WHAT IS DIALYSIS AND ITS TYPES

Dialysis is an artificial process of removing residues and excess fluids from the body, which is necessary when the kidneys are not working properly.

                There are several reasons for dialysis, but the inability of the kidneys to properly filter blood residues (kidney failure) is the most common reason. Kidney function may decline rapidly (this is called acute kidney injury or acute kidney failure), or the kidneys may slowly lose their ability to filter wastes from the body (this is called chronic kidney disease or chronic kidney disease). And the doctors who treat these diseases are called nephrology physicians.

                It is not easy to make the decision to start this treatment because it leads to a drastic change in people's lifestyle and their dependence on devices to keep themselves alive. However, for most people, a successful dialysis program leads to an acceptable quality of life. Most people on dialysis are able to eat an acceptable diet, have normal blood pressure, and prevent the progression of nerve damage, severe anemia (a decrease in the number of red blood cells that carry oxygen to cells body), and other serious complications. Dialysis generally requires the participation of a team of people:

·         A doctor prescribes dialysis, takes care of the complications, and provides medical care.

·         Nurses monitor people's general well-being, educate them about dialysis and what to do to keep themselves in the best possible state of health, supervise the dialysis process, administer medication related to dialysis and supervise dialysis technicians.

·         Often, a social worker assesses mental health, arranges transport and dialysis to other locations if the person is traveling, and arranges home assistance if necessary.

·         A dietitian recommends an appropriate diet and monitors a person's response to changes in the diet.

·         A kidney transplant surgeon is also part of the team when it is planned to use dialysis on a temporary basis while waiting for a kidney transplant.

Types of dialysis

There are two types of dialysis:

·         Hemodialysis

·         Peritoneal dialysis

This article will particularly emphasize on Peritoneal dialysis.

Peritoneal dialysis

The abdominal organs, such as the stomach and intestines, are located in a large hollow space called the abdominal cavity. The peritoneum is a membrane that lines the abdominal cavity and covers its organs. In peritoneal dialysis, the membrane acts as a filter. This membrane has a large surface area and a rich network of blood vessels. Substances in the blood can easily pass through the peritoneum and enter the abdominal (peritoneal) cavity. Fluid (dialysate) is injected into the peritoneal space within the abdomen through a catheter inserted into the abdominal cavity. The dialysate should remain in the abdomen for a sufficient time for the metabolic residues in the blood to gradually pass into the dialysis fluid. The dialysate is then evacuated outside the abdominal cavity,

By placing a flexible silicone probe or a porous polyurethane catheter, the dialysate can circulate regularly and with little risk of complications. A catheter can be placed temporarily in a person's bed, or permanently surgically. One type of permanent catheter adheres to the skin over time and can be closed when not in use.

Peritoneal dialysis can be done using a machine (this is called automated peritoneal dialysis) or without a machine (using manual techniques). Riverside-nephrology provides the best nephrology associates in Riverside.

Manual peritoneal dialysis techniques are the simplest. No device is used. There are two types:

·         In intermittent manual peritoneal dialysis, the bags that contain the dialysate are warmed to body temperature and infused into the peritoneal (abdominal) cavity for about 10 minutes. The dialysate is left in place (residence time) for 60 to 90 minutes and then drained outside in about 10 to 20 minutes. The process is then repeated. The entire treatment may take 12 to 24 hours. Between periods of dialysis, there is no dialysate in the peritoneal cavity.

·         In continuous ambulatory peritoneal dialysis, the dialysate is usually drained and replaced 4 or 5 times a day. Typically, three of these dialysate replacements are done during the day, at intervals of 4 hours or more. A final replacement is carried out during the night, with a long period of stay, from 8 to 12 hours, during sleep. Continuous ambulatory peritoneal dialysis differs from intermittent peritoneal dialysis in that there is always dialysate in the peritoneal cavity.

Automated peritoneal dialysis techniques are fast becoming the most commonly used forms of peritoneal dialysis. In automated peritoneal dialysis, an automated machine performs multiple replacements during the night while the person is asleep. These techniques make it possible to minimize the number of replacements during the day, but they hamper the mobility of the person during the night, due to the size of the equipment. Sometimes a replacement is done during the day. Automated peritoneal dialysis techniques fall into three sub-categories:

·         Cyclic continuous peritoneal dialysis leaves a long residence period (12-15 hours) during the day and performs 3-6 overnight replacements with an automated cycler.

·         Intermittent nocturnal peritoneal dialysis performs replacements with a cycler overnight, while the person's peritoneal cavity is left without dialysate during the day.

·         Reflux dialysis is a modification in which part of the dialysate remains in the peritoneal cavity between two successive replacements. This technique may be more comfortable for the person. The ebb-and-flow dialysis can be done with or without a stay period during the day.

Some people need a combination of continuous ambulatory peritoneal dialysis and continuous cyclic peritoneal dialysis to achieve adequate removal of waste products from the blood. The peritoneal dialysis can be done at home, eliminating the need to visit a hemodialysis center. The most common and bothersome complications of peritoneal dialysis are infection of the peritoneal fluid (causing inflammation of the peritoneum called peritonitis ) and infection of the area where the catheter enters the skin (point of insertion) . Peritonitis can cause constant, sharp, intense pain throughout the abdomen, but sometimes it causes little pain. Infection at the insertion site causes redness of the skin and pain at the insertion site. These infections can be treated with antibiotics and careful care of the lesion.

Psychosocial considerations

People on dialysis experience difficulties in all aspects of life. Loss of autonomy can create considerable distress. The change in lifestyle can be very difficult to bear. Many people on dialysis develop depression and anxiety. It can be helpful to provide them with psychological and social support and their families. Many dialysis services offer this type of psychological and social support. Encouraging people to cultivate their pre-illness interests can help them cope with the loss of autonomy. People on hemodialysis need regular transportation back and forth to the dialysis department. Dialysis sessions can interfere with work, study, or leisure activities.

More than half of people on long-term dialysis are aged 60 or over. Older people often cope better with long-term dialysis and loss of autonomy than younger people. Elderly people on dialysis may, however, become more dependent on their already adult children and may no longer be able to continue living on their own. In addition, they are more prone to fatigue after treatment. Oftentimes, family roles and responsibilities need to be altered to accommodate the routine of dialysis, causing stress and feelings of guilt and inadequacy.