Dialysis is needed in severe kidney failure, also renal failure, stage 5 chronic kidney disease, or end-stage renal) disease. When the kidneys are no longer working effectively, waste products, electrolytes, and fluid build up in the blood. Dialysis takes over a portion of the function of the failing kidneys to remove the fluid and waste products. However, Kidney transplantation is a better choice of treatment for these patients as this completely take over the function of the failing kidneys unlike in dialysis which is needed on regular basis two to three times in a week.
The choice between hemo or peritoneal dialysis is made by a number of considerations such as availability, convenience, underlying medical problems, home situation, and age.
Fore arm AV Fistula (Radio Cephalic)
Here, a small incision is made on lateral side of forearm just above the wrist. The artery and veins are dissected and joined together. After 2 to 3 weeks, the vein gets arteralized because of increase flow diverted from artery into vein. Dialysis is now done with these arteralized veins. The procedure can be done under local anaesthesia.
Upper arm AV Fistula (Brachio Cephalic)
Here a small incision is made just above the elbow. The artery and veins are dissected and join together. After 2 to 3 weeks the vein gets arteralized because of increase flow. The dialysis now can be done these arteralized veins. This procedure usually is offered when distal veins are not good.
Perm Catheter Placement
When no suitable veins are available in either arm or forearm, a double lumen catheter is placed in neck veins. This catheter is tunneled beneath skin of neck before making it entry to neck veins to reduce infection. Longevity of such catheter is 1 to 2 years.
CAPD (Continuous ambulatory peritoneal dialysis)
In some patients, hemodialysis is not possible either because of non accessible vessels or hemodynamic instability during hemodialysis, peritoneal dialysis is offered. Here a catheter is placed in abdomen (peritoneal cavity).Through this, 2 to 3 liter special fluid is put in this cavity so that all the waste is diluted in this fluid and then is drained after six to eight hours. Such two to three cycle is needed in whole day. This can be done by patient himself at home.
Dr. Amit K. Devra with year of experience can help you to decide regarding choice of dailysis. For the access of dialysis arterio venous fistula formation is needed.
When to start Dialysis?
It is recommended that dialysis should start before kidney disease has advanced to the point where life-threatening complications affecting the brain, heart lungs occur. If one starts dialysis very late, then the quality of life is not significantly improved even after receiving regular dialysis.
Emergency Dialysis is usually given when
- Life threatening Hyperkalemia(high potassium levels in blood)
- Loss of hepatitis,continous weight loss and repeated vomiting
- Bleeding diathesis due to uremia
- Bleeding diathesis due to uremia
- Percarditis, i.e. fluid collection around the heart
- Patient is an altered mental state or has motor weakness due to involvement of nerves.
- Blood tests reveal very high BUN/ Serum Creatnine
Generally most patients with ESRD can undergo KTP but some people with kidney failure specially patient in older age and severe heart or vascular disease may be unfit to undergo kidney transplantation and are treated with long term dialysis. The conditions that prevent a person from being eligible for kidney transplantation include:
- Active or recently treated cancer.
- Active infection.
- A chronic illness that could lead to death within a few years.
- Dementia/Poorly controlled mental illness.
- Severe obesity (a body mass index greater than 40).
- Current drug or alcohol abuse.
- Shortness of breath.
- Generalized swelling (edema)
- Generalized weakness due to anemia.
- Loss of appetite.
- Flu-like symptoms.
- Decreased urine output.
Dr Amit K. Devra is well known leading transplant surgeron of Delhi NCR. He has done more than 700+ successful Kidney transplant by himself. He is also expert in doing transplant with unmatched blood group (ABO incompatible), paediatric transplant, Second transplant and donor with complex anatomy/multiple renal vessels. He has started successful transplant programme at many centres at Delhi NCR. He has special interest in kidney transplant surgery and his patients following are not only from different parts of India but also from different countries like Afganistan, Uzbekistan, Tazakistan, Krygistan, Cambodia, Nizeria, Megadaskar and Tanzania.
- A reduced amount of urine.
- Swelling of your legs, ankles, and feet from retention of fluids caused by the failure of your kidneys to eliminate water waste.
- Unexplained shortness of breath.
- Excessive drowsiness or fatigue.
- Persistent nausea
- Pain or pressure in your chest.
- People receiving haemodialysis are at increased risk of developing sepsis (blood poisoning)
- Low blood pressure (hypotension) is one of the most common side effects of haemodialysis.
Patients who are not candidates for kidney transplantation or who must wait for a kidney can usually be treated with either hemodialysis or peritoneal dialysis.
Choosing between peritoneal dialysis and hemodialysis is a complex decision that is best made by you, your doctor, and often other family members or caregivers after careful consideration of a number of important factors.
For example, hemodialysis involves rapid changes of the fluid balance in the body and cannot be tolerated by some patients. Some patients are not suitable candidates for kidney transplantation, while others may not have the home supports or abilities needed to do peritoneal dialysis. Your overall medical condition, personal preferences, and home situation are among the many factors that should be considered. It is possible to switch from one type of dialysis to the other if preferences or conditions change over time.