What is Dialysis?

I’ve mentioned dialysis a few times, and I described what it was in some of my earlier blog posts, but I wanted to go into a bit more detail about its specifics.

Generally, kidney dialysis replaces many of the kidney’s important functions. It is a life-support treatment that uses a special machine to filter harmful wastes, salt, and excess fluid from your blood. This restores the blood to a normal, healthy balance. If you have kidney disease, you will not necessarily have to go through dialysis; most do not undergo it until they reach end stage renal failure. Dialysis is only supposed to be a ‘temporary fix’ while a patient waits for a kidney transplant. Unfortunately, this isn’t usually the case, and many patients are on dialysis for years.

There are two types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis takes in your blood, filters it through a dialyzer, which is essentially an artificial kidney, and returns the clean blood to the body.

hemodialysis
A basic hemodialysis set up
hemo filter
The filter has two parts, one for your blood and one for a washing fluid called dialysate, with a thin membrane in between. The small waste products in the blood like urea, creatinine, extra fluid, and potassium pass through the membrane and are washed away. Blood cells and protein, along with other important things, cannot pass through so they are not lost.

Hemodialysis can be done in a hospital, in a dialysis center that is not part of a hospital, or even at home. Where a patient decides to have it depends on their personal wishes, medical condition, and doctor’s input.

In a dialysis center, hemodialysis is usually done three times a week for about 4 hours at a time. People who choose to do hemodialysis at home may do dialysis treatment more frequently, 4-7 times per week for shorter hours each time.

Peritoneal dialysis is the second type of dialysis. Rather than filtering the blood, the inside lining of your own belly acts as a natural filter. Wastes are taken out by means of a dialysate and which is then washed in and out of your belly in cycles.

peritoneal dialysis
The abdomen first fills with dialysate after raising the solution’s bag. Waste, chemicals, and excess fluid flow through the abdomen’s membrane to the dialysate. Then the dialysate, along with all of the toxins, are drained into a lower bag. This process repeats over and over.

This process usually is done three, four or five times in a 24-hour period while you are awake during normal activities. Each exchange takes about 30 to 40 minutes. It may not seem like much, but carving out a few hours to cleanse your body each day, over and over, can get pretty repetitive and frustrating. Luckily, there is an option for an automated type of this dialysis, which cycles through this process for you while you sleep.

Peritoneal dialysis can be better than hemodialysis in a few ways. With continuous dialysis, you can control extra fluid more easily, and this may reduce stress on the heart and blood vessels. You are able to eat more and use fewer medications. You can do more of your daily activities and it is easier to work or travel. However, it is usually a daily activity rather than a few times a week, and not everyone can undergo it, like those who are obese or have had surgeries on their abdomen.

In terms of cost for these procedures, all types of dialysis are expensive. For most patients, luckily, the federal government now pays 80 percent of all dialysis charges, while private insurance or state medical assistance pays the rest. This is less of an issue for the wealthy and more of one for the poor. Many patients find that the cost of actual treatments are not the burden–it’s the time.

There are a lot of places that don’t have easy access to hospitals that perform these procedures, so patients have to travel exceedingly long distances. Additionally, many patients are elderly, and they can’t always choose the at-home option. The stress of fitting this into a daily schedule along with the other medical problems that usually come along with CKD sometimes becomes enough for people to quit their jobs. At that point, if they don’t have a caretaker, life becomes immensely more difficult. Even with a caretaker, things become more difficult because suddenly their world has to revolve around the patient. On top of all of that, the financial burden that only prolongs kidney failure, not cure it, can start to seem meaningless. Once you’re on dialysis, you can’t ever get off without a kidney transplant, and since the number of available kidneys is so small, most stay on dialysis their whole lives.

Looking into all of this made me realize why there is such a high number of dialysis patients experiencing depression, and why people would voluntarily choose to quit treatment.

On a more positive note, we can look forward to artificial kidneys becoming mainstream. Maybe someday, those with kidney disease can get an artificial one and live their normal lives. For now, though, what these patients have to go through is heartbreaking.

 

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