Hemodialysis

Hemodialysis is a medical treatment used for people whose kidneys are no longer able to adequately filter waste, excess fluids, and electrolytes from the blood. This typically happens when the kidneys are severely damaged due to conditions like chronic kidney disease, diabetes, or high blood pressure.

During hemodialysis, blood is drawn out of the body through a needle and passed through a dialysis machine. This machine acts as an artificial kidney, filtering the blood and removing waste products and excess fluids. The cleaned blood is then returned to the body through a separate needle.

Patients typically undergo hemodialysis several times a week, and the treatment can last a few hours each session, depending on their individual needs.

Hemodialysis is used for treatment of:

  • Acute kidney injury (AKI): a sudden episode of kidney failure or kidney damage that happens within a few hours or days. AKI is usually treated in a hospital setting with intravenous fluids (given through the vein). In severe cases, dialysis may also be needed for a short time until the kidneys get better.
  • Kidney failure end-stage kidney disease (ESKD): when 10%-15% of your kidney function remains, measured by an estimated glomerular filtration rate (eGFR) of less than 15 mL/min.

How Hemodialysis works:

  • Waste and Fluid Removal: The machine removes excess waste products and fluids from your blood, such as urea, creatinine, and extra water, preventing these from accumulating to dangerous levels in your body. Without this filtration, toxins and fluids could build up and cause harm.
  • Maintaining Mineral Balance: It helps maintain the balance of vital minerals in your bloodstream, including potassium, sodium, calcium, and bicarbonate. Keeping these minerals in the correct levels is essential for the proper functioning of your body, including your heart and muscles.
  • Blood Pressure Regulation: Dialysis can also help in controlling blood pressure by removing excess fluid from the blood. This helps in maintaining the right amount of fluid in your body and keeps your blood pressure stable.
  • The Dialyzer (Filter): The dialyzer, often referred to as the “artificial kidney,” is a specialized filter. Blood flows into the dialyzer, where it is filtered. It consists of thousands of tiny hollow fibers through which blood flows. The membrane separating the blood from the dialysate fluid allows for waste and extra fluid to pass out of the blood, but larger components like blood cells and proteins stay within the blood, preventing them from being lost.
  • Vascular Access: To perform hemodialysis, a surgeon creates an opening in one of your blood vessels, typically in the arm. This is called vascular access. It provides a pathway for blood to flow from your body into the dialyzer and back into your body once it’s filtered.
  • Dialysate Fluid: The dialysate, a special fluid, flows on the opposite side of the membrane in the dialyzer. This fluid helps absorb the waste products and excess fluids from the blood. The composition of dialysate is carefully regulated to help maintain proper fluid and electrolyte balance during the treatment.

Types of Hemodialysis:

In-Center Hemodialysis

  • Description: This is the most common form of hemodialysis. Patients visit a dialysis center three times a week, where a healthcare professional performs the dialysis treatment. It usually lasts around 3-5 hours per session.
  • Advantages:
    • Professional medical supervision.
    • Access to emergency care if needed.
  • Disadvantages:
    • Requires travel to the clinic.
    • Can be time-consuming and restrictive.

Daily Hemodialysis

  • Description: Similar to home hemodialysis but typically done every day instead of every other day. This treatment generally lasts for a shorter period of time each session.
  • Advantages:
  • More frequent dialysis may result in fewer fluctuations in fluid balance and waste products.
  • May improve overall health and reduce some symptoms of kidney failure.
  • Disadvantages:
  • Requires more time commitment.
  • Requires training and a reliable home setup.

Short Daily Hemodialysis

  • Description: A variation of daily hemodialysis where shorter sessions (usually 2-3 hours) are performed each day.
  • Advantages:
  • More manageable for patients with busy schedules.
  • Less aggressive than longer sessions, which might reduce complications.
  • Disadvantages:
  • Less efficient than longer sessions.

Effectiveness

Hemodialysis is a very effective treatment option for clearing waste products and extra fluid from your blood. However, it does not fully replace all of the kidney’s functions, so it is not considered a cure for advanced CKD or kidney failure.
In some cases of sudden AKI, hemodialysis may only be needed for a short time until the kidneys get better. However, when kidney disease progresses slowly to kidney failure, your kidneys do not get better. You will need dialysis for the rest of your life unless you can receive a kidney transplant.

Side Effects

Hemodialysis does have side effects. Sometimes, it is hard to tell whether a symptom is due to treatment or if kidney failure is causing discomfort. Some of the most common side effects that people report include:

  • Muscle cramps
  • Blockage in your vascular access site (entrance point)
  • Hypotension (low blood pressure)
  • Weakness, dizziness, or nausea
  • Blood loss

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