Dialysis

There is still confusion among people about what dialysis is? Why is it needed and how does it work?

The main function of the kidneys is to separate the waste fluids, extra water and salt from blood and purify it. These wastages are sent to the bladder and from there, it passes through urine. This separation process is performed by the kidneys in order to avoid the collection of extra waste and fluids in the body, which harms the body severely. If kidneys stop the process of filtration then dialysis takes place.

There are different stages of functions performed by the Kidney. The fifth stage which is observed by the Nephrologists as Chronic Renal Failure stage 5, leads to the process of transplant and just two steps before which are the stage 3b (moderate to severe loss of kidney function) and stage 4 (Severe Loss of Kidney Function), these stages leads to dialysis. In case, kidneys slow down the process of filtering or stops working properly then it is called Chronic Kidney Disease or Chronic Renal Failure.

In the dialysis process the entire blood of the body is cleansed with the help of the mandated machine which is called a dialysis machine. This process helps in maintaining the electrolytes and fluids in the body. This process is also referred to as Renal Replacement Therapy.

 

When do Nephrologists prescribe Dialysis?

So to know the actual working condition of the kidneys, doctors perform a test. The primary test which Nephrologists perform is the Estimated Glomerular filtration Rate. This test is to determine the actual functioning of the kidney. Doctors calculate the process with the blood creatinine test, age and the gender. The eGFR test helps nephrologists to plan the treatment accordingly and to know the whole functioning of the kidney.




  • How eGFR is examined and What are the Stages of Chronic Kidney Diseases (CKD)?

There are 5 stages in Kidney Disease.

Stage 1: Kidney Damage with Normal Kidney Function shows GFR 90 or higher, which means the kidney is working ‘between’ 100% to 90%

Stage 2: Kidney Damage to Mild Loss of Kidney Function shows GFR 89-60, which means kidney is working ‘between’ 89% to 60%

Stage 3a: shows Mild to Moderate loss of kidney function. In this stage GFR shows 59-45. This means the kidney is working 59% to 45%.

Stage 3b: Moderate to severe loss of kidney function. The GFR shows 44-30. Means kidney is 44% to 30% in working condition.

Stage 4: This shows severe loss of kidney function. The GFR shows a critical result 29-10. Means Kidney is 29% to 10% in working condition.

Stage 5: Kidney Failure. The GFR often shows less than 15, meaning less than 15% working.

Conclusion of this report: The GFR defines the working of the kidney. The worst condition of the kidney shows low numbers of GFR. The GFR numbers also depend upon the age of the patient.

 

When is dialysis required? 

When the body of the patient develops End Stage Kidney Failure which means the functioning loss reaches 80% to 90% then dialysis is required. This functioning stage is determined in the eGFR test.

 

Different Types of Dialysis

There are two types of dialysis in Medical world.

Hemodialysis and Peritoneal Dialysis

Hemodialysis

Hemodialysis is considered as the most common form of dialysis. In this process, an artificial kidney is used by the surgeon to remove waste and extra fluids from the blood with the help of the dialysis machine. The blood of the body is extracted and cleansed through a machine and then filtered blood returned to the body.

Preceding the process, Nephrologists create a vascular entrance point in the blood vessel of the patient’s body in order to make the flow of the blood.

Surgeons use to make three types of entrance points;

  1. Arteriovenous Fistula: The most preferred way of the surgeons are said to be AV Fistula. This connects the artery and the vein.
  2. Vascular Access Catheter  &
  3. AV Graft.

At dialysis centers, this process lasts for four hours and has to be performed at least three times in a week. This is the only process, which may be allowed by the Nephrologists to be performed at home by the family members, but the time frame set by the surgeons has to be adhered to at any cost and should be exceeded.

 

Peritoneal Dialysis

This process is a bit technical and has to be performed while the patient is asleep. Many surgeons perform the process while the patient is awake, but they have to be very cautious. In this process, a PD catheter is implanted in the inside lining of the abdomen of the patient’s body and there is no need for the machine. Using the 

The Catheter filters the blood of the body through the peritoneum, which is a membrane inside the abdomen. As it has found that the peritoneum contains hundreds of minute blood vessels and makes it a necessary filtering device. 

This process usually takes 40 minutes in one session and surgeons often prescribe this process 4 times a day and have to be adhered to properly. This process could not be performed at home, as it has to be under the guidance of the surgeons.

There are various types of peritoneal dialysis which are being performed by the surgeons. Some of them are as follows;

  1. Continuous ambulatory peritoneal dialysis 
  2. Continuous Cycling Peritoneal Dialysis  & 
  3. Intermittent Peritoneal Dialysis

 

Side effects of the Dialysis

There are several side effects of dialysis. Many patients’ complaints about itchy skin, low blood pressure, muscle cramping, difficulties in sleep, fluctuating potassium level while some patients’ complaints about the irregular heartbeat. Bloodstream infection. Those underlying long term dialysis may also receive severe heart problems, but all these can be tried to be treated with medicines and other approved medical processes. However some of the cases have reported death in case a patient is prescribed for the kidney transplant and does not agree or the families members of the patient do not agree. This situation occurs very rarely.