolytes stable, such as phosphate, sodium, and potassium. They play a vital role in preventing the buildup of wastes and excess fluid in the body. [1]


Once a person has only 10% to 15% of kidney function left, it means that it is time to start dialysis. Other symptoms people may have before undergoing dialysis, is nausea, swelling, vomiting, and fatigue. There is a high level of waste in the blood, because the kidneys no longer are able to filter it. This amount of waste not being removed from the body can be very toxic. Dialysis is needed to clean the blood and supply the person with the right nutrients. [2]

Hemodialysis

Hemodialysis machine

Hemodialysis treatment requires the use of a dialysis machine. Many patients will have their treatments done at a special unit in the hospital, at a kidney/dialysis center, or possibly at home. This type of dialysis is done three times a week, with each session lasting two to four hours. [3]

Hemodialysis performs the same functions that your kidney would normally do. During hemodialysis, the blood will travel through the tubes from your body into the dialysis machine. The blood inside the machine flows through a filter called a dialyzer, that removes extra fluid and waste. After the blood is filtered and clean, it travels through the tubes from the dialysis machine back into your body[4].

There are different types of access for hemodialysis:

Fistula. A fistula is made by connecting an artery to a vein in your lower arm. A fistula allows repeated access for each dialysis session. It can take several months for the fistula to form. A fistula may not clot as easily as other dialysis access methods. A fistula is the most effective dialysis access and the most durable. Some problems with this is infection at the area of the fistula, and clot formation.[5]

Man undergoing hemodialysis

Graft. If the patient has small veins, a vascular access that uses a synthetic tube is implanted under the skin in your arm. The tube becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft does not need to develop as a fistula does, so a graft can sometimes be used as soon as 1 week after placement. A polytetrafluoroethylene graft is the most common type used for hemodialysis.[5]


Venous catheter. A tube, or catheter, may be used temporarily if you have not had time to get a permanent access. The catheter is usually placed in a vein in the neck, chest, or groin. Because it can clog and become infected, this type of catheter is not regularly used for permanent access. But if hemodialysis is immediately needed, this catheter can be used until a permanent one is ready. [5]

Hemodialysis is required when a patient has: Signs of uremic syndrome, such as nausea, vomiting, loss of appetite, and fatigue. High levels of potassium in the blood. Signs of the kidneys' inability to rid the body of daily excess fluid intake, such as swelling. High levels of acid in the blood. Inflammation of the sac that surrounds the heart.[5]

Risks of Hemodialysis: During the hemodialysis treatments, patients may experience low blood pressure, muscle cramps, itching, sleep problems, high blood pressure, access cite complications, and mood swings such as depression[6].

Dietary restrictions: Each patient must consult with their doctor and dietitian when undergoing hemodialysis, but most patients generally should consume less high salt, high phosphorous, and high potassium foods. They also are advised to eat more high protein foods, and to watch their fluid intake. Controlling sodium in food can help regulate their blood pressure and help reduce weight gain during dialysis treatments [7].

Peritoneal Dialysis

Process of Peritoneal Dialysis

peritoneal dialysis is a home treatment. This continuous treatment is 24 hours a day, seven days a week. This dialysis helps clean waste from the blood, and removes excess fluid. Peritoneal dialysis, also called PD, takes place in the peritoneal cavity in the body. The peritoneal cavity is the continuous area between the parietal peritoneum lining the abdominal wall and the visceral peritoneum surrounding the abdominal organs. It does not contain organs, but instead contains a thin film of peritoneal fluid. [8] The things necessary to do peritoneal dialysis are a semipermeable membrane, a blood supply, and artificial access in the body, and a dialysis solution.

Semipermeable membrane: This covers and supports the internal organs in the peritoneal cavity. It contains tiny holes that allow water and particles to pass through. The membrane is about the same surface area as the skin, and this living tissue has a rich blood supply.[9]

Blood supply: The blood supply comes from capillaries in the membrane. This supplies the blood for dialysis. The peritoneal membrane contains millions of blood vessels. [9]

Artificial access: The artificial access is the peritoneal dialysis catheter. The catheter must be surgically placed 3-4 weeks before it is used for dialysis. The width of it can be similarly compared to a pencil. It extends several inches outside of the abdomen, and it is placed below and to the side of the belly button. [9]

Peritoneal Dialysis fluid

Dialysis solution: Also called peritoneal dialysate, this sterile liquid creates the cleaning and fluid removing actions of dialysis. It is made of a sugar base that attracts the toxins and waste from the blood through osmosis. [9]

All of these element of peritoneal dialysis collaborate perfectly with one another. The peritoneal cavity provides a space for the dialysis to take place. This cavity functions as the “artificial kidney”. The catheter is used to get the dialysis solution into the body.[9]

There are two kinds of peritoneal dialysis: Continuous Ambulatory Peritoneal Dialysis (C.A.P.D) and Continuous Cycling Peritoneal Dialysis (C.C.P.D).

Continuous Ambulatory Peritoneal Dialysis (C.A.P.D): Most patients with renal failure start with this peritoneal dialysis method, because it is the most portable. They have an exchange, with is each fluid change, every 4-6 hours. Each exchange usually takes 30-40 minutes. A patient will have 4-5 exchanges every day, and overnight exchange remains in the peritoneal cavity for up to 9 hours.

C.A.P.D is performed as a series of drain, fill and dwell. This system includes a fresh bag of solution, and empty bag to drain in to and sterile tubing to attach to the catheter. [10]

Continuous Cycling Peritoneal Dialysis (C.C.P.D): Most of the treatment occurs overnight with 1 or 2 daytime exchanges (fluid changes). This type of treatment is well-suited for the working person.

This dialysis has a cycler, and this cycler has many functions: It warms the solution (peritoneal dialysate), measures the solutions going in and coming out of the belly, drains the solution from the body, fills the peritoneal cavity with a fresh solution, repeats the cycle, and has an alarm whenever a task cannot be completed. [3] C.C.P.D allows the patient freedom from having to do multiple exchanges (Dialysate changes). Everything is prepared before the person has to go to sleep, and when they sleep the catheter is attached to the cycler tubing.[9]

Many patients prefer Peritoneal Dialysis over Hemodialysis for many reasons: It is a home therapy, the patient only has to visit dialysis clinics monthly instead of weekly, they can perform the dialysis independently, it’s less stress on the body, no dialysis needles, and it is portable and easy to travel with.[9]

However there are some disadvantages with Peritoneal Dialysis: The catheter and fluid in the belly can change the patient’s body image and weight, it requires a daily schedule, and it requires storage for all of the supplies. Also the risk of inflammation around the areas of the catheter, and infections like peritonitis.[9]

Peritoneal Dialysis is also required when a patient has: to preserve residual kidney function, hemodialysis access failure, hemodialysis complications, congestive heart failure, and a transplant expected in 6 months.[9]

Dialysis video

Describes the differences of Peritoneal Dialysis and Hemodialysis

References

  1. . Your Kidneys and How They Work What are the kidneys and what do they do? National institute of Diabetes and Digestive and Kidney Disease. Web. Last accessed October 5, 2017. Unknown author.
  2. . Hemodialysis National Kidney Foundation. Web. Last accessed on October 5, 2017. Unknown author.
  3. 3.0 3.1 Dialysis Medicinenet. Web. Last reviewed November 12, 2015. Unknown author.
  4. Hemodialysis American Kidney Fund. Web. Last accessed October 11, 2017. unknown author.
  5. 5.0 5.1 5.2 5.3 Hemodialysis WebMD. Web. Last accessed October 11, 2017. Unknown Author.
  6. Risks Mayo clinic. Web. Last accessed October 15, 2017. Unknown author.
  7. Dietary Guidelines for Adults Starting on Hemodialysis National Kidney Foundation. Web. Last accessed October 15, 2017. Unknown author.
  8. peritoneal cavity Kenhub. Web. Last accessed October 8, 2017
  9. 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 Hipolito, Redentor A. “Kidney Dialysis.” Peritoneal Dialysis . 5 Oct. 2017, Lynnwood.
  10. Peritoneal Dialysis National Institute of Diabetes and Diabetes and Kidney Diseases. Web. Last accessed October 7, 2017. unknown author.