Dialysis is a procedure that performs the function of the failed kidneys; it removes waste nitrogenous substances like urea, creatinine and excess water from the blood.
6:2 What are the various dialysis options and How to choose? There are two types of dialysis I) Hemodialysis (H.D) : Synthetic membrane (cellophone ) in the shape of thin tubes (capillary dialysis) is used; blood is passed through these into a dialysis machine at a slow speed for a period of 4 hours; glucose and salt solution (dialysate ) flows in opposite direction outside the tubes; blood thiner (anticoagulant - heparin) is used to avoid clotting of blood; hemodialysis is repeated twice or thrice a week. Average cost of hemodialysis comes to Rs. 12000/- to Rs. 16000/- per month besides, the cost of canulation 2000/- for groin; subclavianor jugular costs approximately Rs. 5000/- . For long term use, 'arteriovenous fistula' (AV Fistula) is used (II) Peritoneal dialysis (PD) : In this, peritoneum of the abdomen is used as membrane. The process lasts for 36 to 48 hours . sugar- salt and solution (exchange of 2 litres) pushed in the peritoneum; One hourly exchanges are used CAPD consists of 2 litre of sugar and salt solution, placed in the peronium for 4 hours under fully hygienic condition, 3 such exchange are done daily or patient could undertake 10 hours of night dialysis using an automatic cycler machine (costing about Rs. 3:5 lakhs). Cost of single 36 hour peritoneal dialysis Rs.2000/ to Rs. 2500/- CAPD works out about Rs. 15000/- to Rs. 20000/- per month. Peritoneal dialysis is preferred for patients having bleeding tendencies, heart disease especially diabetics; also .Hepatitis B positive patients waiting for a place in the isolation unit or transplantation. CAPD is perhaps the best home dialysis option for patients of End-stage renal disease.
6:3 When is dialysis indicated ? It is a life saving procedure in 'acute kidney failure' 'Decision to start dialysis in patients of chronic kidney failure' is based more on patient's symptoms though serum creatinine levels of 10 mg% or more often indicates initiation of dialysis in; loss of appetite, nausea, vomiting, excessive water accumulation indicate early initation of dialysis. In the presence of infection, blood potassium level rises and blood PH falls (acidosis); these indicate urgent need of dialysis for their correction.
6:4 What are the risks of dialysis?
Healthy kidneys regulate the amount of water in the body. In fluid overload (overhydration), ankle/body swelling BP is high; neck veins become prominent, breath less due to lung congestion. Overload can be easily corrected by dialysis; increasing negative pressure of on hemodialysis called 'ultrafiltration' in order to prevent damage to heart by overload, dialysis patient is advised not to gain weight in between two dialysis sessions by restricting fluid intake.
6:6: What is continuous renal replacement (CRRT)?
This is commonly used in ICU in patient with low blood pressure with or without increased fluid retention using special more expensive polysulfone or poly venyl-nitrile filter.
6:7 What is the quality of life expected on dialysis?
Accepting long term dialysis is the key to success of this therapy; educating the patient and his attendants individually or in groups regarding the need for dialysis its various options, these benefits, including dietary relaxation, increased work of fluid fruits etc should be emphasised;