Dialysis is a method of cleaning the blood by removing waste products called uremic toxins and excess water from the blood instead of the weakened kidneys.
Dialysis treatments are of two types:
- Hemodialysis (HD)
- Peritonealdialysis (PD)
Why needs Dialysis?
When chronic renal failure progresses and renal function drops to less than 15% of normal, end-stage renal failure cannot purify blood in one’s kidneys, and waste products accumulate in the body, resulting in loss of appetite and nausea. Symptoms of uremia such as headache, dullness, and swelling appear. Besides, abnormal water and electrolytes may cause arrhythmia, heart failure, pulmonary edema, etc., resulting in respiratory distress. If left untreated, it can be life-threatening, so renal replacement therapy such as dialysis therapy or kidney transplantation is required at the stage of end-stage renal disease.
Your daily life can be almost the same as before with proper dialysis. However, dialysis therapy does not improve the kidney itself. It is difficult to recover the once-decreased renal function so that dialysis will become a part of life.
How does Hemodialysis work?
Hemodialysis removes waste products and excess water accumulated in the body by inserting a needle into a blood vessel in the arm. They are removing blood from the body using a pump and pass it through a Hemodialysis machine called a dialyzer. Blood purified by the dialyzer returns to the body.
In general, Hemodialysis is performed once for 4 hours, three times a week. You may find it a heavy burden to be tied up for that amount of time. But our kidneys work every day without a break. If you convert the work into a week, it will be 168 hours in 24 hours x 7 days, but since dialysis can supplement about 12 hours a week, it is still insufficient to replace the original function of the kidney. It is desirable to take sufficient time for dialysis to prevent further complications.
Since overnight dialysis is performed while sleeping in the middle of the night, long-term dialysis can be performed comfortably. Compared to conventional dialysis, the activity time during the day is increased, so it is possible to balance work, housework, and schoolwork.
In recent years, “online HDF (hemofiltration)” has appeared as one of the new blood purification methods. Online HDF is a treatment method that combines conventional Hemodialysis (HD) with blood filtration (HF). It is said that applying a lot of filtration stabilizes blood pressure during dialysis and prevents various complications. If the patient’s blood pressure is unstable during dialysis, we use online HDF.
Reasons a “shunt” is necessary for Hemodialysis
It is necessary to continuously take out a large amount of blood from the body and circulate it to perform Hemodialysis. Shunt (vascular access) connects veins and arteries to form a single large blood vessel, making it easier to remove blood. Shunting requires surgery, which usually connects the veins and arteries near the wrist opposite the dominant arm.
Shunts include internal shunts that connect veins and arteries under the skin and external shunts that connect extracorporeally. But external shunts are rarely used today due to the high risk of infection. If it is challenging to create an internal shunt using your blood vessel, you may need to add an artificial shunt using an artificial blood vessel.
How does Peritoneal dialysis work?
Peritoneal dialysis is a method of purifying blood by placing dialysate in the abdomen. When dialysate is left in the abdomen for a certain period, waste products and unnecessary water in the blood are transferred to the dialysate through the small blood vessels of the peritoneum. Blood is purified by draining the dialysate out of the body. For Peritoneal dialysis, surgery is required to insert a catheter tube into the abdomen.
Peritoneal dialysis takes time every day to perform. It has the advantage of reducing the burden on the body and maintaining the remaining renal function for a long time compared to Hemodialysis. Also, as long as the kidneys function, dietary restrictions are relatively loose. It takes time and effort to change the dialysate on your own every day. The procedure is not too complicated, and with repeated practice, most people will be able to do it without difficulty. The key is to keep the part of the catheter out of the skin clean and prevent infections.
Often, Peritoneal dialysis cannot be continued for a lifetime, and it is generally said that treatment can be performed for about 5 to 8 years. Since there is a limit to the number of waste products and water that can be removed by Peritoneal dialysis, if the residual renal function deteriorates and the Peritoneal function deteriorates, it is necessary to switch to Hemodialysis or consider kidney transplantation.
Types of Peritonealdialysis
There are two types of Peritonealdialysis, “CAPD” and “APD.”
- CAPD (Continuous Carrying Peritoneal Dialysis)
Put dialysate in the abdomen, and when uremic toxins are transferred into the dialysate, discard the drainage and inject a new dialysate bag. The CAPD repeats this exchange four times a day every 4-8 hours. The replacement time for the dialysate bag is about 30 minutes each time. Since it does not use a large device, dialysis can be performed at home or work, and you can work freely except when changing the fluid. The patient, themselves, exchanges the liquid, but it can be adjusted according to the lifestyle.
- APD (Automated Peritoneal Dialysis)
Using an automatic Peritoneal perfusion device is a method to automatically change the dialysate while sleeping at night (cycler). Since dialysis is performed at night, you can effectively use the time during the day. You will set the machine before going to bed by yourself.
