Hemodialysis
Hemodialysis is a life-saving medical treatment for patients with end-stage kidney disease (ESKD) or acute kidney injury (AKI). It involves using a dialysis machine to remove waste products and excess fluid from the blood when the kidneys are no longer able to perform these functions adequately.
Indications
Hemodialysis is indicated in cases of:
- End-Stage Kidney Disease (ESKD): When kidney function declines to less than 10-15% of normal.
- Acute Kidney Injury (AKI): Temporary loss of kidney function due to severe infection, injury, or other conditions.
- Fluid Overload: Inability of the kidneys to regulate fluid balance, leading to swelling and difficulty breathing.
Procedure
During hemodialysis:
- Vascular Access: A vascular access site (arteriovenous fistula, graft, or central venous catheter) is used to connect the patient’s bloodstream to the dialysis machine.
- Blood Pumping: Blood is pumped from the patient’s body through the dialysis machine’s filter (dialyzer), which acts as an artificial kidney.
- Filtration: Inside the dialyzer, blood flows through tiny tubes surrounded by a fluid called dialysate. Waste products and excess fluid pass from the blood into the dialysate.
- Return: The clean blood is then returned to the patient’s bloodstream.
Types of Hemodialysis
Conventional Hemodialysis:
- Typically performed in a dialysis center three times per week, with each session lasting around 3-4 hours.
- Provides regular clearance of waste products and excess fluid from the blood.
Daily Hemodialysis:
- More frequent sessions (5-6 times per week) with shorter durations (2-3 hours).
- May improve outcomes and quality of life for some patients by providing more consistent control of fluid and electrolyte balance.
Complications
- Hypotension: Low blood pressure during or after dialysis sessions.
- Muscle Cramps: Due to fluid and electrolyte shifts.
- Infection: Risk of infections related to vascular access sites.
- Electrolyte Imbalances: Monitoring and adjustments are necessary to maintain electrolyte balance.
Patient Education
Dr. Tanish Dhir emphasizes the importance of patient education in hemodialysis:
- Diet and Fluid Restrictions: Following a kidney-friendly diet and managing fluid intake to prevent complications.
- Medication Adherence: Taking prescribed medications, including phosphate binders and erythropoiesis-stimulating agents.
- Vascular Access Care: Proper care of vascular access sites to prevent infections and ensure longevity.
