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Dialysis is a method of removing toxic substances (impurities or wastes) from the blood
when the kidneys are unable to do so. The kidneys function as filters for the blood,
removing waste products. They also: regulate body water, maintain electrolyte balance and
ensure that the blood pH remains between 7.35 and 7.45.Dialysis replaces some of the
functions for kidneys that aren't working properly. It removes contaminants from the blood
that could, and eventually would, lead to death if the kidney is not functioning(Mark, F.R
et,al).
Since dialysis is not a constant process, it cannot monitor body functions as do normal
kidneys, but it can eliminate waste products and restore electrolyte and pH levels on an as-
needed basis. Dialysis is most often used for patients who have kidney failure, but it can
also quickly remove drugs or poisons in acute situations. This technique can be lifesaving in
people with acute or chronic kidney failure(.Zbylut, K.I ,et,al)
PROCESS IN DIALYSIS
Hemodialysis uses a machine filter called a dialyzer or artificial kidney to remove excess
water and salt to balance the other electrolytes in the body, and to remove waste products of
metabolism. Blood flows through tubing into the machine, where it passes next to a filter
membrane. A specialized chemical solution (dialysate) flows on the other side of the
membrane. The dialysate is formulated to draw impurities from blood through the filter
membrane. Blood and dialysate never touch in the artificial kidney machine. For this type of
dialysis access to the blood vessels need to be surgically created so that large amounts of
blood can flow into the machine and back to the body(Tolkoff , N).
Surgeons can build a fistula, a connection between a large artery and vein in the body,
usually in the arm, that causes a large amount of blood flow into the vein. This makes the
vein large and its walls thicker so that it can tolerate repeated needle sticks to attach tubing
from the body to the machine. Fistula takes long to mature enough, significant planning is
required if hemolysis is considered an option. If the kidney failure happens acutely and
there is no time to build a fistula, special catheters may be inserted into large blood vessels
of the arm, leg or chest. The catheters may be left in place up to three weeks.( Raymond,
C.P).
TYPES OF DIALYSIS
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There are two main types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis
uses a special type of filter to remove excess waste products and water from the body.
Peritoneal dialysis uses a fluid that is placed into the patient's stomach cavity through a
special plastic tube to remove excess waste products and fluid from the body.
During hemodialysis, blood passes from the patient's body through a filter in the dialysis
machine, called a "dialysis membrane." For this procedure, the patient has a specialized
plastic tube placed between an artery and a vein in the arm or leg (called a "gortex graft").
Sometimes, a direct connection is made between an artery and a vein in the arm. This
procedure is called a "Cimino fistula." Needles are then placed in the graft or fistula, and
blood passes to the dialysis machine, through the filter, and back to the patient. In the
dialysis machine, a solution on the other side of the filter receives the waste products from
the patient.
Peritoneal dialysis uses the patient’s own body tissues inside of the belly (abdominal cavity)
to act as the filter. The intestines lie in the abdominal cavity, the space between the
abdominal wall and the spine. A plastic tube called a "dialysis catheter" is placed through
the abdominal wall into the abdominal cavity. A special fluid is then flushed into the
abdominal cavity and washes around the intestines. The intestinal walls act as a filter
between this fluid and the blood stream. By using different types of solutions, waste
products and excess water can be removed from the body through this process.
COMPLICATIONS OF DIALYSIS
Even though the safety of the hemodialytic procedure has improved greatly over the years,
the procedure is not without risks. Common problems are listed below.
Hypotension
A decrease in blood pressure is the most frequent complication reported during
hemodialysis. When fluid is removed during hemodialysis, the osmotic pressure is increased
and this prompts refilling from the interstitial space. The interstitial space is then refilled by
fluid from the intracellular space. Excessive ultrafiltration with inadequate vascular refilling
plays a major role in dialysis induced hypotension. The immediate treatment to hypotension
is to discontinue dialysis and place the patient in a trendelenburg position. This will increase
cardiac filling and may increase the blood pressure promptly( Mitch, W.E.,.et.al)
Cramps
In the majority of hemodialysis patients, cramps occur toward the end of the dialysis
procedure after a significant volume of fluid has been removed by ultrafiltration. The
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immediate treatment for cramps is directed at restoring intravascular volume through the
use of small boluses of isotonic saline. Prevention of cramps has been attempted with the
prophylactic use of quinine sulfate at least 2 hours prior to dialysis(Raymond, C.P et,al).
Arrhythmia
Patients on maintenance hemodialysis are at risk of cardiac arrhythmias. They occur
predominately in association with hemodialysis or may occur in the interdialytic period.
Both acute and chronic alterations in fluid, electrolyte, and acid-base homeostasis may be
arrhythmogenic in these patients.
Hemolysis
Hemolysis may result from a number of biochemical and toxic insults during the dialysis
procedure. The half-life of red blood cells in renal failure patients is approximately one half
to one third of normal and the cells are particularly susceptible to membrane
injury(Raymond, C.P.,et,al)
Hypoxemia
A fall in arterial PO2 is a frequent complication of hemodialysis that occurs in nearly 90% of
patients. The drop ranges from 5 to 35 mm Hg, and reaches its peak between 30 - 60
minutes after beginning dialysis. Patients on mechanical ventilators with constant minute
volume and inspired oxygen concentration can still develop hypoxemia during
hemodialysis(Mitch, W.E.,et,al).
REFERENCES
1. Mark, F.R., Diaz-Buxo, B.V.M., Piraino, I.R., and Mohamed, K.O.2000. Dialysis
disequilibrium syndrome Fundamentals: dialysis disequilibrium syndrome diagnosis and
management.7th edition. Benjamin/ Cummings, New Zealand.Pp798-801.
2. Mitch, W.E., and Villoca, G.H.2007.Dialysis: processes and treatment.5th edition.
Academic press, New York. Pp131-433.
3. Raymond, C.P., Krediete, M.D., Salzer, M.W., Sloand, V.R., and
th
Williams,P.Y.2003.Peritonial Dialysis Fundamentals: Peritoneal Health.9 edition. Parsons
and sons. Russia. Pp 677-789.
4. Tolkoff-Rubin, N., Goldman, L., and Ausiello, D.2003.Treatment of renal failure.3rd
edition. Saunders elsevier publishing, Philadelphia. Pp 55-133.
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5. Zbylut, K.I., Twardowski, Y.U., and Crabtree, S.T.2005.Hemodialysis treatment and
complications. 11th edition. Preston hall inc. California. Pp123-125.