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Dialysis: What Are The Common Types?

[fa icon="calendar"] Sep 1, 2020 10:00:00 AM / by Calvin Leong

 

 

Dialysis Blog

 

In Malaysia, it is expected that 50,000 people will require dialysis in 2020. Dialysis is a procedure that is done when the kidneys have stopped working properly (kidney failure). It may also be done earlier if it may help improve symptoms. During dialysis, wastes, salt, and extra water are removed from the blood, and the levels of certain minerals in the blood are maintained.

Dialysis is done in sessions which are continued until the kidneys get better. If the kidneys cannot get better, such as in end-stage kidney disease, dialysis is continued for life or until you receive a new kidney from a donor (kidney transplant). There are two types of dialysis: hemodialysis and peritoneal dialysis.

What is hemodialysis?

Hemodialysis is when a machine called a dialyzer is used to filter the blood. Before starting hemodialysis, you will go through surgery to create a site where blood can be removed from the body and returned to the body (vascular access). There are three types of vascular accesses:

  • Arteriovenous fistula. This type of access is created when an artery and a vein (usually in the arm) are connected during surgery. The arteriovenous fistula usually takes one to six months to develop after surgery. It may last longer than the other types of vascular accesses and is less likely to become infected or cause blood clots.
  • Arteriovenous graft. This type of access is created when an artery and a vein in the arm are connected during surgery with a tube. An arteriovenous graft can usually be used within two to three weeks of surgery.
  • A venous catheter. To create this type of access, a thin tube (catheter) is placed in a large vein in your neck, chest, or groin. A venous catheter can be used right away. It is usually used as a temporary access when dialysis needs to begin immediately.

During hemodialysis, blood leaves your body through your access site. It travels through a tube to the dialyzer, where it is filtered. The blood then returns to your body through another tube.

Hemodialysis is usually done at a hospital or dialysis centre three times a week. Visits last about three to five hours. With special training, it may also be done at home with the help of another person.

Kidney Disease - Printed Diagnosis with Red Pills, Injections and Syringe. Medical Concept with Selective Focus.-1

What is peritoneal dialysis?

Peritoneal dialysis is when the thin lining of the abdomen (peritoneum) and a fluid called dialysate are used to filter the blood. Before starting peritoneal dialysis, you will go through surgery to place a catheter in your abdomen. The catheter will be used to transfer dialysate to and from your abdomen.

At the start of a dialysis session, your abdomen is filled with dialysate. During the session, wastes, salt, and extra water in the blood pass through the peritoneum and into the dialysate. The dialysate is drained from the body at the end of the session. The process of filling and draining the dialysate is called an exchange. Exchanges are repeated until you have used up all the dialysate for the day.

You may do peritoneal dialysis at home or at almost any other location. It is done every day. You may need up to five exchanges a day. Each exchange takes about 30–40 minutes. The amount of time the dialysate is in your body between exchanges is called a dwell. The dwell usually lasts one and a half to three hours and can vary with each person. You may choose to do exchanges at night while you sleep, using a machine called a cycler.

Which type of dialysis should I choose?

Both types of dialysis have advantages and disadvantages. Speak with your healthcare provider about which type of dialysis is best for you. Your lifestyle, preferences, and medical condition should be considered. In some cases, only one type of dialysis can be chosen.

Advantages of hemodialysis

  • It is done less often than peritoneal dialysis.
  • Someone else can do the dialysis for you.
  • If you go to a dialysis centre:
    • Your health care provider can recognise any problems you may be having.
    • You can interact with others who are having dialysis. This can provide you with emotional support.

Disadvantages of hemodialysis

  • Hemodialysis may cause cramps and low blood pressure. It may leave you feeling tired on the days you have the treatment.
  • If you go to a dialysis centre, you will need to make weekly appointments and work around the centre’s schedule.
  • You will need to take extra care when traveling. If you usually get treatment in a dialysis centre, you will need to arrange to visit a dialysis centre near your destination. If you are having treatments at home, you will need to take the dialyzer with you when traveling.
  • There are more eating restrictions than with peritoneal dialysis.

Advantages of peritoneal dialysis

  • It is less likely than hemodialysis to cause cramps and low blood pressure.
  • There are fewer diet restrictions than with hemodialysis.
  • You may do exchanges on your own wherever you are, including when you travel.

Disadvantages of peritoneal dialysis

  • It is done more often than hemodialysis.
  • Doing peritoneal dialysis requires you to have a good use of your hands. You must also be able to lift bags.
  • You must learn how to make your equipment free of germs (sterilisation techniques). You will need to use these techniques every day to prevent infection.

Healthy food composition with tablet-1

What changes will I need to make to my diet during dialysis?

Both types of dialysis require you to make some changes to your diet. For example, you will need to limit your intake of foods that contain a lot of phosphorus and potassium. You will also need to limit your fluid intake. A diet and nutrition specialist (dietitian) can help you make a meal plan that can help improve your dialysis and your health.

What should I expect when starting dialysis?

Adjusting to the dialysis treatment, schedule, and diet can take some time. You may need to stop working and may not be able to do some of your normal activities. You may feel anxious or depressed when starting dialysis. Over time, many people feel better overall because of dialysis. You may be able to return to work after making some changes, such as reducing work intensity.

Group of Muslim women working

Summary

  • During dialysis, wastes, salt, and extra water are removed from the blood, and the levels of certain minerals in the blood are maintained. There are two types of dialysis: hemodialysis and peritoneal dialysis.
  • Hemodialysis is when a machine called a dialyzer is used to filter the blood.
  • Hemodialysis is usually done by a health care provider at a hospital or dialysis center three times a week.
  • Peritoneal dialysis is when the peritoneum is used as a filter. You may do peritoneal dialysis at home or at almost any other location.
  • Both types of dialysis have advantages and disadvantages. Talk with your healthcare provider about which type of dialysis is best for you.

This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.

 

References:

Butler CR, Mehrotra R, Tonelli MR, et. al.: The evolving ethics of dialysis in the United States: a principlist bioethics approach. Clin J Am Soc Nephrol 2016; 11: pp. 704-709.

Chen Z.: Good news for end stage renal disease patients. Chin Med J (Engl) 2013; 126: pp. 4203.

Nguyen DB, Shugart A, Lines C, Shah AB, Edwards J, Pollock D, et. al.: National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014.Clin J Am Soc Nephrol 2017; 12: pp. 1139-1146.

 Wong H.S.Goh B.L.23rd Report of the Malaysian Dialysis & Transplant 2015.2017.Kuala Lumpur

 

For more information on kidney health and dialysis, visit:

National Kidney Foundation - Malaysia

Ministry of Health Malaysia – Peritoneal Dialysis

Social Security Organisation (SOCSO / PERKESO) Dialysis Centres

 

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Topics: Wellness

Calvin Leong

Written by Calvin Leong

Calvin Leong holds a Master in Medical Education from the University of Dundee, United Kingdom. He is certified in Clinical Wound Care by the ASEAN Wound Care Association. Calvin has 20 years of clinical and lecturing experience focusing on Mentoring in Healthcare, Traumatology and Medical Sciences. Calvin is HRDC certified trainer. He is also a Life Member of The Malaysian Association for the Study of Pain (MASP) and the Malaysian Society of Wound Care Professionals (MSWCP).

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