What is dialysis?

When the kidney lose their function, excess biochemical material, excess fluids and unwanted waste from the blood is filtered outusing a lifesaving medical procedure called Dialysis.

Who needs dialysis?

• For the patients with glomerular filtration rate (GFR) of less than 15, categorised under Stage-5 or End Stage Renal failure who has become symptomatic.
• For the patients who are suffering from total kidney failure qualify for dialysis

Is there any alternative treatment for ESRD other than dialysis?

• The only alternative treatment for ESRD is kidney transplantation

What are the treatment options available for GFR of 30 or below?

• Medication – ACE inhibitors and ARB Blockers
• Advise on Dialysis options and Transplantation

What is the purpose of Dialysis?

• Act as substitute for kidney function
• Removal of waste and extra fluid from the body to prevent them from building and cause complications
• Help in regulating blood pressure

What are the major types of Dialysis?

• Haemodialysis – Blood is purified in an external machine and returned to the body
• Peritoneal Dialysis – Blood is purified within the peritoneal cavity in exchange for dialysis fluid

What are the various dialysis options available?

Haemodialysis through Arteriovenous Fistula (AVF)

• The most common type of dialysis
• Treatment duration is typically 3-5 hours a day and 3 times a week frequency
• Dialysis machine is used to remove waste and extra fluid
• The connections made surgically help to start dialysis in 2 to 3months
• The access for long term dialysis is AV Fistula.

Haemodialysis through Arteriovenous Graft (AVG)

• One of the most common type of dialysis
• Treatment duration is typically 3-5 hours a day and 3 times a week frequency
• Dialysis machine is used to remove waste and extra fluid
• The connections made surgically help to start dialysis in 2 to 3weeks
• The entry port (AVF) is suitable long term dialysis.

Haemodialysis through Vascular Access Catheter (VAC)

• Mode of dialysis before surgically creating AVF or AVG
• Treatment duration is typically 3-5 hours a day and 3 times a week frequency
• Also helps patients whose blood vessels are weak to support either fistula or graft
• Dialysis machine is used to remove waste and extra fluid
• Non-cuffed tunnelled catheters are used for emergencies and for less than 3weeks
• Tunnelled catheter are used for emergencies and for longer than 3weeks.

Home haemodialysis

• Home dialysis is considered to be more effective than in-centre (Hospital) dialysis
• Home dialysis has been shown to provide clinical improvements in blood pressure regulation, regression of left ventricular hypertrophy, restoration of left ventricular ejection fraction, normalization of phosphate control
• Home dialysis mimics natural kidney function with higher frequency (daily) and shorter dialysis periods (1½ to 2hrs)
• Helps to avoid stressful hospital visits while enabling more time spent at home with family, friends and work
• Helps in better understanding on the condition, treatment process and progress
• Improves health and quality of life when adhered to regular and good practices

Peritoneal Dialysis

• Provides flexibility for dialysis away from hospital i.e. at work, home, while sleeping
• The dialysis catheter is introduced surgically into the abdomen area (peritoneal cavity)
• The blood is purified inside the body using dialysis fluid while being exchanged for waste and excess fluid
• Peritoneal Dialysis should be done 4 to 5 times a day, lasting for 30 to 40mins
• Studies show that the patients who opt peritoneal dialysis live longer than haemodialysis
• mimics natural kidney function with higher frequency (5 times a day) and shorter dialysis periods (30 to 40mins)
• Can be chosen as the preferred dialysis option before haemodialysis and kidney transplantation

Continuous Ambulatory Peritoneal Dialysis (CAPD)

• The most portable type of dialysis and doesn’t need needles
• It is done every day, via your peritoneal cavity
• Dialysis fluid is constantly present in the abdomen
• The fluid is typically exchanged four to five times per day
• It requires peritoneal fluid bag changes four to five times a day
• Cleans up the blood as expected
• Helps to maintain the fluid balance
• Effectively replaces the work of the diseased kidneys

Continuous Cyclic Peritoneal Dialysis (CCPD) / Automated Peritoneal Dialysis (APD)

• Patients who qualify as high transporter can opt for APD
• A cycler machine automatically exchanges fluid into and out of the abdomen
• The patient need to spend between 8 and 10 hours a night for CCPD
• Controlled fluid exchange through peritoneal route
• Provides continuous therapy at night without any on/off procedures during the day
• Ideal for at home dialysis for kids, elderly and bedridden
• Cleans up the blood as expected
• Helps to maintain the fluid balance
• Effectively replaces the work of the diseased kidneys

Hemofiltration (CHF)

• Typically used for critically ill patients suffering from Acute Kidney Injury or Sepsis or Organ Failure
• This gradual and continuous therapy also helps hemodynamically unstable patients
• Provides best control of fluid balance
• It takes the advantage over haemodialysis by offering removal of large volumes of fluid continuously while not causing any hypotension episodes
• It also helps in clearance of medium to larger molecules

Hemodiafiltration (HDF)

• Hemofiltration (Continuous)in combination with Haemodialysis (intermittent) is – Hemodiafiltration
• It helps in clearance of small to larger molecules
• It provides potential benefits in overcoming anaemia, inflammation, oxidative stress, dyslipidaemia, and calcium-phosphate imbalances
• HDF is found to be beneficial in both adults and children

What are the self-management tips or recommendations during Dialysis?

• Ensure to get the dialysis done as per the recommended schedule without missing
• Keep the access port clean and dry with necessary infection control measures
• Consult a registered nutritionist and plan diet according to the dialysis option chosen
• Take medication as advised for – heart and blood vessel problems, high blood pressure, anaemia, bone problems, poor nutrition and diabetes
• Exercise regularly for at least 30mins in a day and stay physically active
• Quit smoking and drinking alcohol
• Limit you salt intake to minimum
• Follow strategies to minimise fluid intake
• Maintain healthy weight and lose extra kilos if needed medically