Dialysis or hemodialysis is a procedure to replace impaired kidney function already no can work properly due to damage to the organ. This procedure too help control blood pressure and balance the levels of minerals in the blood, such as potassium, sodium, and calcium.
The kidneys are a pair of organs located below the back of the ribs. Kidneys have various functions, including regulating fluid balance in the body, filtering metabolic waste, releasing hormones that regulate blood pressure, and controlling the production of red blood cells.
Dialysis is necessary for someone who suffers from severe kidney damage, where the kidney functions can no longer run properly. Dialysis can provide an opportunity for people with kidney failure to still be able to carry out normal daily activities.
Indications for dialysis
Dialysis is performed on patients with kidney failure, both acute kidney failure and chronic kidney failure. In general, kidney failure can be recognized by the following symptoms:
- The appearance of symptoms of uremia, such as itching, nausea, vomiting, loss of appetite, and fatigue
- High levels of acid in the blood (acidosis)
- The occurrence of swelling in body parts due to the kidneys not being able to get rid of excess fluid
- High levels of potassium in the blood (hyperkalemia)
Chronic kidney failure is generally caused by the following conditions:
- Hypertension
- Diabetes
- Inflammation of the kidneys (glomerulonephritis)
- Inflammation of the blood vessels (vasculitis)
- Polycystic kidney disease
While acute kidney failure can occur due to complications after surgery, heart attack, and dehydration.
Dialysis Warning
Dialysis will be stopped if the kidneys are no longer damaged and can work properly. However, for chronic kidney failure, kidney damage is very rarely completely cured, so sufferers need to do dialysis for a long time, even their whole life.
During dialysis, patients must consume lots of protein and limit their intake of potassium, phosphorus, and sodium, including sodium found in juices and energy drinks. Too many minerals in the blood can cause other health problems.
In addition, the patient must also inform the doctor about other diseases that may be suffered and the drugs that are being used, including herbal products and supplements.
Before Dialysis
Preparation for dialysis is carried out several weeks before this procedure is carried out. Patients need to be made access to blood vessels to facilitate the dialysis process. There are three types of vascular access that can be made by a vascular surgeon, namely:
Arterial-venous fistula (cimino)
An arteriovenous fistula or cimino is an artificial channel that connects an artery and a vein. This access is the most frequently recommended vascular access because its safety and effectiveness are better than other types of access.
Arterial-venous graft
An arteriovenous graft is performed by connecting an artery and a vein by adding a flexible synthetic tube. This access method is used if the patient's blood vessels are too small to form a fistula.
Kateter
Access to blood vessels using a catheter is usually a last resort and is used for a certain period of time. There are two types of catheters that can be used for access, namely:
- Catheter non-cuffed
Catheter non-cuffed or catheter double lumen is access made for patients who need dialysis in an emergency. In the process, the doctor will insert a catheter into a large vein in the neck or groin.
The catheter is usually only temporary, which is less than 3 weeks, and will be removed when the patient is no longer required to undergo dialysis or already has access to a more permanent, such as cimino.
- Catheter cuffed (tunneling)
Catheter cuffed or tunneling A catheter is placed under the skin and then connected to a large vein. Tunneling can last up to 3 weeks. This is done when a cimino or an arteriovenous graft cannot be performed or is not ready for use.
Infections in the access blood vessels can interfere with dialysis procedures. Therefore, keep access to blood vessels clean to prevent infection and other complications.
Dialysis Procedure
Dialysis procedures can be done at the nearest hospital. This procedure usually lasts 3-4 hours and is done 2-3 times a week.
The following are the stages of the dialysis procedure:
- The patient will be asked to lie down or sit down during the dialysis process.
- Doctors and nurses will check the patient's physical condition, such as blood pressure, body temperature, and weight.
- The doctor will clean the access blood vessels that have been made for needle insertion.
- The needle that has been connected to the dialysis tube will be placed at the access point that has been cleaned. One needle serves to drain blood from the body to the machine, while the other needle serves to drain blood from the machine into the body.
- After the needle is attached, the blood will be flowed through a sterile tube to a filter or filter dialyzer.
- Metabolic wastes and excess body fluids will be removed, while blood that has gone through the dialysis process will be returned to the body.
- After dialysis is complete, the doctor will remove the needle from the blood vessel access site and tightly cover the needle puncture site so that the patient does not experience bleeding.
- To ensure the amount of fluid removed, the doctor will re-weigh the patient's weight.
During the dialysis procedure, the patient is allowed to do leisure activities, such as watching television, reading, or sleeping, but must remain in bed.
The doctor will monitor the patient's condition regularly, so that the patient can notify the doctor when there is discomfort during the dialysis procedure, such as nausea and stomach cramps.
After Washing Blood
Patients can go home immediately after the dialysis procedure is complete. Even after dialysis, patients are advised to maintain their health by eating healthy foods so that fluid, protein, and salt intake remains balanced.
To ensure that metabolic wastes and excess fluids are removed properly, the doctor will monitor the patient's condition before, during, and after dialysis. At least once a month, the doctor will also perform the following tests:
- Tests for urea reduction ratio (URR) and total urea clearance through blood tests, to monitor the effectiveness of the dialysis process
- Blood flow meter test from access
- Blood cell count and blood chemistry tests
Acute or chronic kidney failure will determine how long a person must undergo dialysis. Generally, patients suffering from acute kidney failure will stop undergoing dialysis procedures once their kidneys are able to function properly again.
Dialysis is one of the three renal function replacement therapies continuous ambulatory peritoneal dialysis (CAPD) or dialysis through the stomach and kidney transplant. People with chronic kidney failure will be given three options for renal function replacement therapy.
Some people who qualify for a kidney transplant may undergo dialysis as a temporary treatment until they get a kidney donor. After getting a kidney donor, the patient will undergo a kidney transplant or transplant surgery and will not need to undergo another dialysis procedure.
Complications Dialysis
Dialysis is one of the medical procedures that are effective in maintaining the quality of life of patients with kidney failure. However, like any medical procedure, dialysis can also cause complications. The following are some of the complications that can occur as a result of dialysis:
- Hypotension
- Muscle cramp
- Nausea and stomach cramps
- Chest and back pain
- Itchy rash
- Sleep disturbance