Dialysis
Dialysis is a form of renal replacement therapy,
typically started when approximately 90% of the kidney function is lost.
The decision of when to start dialysis depends on the discussion between
the nephrologist, patient and the patient’s family. The Nephrologist decides the need
for starting dialysis based on kidney function tests, overall health, nutritional
status, symptoms, quality of life, and personal preferences. Dialysis should begin
well before kidney disease has advanced to the point where life-threatening
complications can occur.
Dialysis
There are two modalities of dialysis- hemodialysis
and peritoneal dialysis. The choice between both of them is influenced by availability,
convenience, underlying medical problems, home situation, and age. This choice is best
made by discussing the risks and benefits of each type of dialysis with the treating
nephrologist.
Peritoneal Dialysis In this type
of dialysis, the lining of the abdominal cavity (peritoneal membrane) is used for
dialysis. A soft catheter is placed into the abdominal cavity which is used to
instil the fresh dialysate fluid and remove the effluent after dialysis is done.
Dialysis solution containing dextrose and other electrolytes flows from a bag through
the catheter into the abdominal cavity. When the bag is empty, the patient or attendant
disconnects it. Then the patient can move around and can do his normal activities.
The dialysis solution absorbs wastes and extra fluid from the body.
There are two types of peritoneal dialysis
a. Continuous Ambulatory
Peritoneal Dialysis: CAPD is done manually by the patient or his family members
or a nursing staff. It usually includes 2 morning
dwells of 6hrs each and a night dwell of 12hrs.
b. Automated Peritoneal
Dialysis: It is carried out by an automated cycler and is mainly done by connecting
the patient to the cycler at night during sleep. APD cycle lasts 10- 12hrs.
Maintenance Haemodialysis
Hemodialysis is a procedure where a dialysis
machine and a special filter called dialyzer, are used to clean the patient’s blood.
Hemodialysis needs a vascular access which is the lifeline for dialysis patients. This
access is a way for the dialyser to access the blood and filter it and return filtered
blood to the body. It is usually done on an outpatient basis where the patient walks
into the hospital, completes his/her session and goes home. Each session lasts about
four hours and is usually done 2-3 times a week.