As the dialysis treatments has two main types: hemodialysis and peritoneal dialysis, you need to select one of them. So, what is the best treatment between hemodialysis vs peritoneal dialysis?

Why do you need dialysis?

In the latter stage of Chronic Kidney disease (CKD), you need to have Renal Replacement Therapy (RRT). RRT includes either transplantation of a kidney or regular dialysis treatment. 

Dialysis is a process of clearing out the unnecessary components of the body. This process includes some toxic elements, excretory products, drugs, etc. 

There are two main types of dialysis;

1. hemodialysis
2. peritoneal dialysis

Although hemodialysis and peritoneal dialysis function differently, the ultimate goal is the same. That is the replacement of the kidney functions of the body. 

What is hemodialysis?

Hemodialysis is a process of purification of blood. This process uses an external machine called the dialysis machine. The blood is taken out of the body. Then the blood is going through a dialyzer.  

When you undergo hemodialysis, you need to have vascular access to train the blood out of the body. You can have an AV Fistula, AV Graft, or some other type of access for this. 

Disadvantages of hemodialysis

Usually, the hemodialysis is done in a hemodialysis center or home. You need to undergo around three hemodialysis for a week. Also, it takes about three to five hours to complete. Therefore you need to adhere to a tight schedule to continue your regular hemodialysis. Also, you cant have long travel distances from your dialysis center. 

Complications of hemodialysis

It has some complications too. The dialysis-related hypotension, dialysis disequilibrium syndrome, Hypoglycemia, etc. are some of them. 

Advantages of hemodialysis

However, the hemodialysis is more effective in clearing out particles than the peritoneal dialysis. Usually, hemodialysis is beneficial in the latter part of the disease. Also, the risk of infection is very low. You do not feel much discomfort to have an AV fistula. 

What is peritoneal dialysis?

In peritoneal dialysis, we use the abdominal cavity to have dialysis. The peritoneal dialysis solution is inserted into the peritoneal cavity. Then we have to wait for 30 – 40 minutes for the dialysis process. Usually, we have to do it 3 to 5 times a day. 

Disadvantages of peritoneal dialysis

When you undergo peritoneal dialysis, you have to have proper training. Also, it would help if you had an aseptic area. It would also be best if you had adequate time to have peritoneal dialysis several times a day. 

Complications of peritoneal dialysis

Also, peritoneal dialysis associate with peritoneal infections. Peritonitis is quite a lethal condition. Therefore you need proper handling during the procedure. But according to some researches, both hemodialysis and peritoneal dialysis have the same morbidity rates. 

Advantages of peritoneal dialysis

However, peritoneal dialysis is cheap compared to haemodialysis. You do not need to travel to a dialysis center for your peritoneal dialysis. You can freely continue your day to day activities and travel. Additionally, the newel methods like Continuous Ambulatory Peritoneal Dialysis (CAPD) have created fewer complications. 

 

What is the better option between hemodialysis vs peritoneal dialysis?

When you ask to start dialysis treatments, your nephrologist will discuss the method of renal replacement. If you are not undergoing a kidney transplant, you will offer another type of RRT. This option is either hemodialysis or peritoneal dialysis. 

But some people can’t undergo hemodialysis effectively, while others can’t have peritoneal dialysis. It would help if you discussed this with your nephrologist. He will explain you cons and pros of hemodialysis vs Peritoneal dialysis. 

Factors contributing to the selection of dialysis method

Usually, if your eGFR falls less than 15, you need dialysis treatments. But you need to select a better dialysis method for you. When you decide the better one between hemodialysis vs peritoneal dialysis, use the following factors. 

1. Your preference between hemodialysis and peritoneal dialysis
2. Distance to nearest hemodialysis center
3. Affordability of dialysis treatment methods
4. Possibility of insurance coverage of your treatment method
5. Plan for transplants
6. Level of education

So, now you would understand the decision between hemodialysis vs peritoneal dialysis is affected by a lot of factors. You need to consider all of them before the selection of one of them. 

Referance:

1. Hemodialysis : https://en.wikipedia.org/wiki/Hemodialysis

Why Kidney disease patient need regular dialysis?

When you have End Stage Kidney Disease you have to undergo regular hemodialysis. This is to give the continuous kidney functions outside the body. This regular haemodialysis will ensure the proper execratory and other regulatory functions of the kidney.

However the haemodialysis is not a one time process. You have to repeat the dialysis in a regular basis like 3 times a weeks, 2 times a week or else. This regular haemodialysis is done at a hemodialysis center or at the patients own home.

Even in a situation like covid 19 , it is necessary part to continue haemodialysis without interruption.

How to be safe as a hemodialysis patient during COVID 19

Make sure you have safe dialysis center

When you are selecting or continue the hemodialysis during covid pandemic it is essential to find a place with proper infection prevention procedures. Specially it it has separate rooms for the each patient it will be beneficial.

Do not use public transport

Some people prefer the public transport than the private transport systems. This is not a good option for a CKD patient to have there transport during COVID 19. As they are less immune, they can get infected easily. Additionally they have a high mortality rate too.

Therefore find a near place for your haemodialysis. Use a private vehicle to reach the dialysis center.

Use facemasks

Face-mask is an essential item for covid prevention. When you are travelling in a public, you always need to wear a mask and follow necessary infection prevention protocols.

However if you use separate dialysis room, you do not need to wear a mask. But if its a common room, you have to wear a mask.

Practice proper hand washing techniques

Hand washing is alos a mandotory part of covid prevention. When you go away from your home, it is essential to practice hand washing. In addition use hand washing techniques before and after dialysis session.

Inform health staff on warning signs

When you use common dialysis facilities, you are also bound to protect the health of other dialysis patients too. Therefore it is necessary to inform the dialysis center about your warning sings of COVID 19 infection like fever, cough, cold etc.

Avoid the crowded places

When you are continue haemodialysis during covid 19 infection, it is necessary to minimize the exposure to the public. This include all social gatherings, visiting to the public places and etc.

This will avoid unnecessary troubles during covid 19 pandemic and ensure the safe hemodialysis.

How to safeguard the hemodialysis patients as health staff ?

In the corona pandemic we have to be safe whenever we are touching or dealing with patients. You may be doctor, dialysis nurse or dialysis technician attached to a dialysis center, whatever the occupation, you all have to be safe whenever possible.

As an staff member of the dialysis center, you have the responsibility to avoid the spread of covid through your dialysis center. Following guide will help you to continue hemodialysis during covid 19 pandemic.

Always screen the patients before entering to the dialysis center

Whenever a new patient or regular patient come for dialysis all of them has to undergo proper screening questioner to select the risk group of patients. The screening questioner should be covering recent visits, warning symptoms and etc.

Use separate rooms for risk groups

In some dialysis centers, they have the separate dialysis rooms. All the risk group of patients awaiting for dialysis has to inserted to these rooms. This will avoid cross contamination of corona infection.

Always use proper safety precautions during dialysis

Always you have to wear a mask, practice hand washing techniques and etc.

Use PPE when necessary during haemodialysis

When you continue the haemodialysis of the risk group of patients for COVID 19, it is always advisable to use a Personal Protective equipment (PPE). PPE will save you from corona infection while continue haemodialysis during corona pandemic.

Reference

https://www.cdc.gov/coronavirus/2019-ncov/hcp/dialysis.html

What is the function of the human kidney ?

Human kidney has various functions in the body. Both kidneys work together to do provide adequate kidney function in body. The functions of the kidney are vary. It has lot of metabolic function to maintain the balance of the chemical balance in the body. In addition it has hormonal functions.

These are the list of functions of the kidneys;

1. Produce urine and remove unnecessary amount of fluid from the body
2. Remove waste products like urea, creatinine and etc.
3. Maintain acid base balance of the blood
4. Maintain electrolyte balance of the blood
5. Produce glucose from the body (Glyconeogenesis)
6. Produce Erythropoitein to maintain hemoglobin levels
   
   

Why there are a two kidneys ?

If you want to know the answer for “can you live with one kidney”, you probably me think why we have two kidneys instead of one. So there may be different explanations for the reasons for two kidneys. However scientist define this as the “Bilateral symmetry” of the body.

Not only you have 2 kidneys, but also you have lungs, eyes, hands, foots, ears and some of other organs as pairs. So when you have some organ as a pair, it two clones of the organ can work cooperatively to achieve its function. Likewise two kidneys can function better than single kidney.

What are the conditions causing single working kidney?

Sometimes you might not believe that there are people who born with single kidney. (unilateral renal aplasia). Usually it is around 1 /1000 live births. In addition there are some other instances for having one kidney.

Unilateral renal aplasia

As mentioned above some babies born with only one kidney. It may be either right kidney or the left kidney. Unilateral renal agenesis usually do not show any symptoms, unless you detected it by chance. In addition you may notice the absence of one kidney due to renal failure which developed later. This is usually due to rare genetic mutation.

Horse-shoe kidney

Congenital horse shoe kidney is another type of problem arises at birth. Even though you have two kidneys, they are fused together and worked like a one kidney.

Unilateral kidney failure

In some situations you may have to face disease conditions like obstructive uropathies due to posterior urethral valve, urinary calculi, urinary track strictures and etc. In such situations, there is a risk of kidney failure in one side.

Donor of kidney transplants

There are some instances you would find people with single kidney due to the live donor kidney transplants. If you become a donor of a living-donor kidney transplant, you have be with only one kidney through out the life.

Can’t we live without two kidneys?

Even though we have two kidneys, most of the patients with one kidney lives fairly normal. Additionally sometimes we do not even notice these patient with unilateral renal aplasia as they do not show any symptoms to the outside.

Therefore it having two kidneys is not a necessary part of maintaining the renal functions. Rather it plays a function of reservoir for future benefits.

How can you live with one kidney through out the life?

One of the common problem for kidney donors is “whether can I live with only one kidney after the donation?” So simple answer is YES, you can live with one kidney. But you have to take precautions to protect remaining kidney.

Steps for live with one kidney

Undergo regular medical screening

When you have only one kidney, you have to protect the kidney through out the life. Unless you will loose the remaining kidney. Then you will have renal failure and has to be haemodialysis dependent patient. So it is necessary to under go regular medical check up and screening. Regular screening of blood pressure, blood sugar levels, Urine reports are some of the very important screenings to protect the kidney.

Control your blood pressure

High blood pressure is one of the common issue causing the renal failure. When you have only one kidney, it is necessary to have strict blood pressure control to protect the kidney.

Control blood sugar levels

You can live with single kidney only when you have good blood sugar control in addition to the blood pressure. Both these play a major role to damage the remaining kidney.

Seek medical advice early

Life with one kidney is not simple as you think. You need to take every possible effort to protect the remaining kidney. There are some special conditions you need to take medical advice soon as possible

1. Pain during urination
2. Fever with back pain
3. Bleeding with urination
4. Pus in the urine

Reference:

1. https://en.wikipedia.org/wiki/Kidney

Why do we do dialysis in patients?

Your kidney have very important set of functions to maintain balance between lots of body functions. This includes excretion of waste products, removal of excess water from the body, maintain electrolyte balance, maintain acid base balance and etc.
If someone fail to maintain these kidney functions, they will be facing lot of problems
Eg:

• Accumulation of water in the lungs (Pleural effusion)
• Accumulation of water in abdomen (Ascites)
• Excess Potassium in the serum (Hyperkalemia)
• Reduced pH in the blood (Acidosis)

As most of above issues are life threatening timely dialysis is very important.

How need hemodialysis?

As mentioned, there are two groups of patients who need dialysis.

1. Patients with Chronic Kidney Diseases (CKD)
2. Acutely ill patient with Acute kidney injury (AKI)

Dialysis of CKD patients

Hemodialysis is one of the very important option in management of CKD patients. It will help to maintain most of the kidney functions.
This will ensure;

• Removal of excess fluid from the body
• Remove excess Potassium from the plasma
• Maintain acid base balance

Dialysis of AKI patients

There are patients who get Acute Kidney Injuries (AKI) following different incidents. Viper bites, Sepsis, Leptospirosis are some of them. In such situations some patients undergo urgent haemodialysis.

How to dialysis a patient?

When we say dialysis most of the time it represents hemodialysis than the peritoneal dialysis.
When we do haemodialysis, the basic of this process is to take blood out of the body, purify it and re transfuse into the body. But this is very complicated process than this.

Steps of hemodialysis

1. Prepare the dialysis machine
2. Heparinize the vascular set properly
3. Connect the patient through Vascular access to the dialysis machine
4. Adjust all parameters of dialysis including UF, BFR, Heparin dose and etc
5. Let blood go through the semipermeable membrane of the dialyzer
6. Re transfuse blood to the patient
7. Reinfuse the blood after completion of procedure
8. Disconnect the Vascular line
9. Await for hemostasis

Important parts of Dialysis procedure

What is dialyzer?

As I mentioned, dialysis is an artificial process. So to give you kidney functions artificially, there should be an artificial kidney. Dialyzer is the one doing the function of an artificial kidney in the dialysis machine.

The dialyzers are made of synthetic semi permeable membranes. These membranes are capable of providing selective permeability to some of the molecules while others do not get it.
So dialyzer is the most important part of the haemodialysis machine.

Vascular access

When you want to undergo haemodialysis, you need to have an access point. This may be a AV Fistula, AV Graft, Perm Cath or Temporary Catheter. So each have different abilities. You should select your vascular access depending on your future dialyzing plan, vascular structure and lots of other factors.

However if you are undergoing an urgent haemodialysis, you have to use a temporary femoral or neck vascular catheter.

The vascular access will ensure the adequate blood supply to the dialysis machine. Also it will return all the purified blood to body.

Water supply

In a dialysis we are doing an invasive procedure to ensure the renal functions of the patient. However if we do not use proper water for this process, patients ended up with lot of complications. Sepsis is one of them.

Therefore we use a water plant with reverse osmotic systems.
This includes both filtering capacity of unnecessary particles and germs.

Complications of Haemodialysis

Although haemodialysis is a very important and effective treatment method, it may have lot of complications.

1. Dialysis Disequilibrium Syndrome
2. Hypotention during dialysis
3. Hypoglycaemia
4. Headache
5. Fever
6. Infections
7. Bleeding from vascular access

Reference

https://www.ajkd.org/article/S0272-6386(05)00436-1/fulltext