Dialysis is a process that helps remove waste products, excess fluid, and toxins from the blood when the kidneys are no longer able to perform this function effectively.
There are two types of dialysis:
Hemodialysis:
Hemodialysis is a procedure performed by our trained and skilled technical staff and nurses through a specialized equipment consisting of a dialysis machine, dialyzer, tubing’s and dialysis water. Within the dialyzer, the blood from the patient’s body that contains toxins and a specialized fluid (dialysate), flows on either side of a semipermeable membrane. This removes the toxic waste and returns relatively cleaner blood to the patient’s circulation. In addition, extra water can also be removed during dialysis.
Before the hemodialysis procedure begins, the team checks the patient's vital signs (such as blood pressure, heart rate, temperature, and weight). In case a blood test is needed blood is collected before dialysis.
The bloodstream is accessed through vascular access created earlier which could be an AV fistula, graft, or catheter.
Temporary and permanent hemodialysis catheter insertions for vascular access:
A hemodialysis catheter is a medical device inserted into a patient's blood vessels to provide access for hemodialysis, a medical procedure that removes waste products and excess fluid from the blood when the kidneys are not functioning properly.
Temporary hemodialysis catheter insertion involves the placement of a catheter that is intended to be used for a short period. Temporary catheters are typically inserted in an emergency. They are also used as a bridge while a patient waits for a more permanent access option to be established.
Permanent hemodialysis catheter insertion involves the placement of a catheter that is intended to be used for a longer period, usually several months to a few years. Permanent catheters are typically used when a patient's veins are not suitable for an arteriovenous fistula or graft, which are the preferred access options for long-term hemodialysis.
Both temporary and permanent hemodialysis catheters are inserted into the blood vessels, usually in the neck or groin area. The catheter has two lumens or tubes, one for the removal of blood from the patient and the other for the return of blood to the patient after it has been filtered through the dialysis machine.
The team then set up the dialysis machine by connecting tubes to the vascular access. The machine is programmed to perform the appropriate dialysis prescription.
The patient's blood is pumped through the machine's dialyzer, which contains a semipermeable membrane that filters out waste products and excess fluids.
During the dialysis procedure, the patient's blood is passed through specialized tubes against a sterile solution called dialysate, which helps to maintain the proper balance of electrolytes and other substances in the blood.
The team monitors the patient's vital signs throughout the procedure to ensure that the procedure is proceeding safely and effectively.
Hemodiafiltration:
HDF is an important renal replacement therapy that can provide more efficient removal of waste products and excess fluids from the blood of patients with kidney failure, potentially leading to improved health outcomes and survival rates.
The process of HDF is similar to hemodialysis, but it also involves an additional step of filtration. During HDF, the patient's blood is passed through a hemofilter that removes waste products and excess fluids.
- Peritoneal dialysis:
It is a more efficient removal of waste products and excess fluids and can help to improve their overall health. It has a lower risk of cardiovascular disease in patients with kidney failure, possibly due to improved removal of inflammatory mediators and better control of fluid balance.
Peritoneal dialysis involves using the peritoneum, a membrane lining the abdominal cavity, as a natural filter. A sterile dialysis solution is introduced into the abdominal cavity through a catheter. Waste products and excess fluid pass from the blood vessels into the dialysis solution, which is later drained out of the body. Peritoneal dialysis can be performed at home, allowing for more flexibility in treatment schedules. It is more “physiological”, as it is a continuous process and avoids the blood pressure fluctuations that are likely to occur with hemodialysis. - C A P D:
CAPD (Continuous Ambulatory Peritoneal Dialysis) is a type of renal replacement therapy to treat patients with end-stage renal disease. It is a service offered by the Department of Nephrology. It is another form of RRT (renal replacement therapy) for ESRD. It is performed manually after proper training of the individual and his/ her family member.
CAPD involves the use of the peritoneal membrane, which lines the abdominal cavity, as a filter to remove waste and excess fluids from the body. During CAPD, a sterile solution known as dialysate is infused into the peritoneal cavity of the patient. This is done through a catheter surgically placed in the abdomen 2-3 weeks prior to starting training for CAPD. The dialysate stays in the abdomen for a few hours, absorbing waste and excess fluids from the blood vessels in the peritoneal membrane. The dialysate is then drained out of the abdomen and replaced with a fresh solution. This process helps to cleanse the blood of toxins and other harmful substances, which in turn improves the patient's overall health and well-being. This procedure is carried out by patients themselves either manually or with the help of a cycler.
CAPD is an effective form of renal replacement therapy for patients with end-stage renal disease who are unable or unwilling to undergo hemodialysis. It can be performed at home, allowing patients greater flexibility and independence in their daily lives. However, CAPD requires strict adherence to a treatment regimen and careful monitoring to prevent complications such as infection or fluid overload. - APD:
APD stands for Automated Peritoneal Dialysis, it involves the use of a machine called a cycler to perform peritoneal dialysis automatically.
A catheter is surgically inserted into the abdominal cavity. The catheter has two tubes, one for the inflow of dialysis solution and the other for the outflow of the used solution.
The solution is infused into the peritoneal cavity through the catheter. The dialysate remains in the abdominal cavity for a prescribed dwell time, allowing waste products and excess fluid to pass from the blood vessels into the solution.
The cycler is programmed to perform a series of dialysate exchanges. It controls the inflow, dwell time, and outflow of the dialysate. The machine monitors and adjusts the cycle duration, fill volumes, and dwell times based on the patient's prescribed treatment plan.
It drains the used dialysate from the abdominal cavity into a drainage bag and then refills it with fresh dialysate. This process is repeated several times throughout the night, typically for 8-10 hours.
APD provides regular and efficient removal of waste products and excess fluid from the body in individuals with ESRD.
APD allows patients to perform dialysis at home, offering greater freedom and flexibility in their daily routine compared to in-center hemodialysis.
