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Dialysis

Kidneys are the important organs in the body responsible for excretion of waste, toxic materials, and extra fluid from the body. Sometimes, the kidneys don’t work efficiently, causing accumulation of fluids, and metabolic wastes in the body. This accumulation of chemical can reach a toxicity levels, making the person sick. These patients may require dialysis- a treatment that purifies the blood by removing the waste, toxic materials, extra salts, and fluids from the body.

Types of dialysis

The two types of dialysis are:

  1. Hemodialysis
  2. Peritoneal dialysis

Hemodialysis: This type of dialysis is the most common type of dialysis, and involved purification of blood outside the body with the help of a machine. During the procedure, a dialysis machine, and a special filter called artificial kidney or dialyzer are used to purify the blood. The dialysis is usually performed three times per week, each session may last upto four hours.

Peritoneal dialysis: This type of dialysis involves purification of blood inside the body. A special fluid (dialysate) is passed through a catheter placed in the inside of the abdomen lining (peritoneum). This fluid absorbs waste materials that pass through the small blood vessels in the abdominal cavity. The fluid is drained out after some time, and again replaced with another set of fresh fluid. Peritoneal dialysis is performed at night with the help of a machine, usually while sleeping. This type of dialysis needs to be performed every day.

The two types of peritoneal dialysis are:

  1. CAPD (Continuous ambulatory peritoneal dialysis)
  2. APD (Automated peritoneal dialysis)

Continuous ambulatory peritoneal dialysis: The dialysis is performed without any machines, and by the patient himself. The patient puts about two quarts (bag) of dialysate into the peritoneal cavity and then drains this dialysate after a period of 3 to 4 hours time. This is called as an exchange and the patient needs a new bag of dialysate for each exchange. This procedure is performed continuously.

Automated peritoneal dialysis: This type of dialysis is done at home using a machine called cycler. The number of cycles (exchanges) is more than CAPD. Exchanges last for a period of 1 to 2 hours and must be done continuously.

Indications for dialysis

Dialysis may be needed in patients with:

  • Chronic kidney disease
  • Kidney failure
  • End-stage renal disease
  • Failed kidney transplant

Pre-requisites for a dialysis

It is necessary to have laboratory tests done to assess the need for dialysis, and an intravenous access for hemodialysis.

Diagnostic tests that confirm the need for dialysis may include serum creatinine levels, glomerular filtration rate test, blood urea nitrogen test, and creatinine clearance test. A kidney biopsy is done to find the extent of damage to the kidney.

Intravenous access

The patient may need a minor surgery to create a direct access to the bloodstream. It is done prior to the start of the dialysis in the initial stage. Surgery is done through any one of the following:

  • Arteriovenous fistula or A-V fistula or fistula
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