HEMODIALYSIS

Introduction

The word hemodialysis includes two components -heme(blood) and dialysis.

It simply means purification of blood.

Hemodialysis is a life saving treatment.

Millions of lives around the world are being saved and benefited by this therapy on a day to day basis.

History of dialysis

The history of dialysis is a classic example of how technology has contributed immensely to the development of modern medicine.

As early as 1913,there has been ongoing research into dialysis with researchers like Abel, Rowntree and Turner performing dialysis on anesthetized animals. They used semipermeable membrane tubes made from collodion.

The first hemodialysis in history was reportedly performed by a German doctor Georg Haas from Giessen near Frankfurt.

Further in 1945,Willem Kolff of the Netherlands made a pathbreaking invention which revolutionized the technology involved in dialysis.

He used a rotating drum kidney to do dialysis therapy on a 67 year old patient who had been undergoing treatment for acute kidney failure.

The above mentioned patient who was suffering from uremic coma recovered consciousness after 11 hours of dialysis with Kolff’s dialyser.

Over the last 100 years there has been a significant improvement in the technology of dialysis which has only benefited the people positively.

Kidneys and renal replacement therapy

The kidneys are one of the most important vital organs of our body.

It is concerned with the filtration of blood and the excretion of toxic metabolic wastes and byproducts.

There are certain scenarios in which the kidneys do not function effectively so as to excrete the metabolic waste and maintain the homoeostasis.

Such a situation when the body needs an external support for purification is called kidney failure.

Kidney failure or dysfunction is broadly classified as

Acute kidney failure
Chronic kidney disease

Hemodialysis is a type of renal replacement therapy.

The other types of renal replacement therapy include peritoneal dialysis where in the abdominal peritoneal fluid and peritoneal membrane is utilised for purification and removal of toxins from the body.

NEPHROLOGIST

The doctor who specializes in kidney diseases is the nephrologist.

The nephrologist is the professional who is concerned with the diagnosis of kidney diseases and the prescription of renal replacement therapy like hemodialysis.

Nephrologist decides when a patient would require dialysis and the treatment prescription for the dose of hemodialysis which varies from individual to individual based on several clinical and biochemical parameters.

Principles of dialysis

The basic principle of hemodialysis involves diffusion of solutes across a semipermeable membrane.

Hemodialysis equipment involves dialyser ,the machine and the dialysis access which completes the dialysis circuit.

The basic concept is that the machine circulates the patient’s blood to a dialyzer, where filtration occurs, and then returns the purified blood to the patient.

ACCESS

This refers to the site from which the healthcare provider withdraws the patient’s venous blood, which will then circulate to the dialyzer.

There are various types of access.

1. Arteriovenous fistula-AV fistula(AVF)

It is a surgically created fistula, typically located on the upper limb.

The common types are

Radiocephalic
Brachiocephalic
Brachiobasilic AVF

A skilled surgeon usually creates an AVF under local anesthesia.

The maturation time of an AV fistula is 4-6 weeks, referring to the time from its surgical creation to when it can be used for starting dialysis therapy.

2. Internal jugular vein non tunneled catheter

The internal jugular vein, a major neck vein, is used to insert a dialysis catheter for hemodialysis.

A nephrologist performs the insertion of an internal jugular vein catheter under local anesthesia and strict aseptic precautions.

3. IJV tunnelled catheter

Another type of catheter is tunneled under the skin during insertion.

The advantage of this catheter is it can last for a longer time compared to non tunnelled catheter and there is less risk of infections.

A nephrologist performs the insertion of a tunneled catheter into the internal jugular vein under local anesthesia and strict aseptic precautions.

Schedule for hemodialysis

In North America the most common schedule for dialysis is like 3-4 hours duration of hemodialysis which is repeated thrice in a week.

Then there is the concept of home hemodialysis where in the patient can comfortably undergo hemodialysis at home on a daily basis for short sessions(1.5-4 hours).

Nocturnal hemodialysis

It involves dialyzing the patient for 8-9 hours every night, 3-6 times per week commonly at home.

Daily hemodialysis

This involves home hemodialysis where in the patient undergoes daily dialysis usually at home.It is convenient for the patient but requires frequent access.

Advantages of hemodialysis

1.The patient who suffers acute kidney injury for example to completely reversible factors like acute diarrheal disease,snake bite and infections hugely benefits from hemodialysis.

It supports and buys time for the recovery of kidneys to its normal state.

2. It helps in correction of dangerous electrolyte abnormalities when there has been no response to medical management. like

Hyperkalemia
Hypercalcemia
Hypermagnesemia
Hyperphospatemia

3. For chronic kidney disease patients continuing on hemodialysis helps them immensely in continuing their normal routine work and life.

4. Improves the appetite and general health and well being of patients with chronic kidney disease.

Disadvantages of hemodialysis

1. Majority of patients undergo hemodialysis at hospitals-hence this is a hospital dependent modality of treatment.

2. The patient has to come to the hospital on a regular basis which involves considerable economic and social burden.

3. Requires experienced technicians and support of advanced technology which may be lacking in remote or rural areas.

4. Increased risk of blood borne infections and catheter related infections.

Strategies for Maintaining a Positive Mindset while Undergoing Hemodialysis.

Maintaining a positive mindset is crucial for individuals undergoing hemodialysis.

It helps them navigate the physical and emotional challenges that accompany the treatment.

One effective strategy is practicing gratitude.

Keeping a gratitude journal and reflecting on the things they are grateful for can shift their focus from the difficulties of dialysis to the blessings in their lives.

Engaging in hobbies and activities

Engaging in hobbies they enjoy is another way individuals on hemodialysis can maintain a positive mindset.

Whether it’s painting, reading, or gardening, having a creative outlet provides a sense of fulfillment and distraction from the demands of treatment.

Coping Mechanisms and Support Systems for Individuals on Hemodialysis

Coping with the physical and emotional aspects of living with hemodialysis requires a strong support system.

Family and friends play a crucial role in providing emotional support and encouragement.

They can accompany individuals to dialysis sessions, engage in conversations about their experiences, and help them maintain a sense of normalcy in their lives.

Support Groups

These groups are specifically tailored for individuals on hemodialysis can also be immensely beneficial.

These groups offer a safe space to share experiences, exchange coping strategies, and learn from others who have been through similar challenges.

Connecting with individuals who truly understand their journey can alleviate feelings of isolation and foster a sense of belonging.

Tips for Managing the Physical and Emotional Aspects of Living with Hemodialysis

Managing the physical and emotional aspects of living with hemodialysis requires a holistic approach.

It is essential to prioritize self-care and adopt healthy habits.

This includes

Following a nutritious diet
Staying physically active within the limitations of the treatment
Getting enough rest and sleep.
Taking care of one’s mental health is equally important
Individuals should seek professional help if they experience anxiety, depression, or other mental health challenges.
Additionally, open communication with healthcare providers is crucial.
Regular check-ups and consultations allow individuals to address any concerns or complications promptly.
Adhering to medication regimens, attending dialysis sessions regularly, and actively participating in their treatment plan are essential for ensuring the best possible outcomes.

Resources and Organizations that Provide Support for Individuals on Hemodialysis

Various resources and organizations provide support for individuals on hemodialysis.

The National Kidney Foundation is a prominent organization that offers educational materials, support groups, and resources for individuals with kidney disease.

They also advocate for policy changes to improve the lives of those affected by kidney failure.

The American Association of Kidney Patients (AAKP) is another valuable resource.

They provide information on treatment options, financial assistance programs, and support networks.

AAKP also organizes events and conferences, creating opportunities for individuals on hemodialysis to connect with others and stay informed about the latest advancements in kidney care.

Advances in Hemodialysis Technology and Treatment Options

Advances in hemodialysis technology and treatment options have significantly improved the quality of life for individuals on dialysis.

One notable advancement is the development of home hemodialysis machines.

These machines allow individuals to receive treatment in the comfort of their own homes, providing more flexibility and independence.

Additionally, research is continually being conducted to explore new treatment modalities, such as wearable artificial kidneys and bioengineered kidneys.

These innovations hold the promise of revolutionizing the field of renal care, potentially offering individuals with kidney failure alternative treatment options that are more convenient and mimic the function of natural kidneys.

Promoting Awareness and Understanding of Hemodialysis within the Community

Promoting awareness and understanding of hemodialysis is essential to remove stigmas and misconceptions surrounding kidney disease.

Education initiatives can include

Community outreach programs
Public seminars
Online campaigns that provide accurate information about kidney health and the impact of hemodialysis.

Encouraging open conversations about kidney disease and sharing inspiring stories of individuals on hemodialysis can also help to create a more inclusive and supportive community.

By fostering empathy and understanding, we can help individuals on dialysis feel more accepted.

CONCLUSION

Hemodiaysis is a modality of treatment which has revolutionised the treatment of kidney diseases and has positively benefitted millions around the globe.

With development of science and technology every hour we can expect better hemodialysis machines to contribute to next level patient care in the coming years.

Living with hemodialysis is undoubtedly challenging, both physically and emotionally.

However, the inspiring stories of individuals who have thrived on dialysis remind us of the incredible resilience and strength of the human spirit.

If you are living with hemodialysis or supporting someone who is, remember that you are not alone.

Seek out support, connect with others on a similar journey, and never underestimate the power of your own resilience.

References

National Kidney Foundation

American Association of Kidney Patients (AAKP)