Hemodialysis – A saviour for kidney diseases

D Hriiziini
BSc Dialysis Technologist, Dialysis Unit CIHSR Dimapur

What is dialysis? Dialysis is a treatment that does some of the things (functions) done by healthy kidneys. It is needed when your own kidneys can no longer take care of your body's needs.

When is dialysis needed? You need dialysis when you develop end stage kidney failure --usually by the time you lose about 85 to 90 percent of your kidney functions.

What does dialysis do? When your kidneys fail, dialysis keeps your body in balance by:
•    removing waste, salt and extra water to prevent them from building up in the body
•    keeping a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate
•    helping in controlling blood pressure

Where is dialysis done? Dialysis can be done in a hospital or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes. Also, there are two types of dialysis --hemodialysis and peritoneal dialysis.

Is dialysis expensive? Yes, it is expensive. The costs differ from one healthcare institute to another. However, some hospitals accept government issued healthcare scheme cards e.g. Ayushman Bharat card which gives you the benefit to acquire free dialysis.

One will need to have dialysis treatments for their whole life unless you are able to get a kidney transplant. Life expectancy on dialysis can vary depending on your other medical conditions and how well you follow your treatment plan. Let us look into the types of dialysis, 1. Hemodialysis 2. Peritoneal dialysis

Hemodialysis: In hemodialysis, an artificial kidney (hemodialyzer) is used to remove wastes, extra chemicals and fluid from your blood. For the blood to be drawn out of the body, the patient will have to surgically create a permanent access called ‘fistula’ on the hand. Fistula will make the veins to dilate (grow in size) and create a force within the vein thus pumping out enough blood required for dialysis. Another type of access can also be channeled by inserting a small plastic tube called ‘catheter’ inside one of the central veins (large veins) of the body. However, these are temporary lasting only for 1-4 weeks. So, for the long run, one has to construct fistula surgery. Usually, each hemodialysis treatment lasts for four hours and is done three times per week. Hemodialysis treatment is done in the hospital; therefore, the patient will have to travel to and fro from home. Dialysis, as a regular treatment, began in 1960 and is now a standard treatment all around the world. Thousands of patients have been helped by this treatment. 

Patients on hemodialysis can live a normal life. They can travel, they can go to work if they have a job that doesn’t require a lot of physical labor (e.g. lifting, digging etc.), they can surely carry on with their hobbies (e.g. Playing musical instruments, gardening, fishing, etc.). They have to follow a special diet with restrictions but with the supervision of the doctor and dietitian they can enjoy their favorite food at times.

Peritoneal dialysis (PD) aka home dialysis: Yes! You heard it right. This type of dialysis is done at home. There is no dealing with blood withdrawal situation in this case. The patient and the caregiver will be trained from the hospital which lasts for 1-2 weeks as required. They will be trained to perform dialysis, catheter dressing, injecting medications, counteract complications etc. by themselves at home. The doctor will insert a plastic tube called ‘catheter’ in your belly (abdominal cavity). The dialysis will be done inside the body. There are two different types of peritoneal dialysis viz., CAPD (continuous ambulatory peritoneal dialysis) and APD (automated peritoneal dialysis). 

CAPD: It requires no machines, all that’s needed are a chair, table and an IV stand. Patient can do the procedure by themselves. It is usually done 4-5 times a day, each session lasting for 20-30 minutes. A patient will have to buy CAPD solution bag and other items from a respective supplier and store them at home. The CAPD solution will be hanged on the IV stand while the patient sits and connects it to the catheter inserted in the belly. The solution fills the belly which takes around 10-15 minutes plus another 10minutes for dressing (only once daily). When the infusion completes the patient can disconnect oneself from the catheter and is good to go about with the usual activities at work, school or at home. The solution stays in the belly for 4-6hrs. This time duration is important and it is decided by the healthcare staff after examining the patient. After the given time duration exhausts, patient will repeat the procedure again.

APD: It is usually done at home throughout the night while you sleep. The procedure is similar to CAPD with the difference being the use of a machine. Before going to bed, the patient connects the catheter to the machine after which the process begins automatically throughout the night. One factor of difference is the cost as APD machine is expensive.

There are still so much more to learn and know about dialysis. For more hands-on knowledge you can also visit your nearest hospital with dialysis facilities.

Hey! Would you like to be a dialysis healthcare professional? You can study the following courses and join the healthcare team..

1.BSc Dialysis Technology (3.5 years + 1 year internship)

 2.Diploma in Dialysis Technology (2years + 6 months internship)

To be eligible you need a minimum qualification of 10+2 with Physics, Chemistry & either of Biology/ Mathematics as main subjects

Naming few of the institutes that provide the course in the country;

i.    Christian Medical College (CMC), Vellore 
ii.    Manipal University, Manipal
iii.    SRM University, Kanchipuram
iv.    M.M.M. College of Health Sciences, Chennai
v.    Jamia Hadard University, New Delhi