Dialysis

by Editorial Staff And Contributors

En Español (Spanish Version)

Definition
Dialysis is a treatment that takes over the job of the kidneys when they fail. Most patients begin dialysis when
their kidneys have lost 85%-90% of their ability. Dialysis will continue for the rest of their lives (or until they
receive a kidney transplant). This is called end-stage renal disease (ESRD).

ESRD is caused by conditions such as diabetes, kidney cancer, drug use, high blood pressure, or other kidney
problems. Dialysis is not a cure for ESRD. It helps you feel better and live longer.

There are two types of dialysis:

Hemodialysis
Peritoneal dialysis

Parts of the Body Involved

Hemodialysis—veins in the arm, leg, or neck
Peritoneal dialysis—abdomen

Reasons for Procedure

The main functions of dialysis are to:

Remove waste and excess fluid from the blood to prevent build-up
Control blood pressure
Keep a safe level of chemicals in the body, such as potassium, sodium, and chloride

It may also be done to quickly remove toxins from the bloodstream. This can occur in cases of poisoning or drug
overdose.

Risk Factors for Complications During the Procedure

Hemodialysis

Heart problems

Peritoneal dialysis

Adhesions or significant abdominal scar tissue

Infection of the peritoneum (lining of the abdominal cavity)
Abdominal hernia
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 Diverticulitis
Abdominal defects

What to Expect
Prior to Procedure

Hemodialysis

Weight, blood pressure, and temperature are taken

Topical anesthetic (a pain numbing medicine) is applied to the arm for needle insertion
Heparin (a medication that prevents blood clotting) is given

Peritoneal Dialysis

Before the first treatment, the physician places a small, soft tube (approximately 24 inches long) in the abdomen.
This tube will remain there permanently. A portion of the tube remains outside the body for use in the process. It
is important to keep this access clean and dry to prevent infection.

Anesthesia

For hemodialysis: topical anesthetic

Description of the Procedure

Hemodialysis

Blood is filtered through an artificial kidney machine, called a dialyzer. The blood travels from the body to the
machine through tubes inserted into a vein in your arm, leg, or neck. An access site called a fistula or shunt may
be surgically created in one of your veins.

Fistulas may need as long as 2 to 3 months to fully heal before they can be used. They are never used if the
treatment is temporary. They are typically created many months before dialysis is begun.

Hemodialysis is usually done at a dialysis center or hospital. It may be done at home with assistance. It is usually
done three times a week. Each treatment lasts from two to four hours.

Hemodialysis

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Peritoneal Dialysis

The abdominal lining is called the peritoneal membrane. In this type of treatment it is used to filter blood instead
of a machine. A cleansing solution, called a dialysate, is inserted into your abdomen. Fluid, wastes, and chemicals
pass from the tiny blood vessels in the peritoneal membrane into the dialysate. It is then drained after several
hours. New dialysate can then be added to repeat the process. A port in the abdomen may be needed for long-term
treatment.

There are three types of peritoneal dialysis:

Continuous ambulatory peritoneal dialysis (CAPD)—is the most common type of peritoneal dialysis. A bag
of dialysate is infused into the abdomen through a catheter. It remains there for 3-6 hours and is drained. The
abdomen is refilled with fresh solution. This way your blood is always being cleaned. No machine is needed.
Continuous cyclical peritoneal dialysis (CCPD)—is done by machine. It is done at night while sleeping.
Intermittent peritoneal dialysis (IPD)—uses the same type of machine as CCPD. This requires assistance and
is usually done at a hospital or center. It often takes longer than CCPD.

Peritoneal Dialysis

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After Procedure

Your blood pressure will be monitored.

How Long Will It Take?

The time needed for dialysis depends on a few factors:

How much kidney function remains

How much fluid weight gain has occurred since the last treatment
Amount of waste in the body
Body size
Level of minerals in your body such as sodium, potassium, and chloride
Dialysis method used

The approximate time and frequency of each method:

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 Type Length of procedure Frequency of procedure
Hemodialysis 2-4 hours 3 times/week
CAPD 3-6 hours, plus 30 minutes to drain 4 times/day
CCPD 9-12 hours Every night
IPD 12 + hours 36-42 hours/week

Will It Hurt?

In general, dialysis procedures do not cause pain. You will not feel the blood exchange. There may be some
temporary discomfort with the insertion of the needle or tube.

Possible Complications

Anemia
Drop in blood pressure during dialysis
Muscle cramps
Nausea, vomiting
Headaches
Infection
Feeling hot, sweaty, weak, and/or dizzy
Peritonitis (infection of the peritoneum), which causes fever and stomach pain (peritoneal dialysis only)
Growth problems in children
Inflammation of the heart sac (pericarditis)
Neurologic problems
Disruption of calcium and phosphorus balance, resulting in weakened bones

Average Hospital Stay

None

Postoperative Care

Once the procedure is complete and blood pressure is stable, you are free to continue daily activities. There are
some special considerations:

Dietary Guidelines

Certain dietary guidelines should be followed. This will help to keep overall health and optimize the treatment.
Patients who have peritoneal dialysis may have slightly fewer dietary restrictions than hemodialysis patients. This
is due to the more frequent filter schedule. Talk to your doctor about your specific dietary needs.

Medications

Your doctor may give various types of medication. These include, but are not limited to

Blood pressure medications

Calcium supplements or multivitamins
Phosphorus binders—to lower phosphorus levels in the blood
Diuretics—to remove excess fluid
Stool softeners or laxatives—to prevent or treat constipation, which can be caused by decreased fluid intake
Iron supplements—to increase iron intake, which is important for production of red blood cells

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Outcome
Dialysis helps maintain blood pressure, cleaning of the blood, and chemical and hormonal exchanges that are
critical to survival.

Call Your Doctor If Any of the Following Occurs

Signs of infection, including fever and chills
Redness, swelling, warmth, increasing pain, excessive bleeding, or discharge at the catheter or tube insertion
site
Blood or cloudiness in the peritoneal dialysis fluid
Nausea or vomiting
Abdominal pain
Dizziness or weakness

RESOURCES:

The Kidney Dialysis Foundation

http://www.kdf.org/

National Kidney Foundation

http://www.kidney.org/

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)

http://kidney.niddk.nih.gov/

CANADIAN RESOURCES:

The Kidney Foundation of Canada: British Columbia Branch

http://www.kidney.bc.ca/

The Kidney Foundation of Canada: Northern Alberta and the Territories Branch
http://www.kidney.ab.ca/

REFERENCES:

Dialysis. National Kidney Foundation website. Available at: http://www.kidney.org/. Accessed July 28, 2008.

Peritoneal Dialysis Dose and Adequacy. National Diabetes Information Clearinghouse (NDIC) website. Available
at: http://diabetes.niddk.nih.gov/. Accessed July 28, 2008.

Last reviewed February 2008 by Daus Mahnke, MD

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