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TREATMENT OPTIONS FOR RENAL DISEASE PATIENTS

HEMODIALYSIS

Hemodialysis removes body waste and extra fluid directly from the blood using an artificial kidney machine. A blood access is surgically created to allow entrance into your blood stream. The access is usually in the arm, but may be in the leg or in an area of the neck, temporarily.

Blood is pumped from your body through a special needle inserted into the blood access (Fistula needles). The blood travels to the machine and through the artificial kidney (dialyzer). When the blood goes through the dialyzer, there are thousands of membranes inside the artificial kidney that separated the blood from the dialysate (bi-carb solution used to clean the blood) .

The wastes and extra fluid are filtered out of the blood and drain away with the used dialysate. The filtered blood is returned to your body through a second needle placed in the same blood access. The treatment takes approximately 3.5 to 4.5 hours, three times per week, but treatment times and frequency vary from patient to patient.

REPORTED ADVANTAGES OF HIGH FLUX DIALYSIS

  • Fewer complications during treatment. The following benefits have also been reported by patients: better blood pressure control, more energy, a better appetite, being able to sleep better, decreased itching and nausea.
  • Biocompatible membrane. Some high flux dialyzers use a synthetic membrane that is thought to be more compatible with the blood than the membranes found in most conventional dialyzers.
  • Better clearance of middle molecules. This provides protection against a degenerative bone disease that can develop in patients who are on long-term dialysis. Other benefits of middle molecule clearance are not fully understood.

DISADVANTAGES OF HIGH FLUX DIALYSIS

  • Highly permeable membrane. The membranes in high flux dialyzers allow more substances, like bacteria and contaminants, to pass back and forth between the dialysate and blood. A reaction (chills, fever, and a general ill feeling) can occur when the water used in the high flux treatment has a high level of bacteria. Treatment and careful monitoring of the water can prevent these reactions.
  • High Cost. High flux dialysis machines and dialyzers are considerably more costly than conventional equipment. High flux dialyzers are reused because they cost 3 or 4 times more than conventional dialyzers. Those patients that do not reuse dialyzers are offered conventional dialysis.

BLOOD ACCESS FOR HEMODIALYSIS

In order to be treated with hemodialysis, you must have a blood access surgically created. This blood access needs to be large enough to allow blood to flow through needles, from your body through the dialyzer, and back to your body. There are several types of accesses.

The most common are fistulas and grafts: -

  • A fistula is created by connecting a vein and an artery under the skin. Once they are connected, more blood flows through the vein and the vein gets larger.
  • A graft is formed under the skin using a synthetic material to connect an artery and a vein. After the access is created, it is usually allowed time to "mature" or to become stronger and larger. If a new access is swollen, it may help to keep the arm or leg elevated. If there is redness, bleeding, excess swelling, pain, or fever, the surgeon or nephrologist should be called.

To protect a graft or fistula:

  • Do not wear anything tight that will put pressure on the access (elastic sleeve, watchband, or other jewelry).
  • Do not tape anything across or around the access.
  • Try not to sleep with the access under any part of your body.
  • Do not allow anyone to take a blood pressure on your access arm or take blood from your access arm.
  • Do not carry heavy objects on or over your access.

It is important to check your access regularly. Check it when you wake up, once or twice during the day, and at bedtime. You can place your fingers over the access and feel for a rushing of blood. This is called a "thrill". You can also use a stethoscope placed over the access to listen for a "bruit" or rushing noise. If you do not feel or hear the blood flow, your access may be clotted and unavailable for dialysis. You should call your doctor immediately so that the problem can be corrected.

After dialysis treatment, you should:

When dialysis treatment ends, the needles are pulled out of your access and pressure is applied to stop the bleeding. Once the bleeding stops, dressings are put over the needle puncture sites. If the sites begin to bleed again, you should:

  • Immediately apply pressure for at least 10-15 minutes, using a gauze pad, before you check to see if the bleeding has stopped.
  • If the bleeding continues, reapply pressure and check after 15 minutes.
  • If the bleeding continues after 1 hour of holding pressure, call the doctor.
  • Be sure to tell the dialysis staff about the bleeding before you start your next dialysis treatment.

Is Your Blood Access OK?

Good dialysis depends on having a blood access (fistula, graft) that works well. Poorly functioning accesses cause inadequate dialysis as well as many visits to the hospital, many of which can be avoided if the problem is detected and corrected early. You should talk with your doctor about your access and ask him to check it and make sure it is working properly. If your arterial (red) needle "sucks" or your venous (blue) pressure is too high, then there is a problem with your access and it needs to be fixed.

Hand-gripping exercise will help improve the functions of the access: See diagram A below

Diagram A

  1. Straighten your arms naturally, holding a soft ball in your hand
  2. Start gripping the ball for 5 second, then release your hand and relax for 5 seconds & start gripping & relaxing for about 15 mins.
  3. Have hand-gripping exercise several times a day

POSSIBLE COMPLICATIONS OF HEMODIALYSIS

Low Blood Pressure
Your blood pressure can drop during or after treatment if extra fluid is removed too quickly or if too much fluid is removed. A drop in blood pressure can cause dizziness, weakness, headache, nausea, vomiting, and even fainting. If your blood pressure drops during treatment, you will be reclined in your bed or chair and may also be given saline solution. If you have low blood pressure at home, sit or lay with your legs raised.

Muscle Cramps
Your muscles may cramp or tighten up during dialysis. Limiting salt and fluid intake between dialysis treatments may help prevent cramping. If you have a muscle cramp, massaging the area may help or the dialysis staff may need to take other action.