Dialysis Q&A

Davita dialysis center has a class called Kidney Smart.  Once your doctor sees dialysis in your near future you should go to a class and learn all of the different options out there for dialysis.  There are 2 main options available to you Hemodialysis and Peritoneal Dialysis.

Peritoneal Dialysis (PD) starts with having a catheter surgically inserted into the abdomen.  Bags of dialysate fluid are infused into the abdomen (peritoneal cavity) through the catheter (takes about 30 minutes) and left to capture toxins and waste products that leach out of the blood vessels in your abdomen over a period of time, called dwell time, usually 4-6 hours.  After your dwell time, the fluid is then drained and disposed of.  This procedure, called an exchange is done 3-4 times a day, every day.

There is a second option called Nocturnal Peritoneal Dialysis.  NPD is done while you sleep and takes about 9 hours to complete.  You get a machine called a Cycler that fills your abdomen with dialysate fluid slowly though the night, allows dwell time, drains the fluid and then refills your abdomen again. Your next drain will be later in the day.  This process is done every night.  NPD is the most requested form of dialysis as it gives the patient more freedom to come and go during a normal day.  The downside with NPD or PD for me is if you wish to travel you must take several boxes of supplies with you on your trip as well as your machine.  You can not switch back and forth between PD and NPD.  Another downside is that you can not submerge your cath tube.  We have a pool and swimming is a huge part of my life, so I don't think this technique is for me personally.

Question:  Where do you get the dialysis supplies?  
A company called Baxter will ship all of your PD supplies to your home.  You must have room to store several large boxes of different volume bags of dialysate fluid, boxes of masks, catheter caps, alcohol wipes, tubing, cassettes and gloves.

A second option is Hemodialysis.  Hemo means blood.  This dialysis treatment removes the blood from your body, runs it through a machine with a cartridge similar to the filters in your natural kidneys, called an Artificial Kidney, cleans the blood and returns it back to your body.

The kidneys are powerful organs. Each person has two kidneys located near the back just under the rib cage and about the size of your fist.  The kidneys have 5 very important jobs.  They are to remove wastes and extra fluids, Control blood pressure, Make red blood cells to carry oxygen from your lungs to supply all your body's needs, Keep bones healthy (they make vitamin D), and control PH levels.  Without them we would die.

In Hemodialysis a surgeon makes a Fistula in your arm  (sometimes in a different place if your veins don't cooperate).  A fistula is the joining together of a vein and an artery making a super vein.  Some patients require a flexible tube inserted between the vein and artery to bridge them together, this is called a graf. (not pictured)  A fistula needs 2-3 months to heal before it can be used.


During dialysis two needles are inserted into the super vein at the time of dialysis.  One removes the blood and the other replaces the blood back into your body.  The blood is cleaned in the Artificial Kidney machine.  A typical dialysis treatment takes place 3 times a week for about 3-4 hours per session.  A strict diet and fluid intake must be followed.  Labs are drawn at each dialysis session to determine your treatment time as well as to inform the kidney dietitian how to counsel you on diet modifications.

The second Hemo option is Home Hemodialysis.  You get a machine to use in your home to filter your blood.  You must have a partner to insert the needles and set the machine.  Because you are dealing with blood, your partner stays with you during the treatment in case of an emergency and unhooks you from the machine after the procedure.  You will need an area to store boxes of supplies similar to what is mentioned in PD.

Question:  If I choose Hemodialysis, can I travel? 
Yes!  There are dialysis centers all over the US that you can visit while on vacation and get the treatment you need.

Question:  Can I swim if I'm on Hemodialysis?
Yes!!  Believe it or not the ocean is often suitable for swimming in while on dialysis because the salt content is high and a naturally cleaner than lakes and rivers.  Lakes and rivers are discouraged.  Home swimming pools are approved.  You must keep your chlorine levels high and only swim in clear water.

So what did I decide to do?
Here are some very good questions that two of my friends asked me yesterday that you might be thinking about too.

How was your Kidney Smart class?
It was great.  There were only 2 of us in the class, along with our spouses.  The class was very informal and questions were encouraged.  We watched a video on the types of dialysis options out there and received a cook book full of kidney friendly recipes.

Are you going to start dialysis at this time or in the future and is it 3 days a week?
Because I choose In Center Hemodialysis, I have to go and have the fistula surgery before I can start dialysis.  Most patients do go to dialysis 3 days a week, M,W,F or T,TH,S for treatment.

Are you getting fistula surgery soon?
My Nephrologist has put the referral in to the surgeon.  I am waiting for the phone call to schedule the appointment.  After the surgery I will need to allow the fistula to heal a few months before it can be used.  Side note:  It's never too early to get a fistula.  You can have it a year before it's needed to be used.  It will always be there and be ready when you need it.

What are the benefits of a fistula?
The vein and the artery that are joined become a super vein.  It enlarges and becomes tough creating a better avenue for handling the heavy load of blood that will move in and out of my body every week.

Will it create less bruising or pain?
No less bruising or pain.  I will get 2 needles in my arm every dialysis and each time they will go into a different place.  It's call laddering or the button hole technique.  They start with the needle at the bottom of the arterial and venous sites of the fistula and move up to fresh skin on the next dialysis and so on utill you get to the top and then they start sticking at the bottom again.



This must be difficult. How are you processing all of this? The family?
I would be lying if I said fine. I'm a roller coaster of emotions.  Some days up and some days down.  The more I read about it all the more nervous I get, but knowledge is power, so when the time comes being well informed will help me remain calm and collected. I hope!
I think my family is as concerned as any family would be.  My kids call often, which soothes this mama's soul more that they realize.  My parents ask a lot of questions and my husband is a rock star, helping around the house and understanding when I'm tired or sad or just needing a break from reality and need to do something that takes my mind off of everything.


Thanks for reading my little blog!  I hope somehow someone out there feels more educated and empowered.  I will discuss what I know about the transplant on my next blog post.

Do you know anyone on Dialysis?  What option did they choose?  Leave me a message in the comments!!

Stay hydrated!





Disclaimer: I am not a doctor. I am not a medical professional. NO information on this site should be used to diagnose, treat, prevent or cure any disease or condition.

Comments

  1. Rick did all 3. Started with PD in 1990, then went to NPD until his transplant. When he went back on dialysis in 2003, went to in-center Hemo. It was September 2016 when we did home Hemo because of Rick's inability to drive anymore and the center was too far away to take him and still work as we were heading into the winter. At home, they wanted us to dialysis 5 days a week, but we settled on 4 days. Something I did learn is that the reason people go to in-center for 3 days a week is it's because the government figured out that is the bare minimum to keep someone alive. They tried once a week, people died... then twice a week, people died. Three times will keep you alive, but when you think about the human body, it filters 24/7. So more is better. Other countries recognize this too.
    Anyway, when you start dialysis, pay attention to your diet as it becomes very important to not eat certain foods to keep your labs normal.

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