Hemodialysis: Types & Procedure

 

Hemodialysis is a type of dialysis that maintains normal kidney function. It removes your blood, filters it in a machine, and then returns the filtered blood to your body.  Hemodialysis can be performed in a specific healthcare facility or at home.

You don't have to handle hemodialysis alone, but it is a significant burden. Your medical team, which includes a kidney specialist and other experts with hemodialysis management experience, may work closely with you. Hemodialysis may be something you do at home.

Also Read: Chronic Kidney Disease: Symptoms, Causes, Treatment & Prevention

What is hemodialysis?

Hemodialysis is a type of dialysis. If your kidneys are unable to function properly, dialysis can help by filtering your blood to remove waste products and excess fluids. Common waste products include urea, creatinine, and acids.

During hemodialysis, a machine extracts blood from your body, filters it through an artificial kidney (dialyzer), and returns the cleaned blood to your body.

How does hemodialysis work?

The dialyzer is a part of the hemodialysis machine that filters your blood. Your blood passes through small mesh tubes within the dialyzer's core. Waste products and excess fluids in your blood travel through the mesh tubes and into the dialysate. Dialysate is a fluid composed of water, salts, and electrolytes.
Your filtered blood returns to the body. The dialyzer subsequently disposes of the dialysate, which contains your blood's waste products and excess fluids.

Which two types of hemodialysis are there?

Hemodialysis comes in two primary types. What type of hemodialysis is best for you should be discussed with your healthcare provider.
The primary types of hemodialysis consist of:

Hemodialysis in-center: You visit a unique medical center that specializes in hemodialysis for this type of treatment. The process is carried out by a hemodialysis nurse or technician. The majority of people receive hemodialysis in-center at least three times a week. It takes three to four hours to finish each session.

Home Hemodialysis : You receive this type of hemodialysis at home.  Your medical professionals will teach you on how to administer hemodialysis and resolve frequent issues that may arise over a period of weeks or months.  After that, you carry out the process on your own schedule.

Home hemodialysis comes in three different types, including:

• Conventional home hemodialysis: Three times a week, you get this type of treatment. At least three to four hours are dedicated to each session.

• Short daily home hemodialysis: Shorter treatments are made possible by new technology used in short daily home hemodialysis. Five to seven days a week, you carry out the procedures. The duration of each session is approximately two hours.

• Home hemodialysis that occurs at night while you are asleep is known as nocturnal (overnight) hemodialysis. Four to six days a week, you carry out the procedure. The duration of each session ranges from six to eight hours. Because you spend more time on dialysis each week than with other types, this type of hemodialysis removes more waste from your blood.

Risk factors:

The majority of hemodialysis patients have several health issues. Although many people's lives are prolonged with hemodialysis, those who require it still have shorter life expectancies than the general population.
Even while hemodialysis can effectively restore some lost kidney function, you might encounter some of the following linked diseases, but not everyone will have all of these problems. You can handle them with the help of your dialysis team.

• Hypotension (Low blood pressure). One of the most frequent side effects of hemodialysis is lower blood pressure. Shortness of breath, cramping in the muscles and abdomen, nausea, and vomiting can all be signs of low blood pressure.

• Cramping in the muscles. Muscle cramps during hemodialysis are prevalent, but the cause is unknown. Sometimes the hemodialysis prescription might be changed to relieve the cramping. Treatment-related symptoms may also be prevented by adjusting sodium and fluid consumption between hemodialysis sessions.

• Itching. Many hemodialysis patients have skin irritation, which frequently gets worse during or shortly after the procedure.

• Issues sleep. Hemodialysis patients frequently experience difficulty falling asleep, possibly due to breathing pauses during sleep (sleep apnea) or painful, unpleasant, or restless legs.

• Anemia. Anemia (low red blood cell count) is a common side effect of hemodialysis and kidney failure. The hormone erythropoietin (uh-rith-roe-POI-uh-tin), which promotes the creation of red blood cells, is less produced when the kidneys fail. Anemia can also be caused by restricted diets, poor iron absorption, frequent blood testing, or hemodialysis, which removes iron and vitamins.

• Disorders of the bones. Your bones may deteriorate if your damaged kidneys are unable to produce vitamin D, which aids in the absorption of calcium. Additionally, excessive parathyroid hormone production, a frequent side effect of kidney failure, might cause your bones to lose calcium. Because hemodialysis removes too much or too little calcium, it may exacerbate these diseases.

• Hypertension (high blood pressure). Your high blood pressure is likely to worsen and result in heart issues or strokes if you eat too much salt or drink too much water.

• Excess of fluid. Drinking more fluids than is advised in between hemodialysis treatments might result in potentially life-threatening issues heart failure or fluid buildup in your lungs (pulmonary edema), as hemodialysis removes fluid from your body.

• Pericarditis is an inflammation of the membrane that surrounds the heart. Your heart's capacity to pump blood to the rest of your body may be hampered by inflammation of the membrane around your heart caused by inadequate hemodialysis.

• Potassium levels can be either low (hypokalemia) or high (hyperkalemia). Potassium is a mineral that your kidneys normally remove from your body; hemodialysis removes excess potassium. Your heart may stop beating or beat irregularly if dialysis removes too much or too little potassium.

• Issues with the access site. The quality of your hemodialysis may be impacted by potentially dangerous consequences like infection, obstruction, or aneurysms, which are narrowing or bulging of the blood vessel wall. As instructed by your dialysis team, look for any changes in your access site that might point to an issue.

• Amyloidosis. Amyloidosis associated with dialysis (am-uh-loi-DO-sis) occurs when blood proteins accumulate in tendons and joints, resulting in joint pain, stiffness, and effusion. Those who have received hemodialysis for several years are more likely to have the disorder.

• Depression. People with kidney failure frequently experience mood swings. Discuss effective therapy options with your medical team if you feel anxiety or depression after starting hemodialysis.

Treatment:

What happens before hemodialysis?
Your first hemodialysis session requires weeks or perhaps months of preparation.
Your healthcare provider will brief you on how to carry out hemodialysis correctly and go over potential issues if you can conduct it at home.
To make it easier to access your bloodstream, you will first have some minor surgery. There are two possible procedures for you:

• An artery and vein in your arm are joined by your surgeon in an arteriovenous fistula (AV fistula).
•  Arteriovenous graft (AV graft): Your surgeon will use a soft, hollow tube (graft) to unite your arm's vein and artery if they are too short to do so.
•  During hemodialysis, these methods facilitate simpler access to the artery-vein link.  Additionally, they help faster blood flow into and out of your body.
•  You might need to begin hemodialysis right away in some situations.  A catheter may be temporarily inserted by your healthcare professional into a vein in your neck, chest, or leg.  A soft, hollow tube is called a catheter.  It is made of silicone, rubber, or another material suitable for medical use.

In order to avoid infections, your healthcare provider will also instruct you on how to clean your fistula or graft. Infection symptoms include:

• Tenderness and pain
• Swelling
• Discoloration (black, brown, pink, gray, or red)
• Fever

It's crucial to keep your fistula or graft and the surrounding area safe. The areas can be protected with the following advice:

• Refrain from dozing off in your access area.
• Steer clear of jewelry and clothing that could restrict your access.
• Don't cross your access with a purse or bag strap.
• Avoid having blood drawn from your accessible arm or taking your blood pressure.
• You might not be able to utilize your fistula or graft for hemodialysis if you accidentally damage it.

Does starting hemodialysis require me to alter my diet?

Your diet and beverages can have an impact on your mood and reduce the effectiveness of hemodialysis. Certain foods and beverages might cause your blood to contain a lot of waste, excess fluid, a high blood pressure, and a fast heartbeat.
A renal dietitian, a dietician who specializes in kidney diseases, will work with you to develop a hemodialysis diet before the creation of hemodialysis.
It is advisable to stay away from foods that are high in:

• Potassium: Eating a diet high in potassium might quicken your heartbeat. Foods high in potassium include avocados, bananas, and dry fruits.
• Phosphorus: Consuming too much phosphorus can cause skin irritation and brittle bones. Dairy products, poultry, turkey, hot dogs, and canned chili are a few foods high in phosphorus.
• Sodium: Consuming excessive amounts of sodium (salt) causes you to drink more water. Vegetable juice, sports drinks, fast food, and seasonings are a few examples of foods and beverages high in sodium.

What takes place while receiving hemodialysis?

Two needles will be inserted into your arm by your hemodialysis nurse or technician.
The gauge of the needles is either 15 or 16. A 15-gauge needle's outer diameter is roughly 1.8 millimeters (mm), which is almost 2.5 times bigger than a ballpoint pen's tip. A 16-gauge needle has a slightly smaller outer diameter of roughly 1.65 mm. Both needles are attached to the hemodialysis machine via soft tubing.
You can insert the needles yourself if you are receiving hemodialysis at home and have received the necessary training. One of the needles in your arm is used by the hemodialysis machine to removing blood. Your blood is subsequently circulated through the dialyzer's many mesh tubes. Excess waste and fluids are transferred into a dialysate solution by the dialyzer. Eventually, the second needle in your arm is used by the hemodialysis machine to return your filtered blood to your body. Your hemodialysis machine continuously checks your blood pressure during the session. It might change how quickly blood enters and exits your body.

What happens after hemodialysis?

The needles will be taken out, and your access areas will be cleaned by you or your healthcare practitioner. You can carry on with your regular activities.
After routine hemodialysis sessions, many patients experience fatigue or illness. The duration of your symptoms could be many hours. On the other hand, some people claim that receiving hemodialysis more frequently gives them more energy. Which type of hemodialysis is best for you should be discussed with your healthcare practitioner.

What advantages does hemodialysis offer?

Hemodialysis's primary benefit is that it replaces your failing kidneys by clearing excess water and harmful waste from your blood. You will get uremia if you don't have hemodialysis. Without treatment, uremia is fatal.
Hemodialysis sessions often take place about three times a week, which is another benefit.
The time and location of your home dialysis treatments are up to you. Even overnight sessions are an option. You can keep up a more regular daily schedule with nocturnal home hemodialysis.

What complications might hemodialysis cause?

A fistula or graft may cause problems for certain individuals. These could consist of:

• Infection.
• Blockage-causing scar tissue.
• Clots of blood. Dialysis is not possible if the fistula or graft has blood clots. A minimally invasive treatment is typically able to remove the clot. Rarely, removing a blood clot may need an open surgical procedure.

Rarely, a tube from your hemodialysis machine may come loose, or the needles in your arm may come out. The device will notify you or your healthcare provider in these circumstances. After that, the machine turns off to prevent blood loss until the issue is resolved.

What side effects might hemodialysis cause?

Hemodialysis side effects include:

•  Hypotension (low blood pressure)
• Vomiting and nausea
•  Lightheadedness
•  Syncope (fainting)
•  Chest discomfort
•  Back discomfort
•  Headaches
•  Skin irritation (pruritus)
•  Cramping in the muscles
•  Syndrome of restless legs

How long is hemodialysis safe?

The typical life expectancy for hemodialysis patients is five to ten years.

On the other hand, some patients have received hemodialysis for up to 30 years without seeing significant improvements in their quality of life.

References:

• Hemodialysis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/genitourinary_disorders/renal_replacement_therapy/hemodialysis.html. Accessed April 25, 2021.

• American Kidney Fund. Home hemodialysis (https://www.kidneyfund.org/treatments/dialysis/home-hemodialysis). Accessed 11/30/2022.
• Hemodialysis. National Kidney Foundation. https://www.kidney.org/atoz/content/hemodialysis. Accessed April 25, 2021.

• National Institute of Diabetes and Digestive and Kidney Diseases. Kidney Disease Statistics for the United States (https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease). Accessed 11/30/2022.

• Berns JS. Patient information: Hemodialysis (beyond the basics). https://www.uptodate.com/contents/search. Accessed April 25, 2021.

• National Kidney Foundation. Hemodialysis (https://www.kidney.org/atoz/content/hemodialysis). Accessed 11/30/2022.

• Kidney disease: Causes. National Kidney Foundation. https://www.kidney.org/atoz/content/kidneydiscauses.cfm. Accessed April 25, 2021.

• Acute kidney injury (AKI). National Kidney Foundation. https://www.kidney.org/atoz/content/AcuteKidneyInjury. Accessed April 25, 2021.

• Office of Patient Education. Chronic kidney disease treatment options. Mayo Clinic; 2020. AskMayoExpert. Hemodialysis. Mayo Clinic; 2020.