Freelance Writing Jobs | Today's Articles | Sign In

Dialysis

The Treatment for Late and End-Stage Kidney Failure

May 31, 2007 Anthony Lee

Hemodialysis and peritoneal dialysis involves major lifestyle changes and other issues. Find out what is in store for those who need it.

Dialysis is the artificial means to clean blood in the body in those with late kidney failure. It comes in one of two common types: hemodialysis and peritoneal dialysis. The first thing to understand is that starting dialysis is a major life change. It involves adhering to a fixed schedule to keep the blood clean. Fortunately, this is a technology that has improved many lives, so there is some benefit attached.

Hemodialysis

Hemodialysis involves removing the blood, running it through a machine with capillary tubes, allowing the blood to exchange waste products and electrolytes with a fluid mixture called dialysate, and returning the cleansed blood to the body. This is generally done three days a week, usually on a Monday-Wednesday-Friday or Tuesday-Thursday-Saturday schedule. The patient would spend a few hours at a dialysis center on those days. If the patient happens to be hospitalized for whatever reason, arrangements can be made for regularly scheduled dialysis to be done while in the hospital.

In the early days, dialysis involved a needle in an artery for blood outflow and another needle in a vein for blood return. This had it problems because veins are fragile. Since then, new means for vascular access were developed. The most common type is an arteriovenous fistula or graft. A surgeon would connect the artery and vein together, either directly (fistula) or with an artificial vessel (graft), so that some blood would bypass the capillaries and go straight to the vein. With increased venous blood flow, the vein walls become thicker. Hemodialysis from this site can be done with little concern for easily traumatizing the vein. Plus, the flow rate is much faster and ideal for dialysis. AV fistulas take months to fully develop after the operation, but they last the longest. They have less of a chance for clotting or infection, which AV grafts are more prone to.

The patient may also have access with a catheter in a vein, like the internal jugular vein in the neck or the subclavian vein in the upper chest. The venous catheter is good if one gets an AV fistula or graft but need temporary access for dialysis until the permanent access is fully developed. It is also a long-term option for those with poor vasculature, although it is not the best.

Peritoneal Dialysis

Peritoneal dialysis works in a different way. Inside the belly, there is a membrane called the peritoneum that surrounds many of the inner abdominal organs. For this type of dialysis, a catheter is inserted through the peritoneum. When starting peritoneal dialysis, arrangements are made for materials and bags of dialysate to be sent to the patient. He or she pours the fluid into the abdominal cavity through the catheter and lets it settle. Over the course of a few hours, the fluid and the blood exchange waste products and electrolytes. Afterwards, the fluid is drained out. All of this can be done with or without the aid of a cycler that can do this automatically.

Unlike hemodialysis, one does not have to go to a center for this. However, peritoneal dialysis must be done several times a day on a daily basis to achieve comparable benefit with hemodialysis. As for complications, the most common is peritonitis, or infection of the peritoneum. The chances of this can be lowered with good hygiene.

Considerations

Hemodialysis and peritoneal dialysis have their own advantages and disadvantages. Which one the patient would have depends on several factors. Does the patient have the time and means to travel to a hemodialysis center? Is the patient willing to perform actions involved with peritoneal dialysis? One must also consider medical conditions that may be interfering. For example, peritoneal dialysis may not be best for someone with recent abdominal surgery. All of these considerations are discussed with a doctor, particularly the nephrologist, to determine what is best.

References

The copyright of the article Dialysis in General Medicine is owned by Anthony Lee. Permission to republish Dialysis in print or online must be granted by the author in writing.