Understanding your hemodialysis options

Dr. Keshav Das Sadhwani, MBBS, MD (Medicine), DNB (Nephrology), Consultant (Nephrology), 35 Years in Nephrology Speciality, Manipal Hospital, Ghaziabad

Published: Dec 15, 2022 01:11:20 PM IST
Updated: Dec 15, 2022 01:33:57 PM IST

Understanding your hemodialysis optionsHemodialysis is a treatment to filter waste products and fluid from the kidneys. When the kidneys are nearly 90% failed and become unable to perform their normal functions, waste material starts to collect in the blood. Dialysis takes over a small part of damaged kidneys to filter excess water and waste products.

Hemodialysis maintains blood pressure and retains the balanced amount of minerals like sodium, calcium, and potassium in the blood. In this process blood filters through the dialyzer outside the body.

Before hemodialysis, access is made in the patient's body near the artery or vein for the dialyzer. This insertion helps in reaching the machine to the blood which process clean blood to the body and returns impure blood through a separate pipe.

The three access options for dialysis are catheter, fistula, and graft. Fistula takes 1-4 weeks for formation after an artery and veins are joined making the vein strong and suitable for insertion. Graft heals in 3-6 weeks after an artery and vein are joined by the doctor through an artificial tube called a graft. A catheter is a temporary option used until fistula or graft forms. It is attached in the veins of the chest, neck or upper leg.

Primarily dialysis is performed in the clinic to keep the patient under medical supervision. After the doctor's approval other options can be considered. The options available for hemodialysis are:
•    Conventional hemodialysis
    –  Home hemodialysis
    –  In-center hemodialysis
•    Short daily home hemodialysis
•    In center nocturnal dialysis

In-center Conventional Dialysis

In-center hemodialysis
•    In the case of in-center hemodialysis the patient goes to the hospital for hemodialysis. The majority of ESRD patients get treated with in-center hemodialysis. This treatment is administered by the medical professional only three times a week.
•    Patients are free to interact with other patients who are facing the same problem and undergoing similar treatment therapy.
•    Professional technicians handle the complete procedure including a doctor, nurses, dialysis technicians, etc. They supervise the therapy and maintain cleanliness by cleaning the area and equipment after use.

Home hemodialysis

•    This procedure requires help from others as it is performed at home. A nurse guides the patient and his caregiver regarding the use of the dialyzing machine. The caregiver should be available all the time. This training takes place in the hospital during the time patient is admitted to the hospital and receiving treatment.
•    The treatment training lasts for 4-12 weeks and after the medical staff is convinced the patient can start preparation for home hemodialysis.
•    The patient should visit the doctor for follow-up for further procedure and treatment.

Short Daily Home Hemodialysis
•    In short daily home hemodialysis, patients have to undergo dialysis five to six days a week which makes the schedule very hectic.
•    Due to the frequency of dialysis, the time period for every session decreases. The symptoms are seen after and during the treatment decrease with time in short daily home hemodialysis. The duration of treatment is decided by the attending doctor.

Nocturnal Hemodialysis
•    Nocturnal hemodialysis is performed when the patient sleeps. It can be performed either in the center three times a week or at home 5-7 times a week.
•    It provides very high doses for a long time period.
•    Patient may feel more enthusiastic and energetic because of improved appetite, increased stamina, reduced frequency of vomit.

Hemodialysis is a process of filtering waste material and excess fluid from the blood. It is used when the patient’s kidneys become unable to perform their normal function. A dialyzing machine is used for this procedure which needs access in the body for the procedure i. e, fistula, graft, and catheter. Modern dialysis options include in-center conventional hemodialysis (in-center, home dialysis), short daily home nebulization, and nocturnal hemodialysis. The methods work in separate ways and have different advantages as well as disadvantages. Patients with chronic kidney diseases get relief and increased quality of life with these hemodialysis options.

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