Dialysis

Why would someone need dialysis?

Dialysis substitutes the natural work of the kidneys, so it is also known as renal replacement therapy (RRT). Healthy kidneys regulate the body's levels of water and minerals and remove waste. The kidneys also secrete certain products that are important in metabolism, but dialysis cannot do this. 

A person who has lost 85 to 90 percent of their kidney function will be a likely candidate for dialysis. Around 14 percent of the population of the United States are thought to have chronic kidney disease (CKD).

Common medical problems that damage kidneys are diabetes and hypertension.

How is the blood removed and cleaned?

This is called dialysis access. There are four ways this can be done.

  1. A tunneled catheter in your neck—temporary, because the possibility of infection is high.
  2. An AV fistula—taking a piece of a vein from your arm or leg and sewing it into a nearby artery, and allowing the sewn-in vein to enlarge and become thicker, like an artery. Considered the best option because it has the lowest risk of infection.
  3. An AV graft—the sewing of a prosthetic graft between an artery and vein in your arm or leg. The preferred option if your veins are too small for an AV fistula. AV grafts tend to close more quickly and are more prone to infection because they are not formed from natural tissue.
  4. Peritoneal dialysis—placement of a small tube, called a cannula, in your abdomen to allow the use of the lining of the abdomen (peritoneum) to filter your blood. It requires several “exchanges” every day: you introduce and remove fluid through the tube. A convenient option because you perform the dialysis therapy at home, but infections sometimes occur and the tube can become clogged.

Preparation for dialysis

  • Avoid having blood drawn from your non dominant arm- the usual arm chosen to create the access
  • Your surgeon will order an US to “size” your veins and make sure they are large enough to create a fistula. If they are too small then an AV graft will be placed.
  • The surgery- It takes 1-1.5 hours and is an outpatient procedure. 
  • Both AV fistulas and AV grafts take time to “mature” before they can be used. Fistulas take 90 days. Grafts take 21.

After the surgery

  • You should feel a “tingling” over the vein or graft- this is called a thrill Check for this every morning
  • Do not sleep on the operated arm
  • Avoid tight fitting garments over the site.
  • Call your surgeon for increased pain, drainage or inability to fill the thrill.

Dialysis can be a frustrating experience for some people and problems may arise.

MetroHealth surgeons and kidney specialists are on your team and will do everything possible to minimize problems and correct them as they occur.

Content reprinted with permission from the Society for Vascular Surgery® (SVS).

 

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