Dialysis or hemodialysis is a medical procedure that aims to replace kidney function due to damage to the organ. During the dialysis process, blood will be flowed by a machine from the patient's body through a sterile channel and through a special dialysis membrane. Through these membranes, the body's metabolic wastes will be removed and stored in special fluids.
The main function of the kidneys is to regulate fluid balance in the body by producing urine. In addition, the kidneys also function to remove various metabolic waste in the body through urine.
Dialysis is needed for someone who has suffered severe kidney damage so that kidney functions cannot function properly. Dialysis can provide an opportunity for patients with kidney failure to continue to undergo daily activities properly.
Indications Dialysis
Dialysis is done in patients with kidney failure, both acute kidney failure and chronic kidney failure. Symptoms of kidney failure that can be observed include:
- The emergence of uremia symptoms, such as itching, nausea, vomiting, loss of appetite, and fatigue.
- High levels of acid in the blood or acidosis.
- The appearance of swelling in the body parts due to the kidneys cannot remove excess fluid.
- Hyperkalemia or high levels of potassium in the blood.
Common causes of chronic kidney failure include:
- Hypertension
- Diabetes
- Inflammation of the kidneys (glomerulonephritis)
- Inflammation of blood vessels or (vasculitis)
- Kidney cysts or polycystic kidney disease
The kidneys can also experience sudden (acute) damage that can be caused by post-surgical complications, heart attacks, and dehydration.
Blood Wash Warning
Dialysis is one of the effective medical therapies in maintaining the quality of life of patients with kidney failure. However, this procedure can also pose risks for patients who undergo it, such as:
- Blood pressure drops, especially in patients undergoing diabetes-related dialysis.
- Muscle cramp.
- Sleep disturbance.
- Depression, mainly due to emotional changes in patients suffering from kidney failure.
- Nausea and stomach cramps.
Preparation for dialysis
Preparation for dialysis is done several weeks before the procedure is first carried out. Patients need to be made access to blood vessels to make it easier for blood to enter and exit the body. There are 3 types of access arteries that can be made by a surgeon on a patient's body, namely:
- Arterial-venous fistula (cimino). Cimino is an artificial channel that connects arteries and veins, the arms that are used less frequently. Cimino is the type of access most often recommended because of its security and effectiveness better than other types of access.
- Arterial-venous grafts. Venous artery grafts are performed by connecting the arteries and veins by adding a flexible synthetic hose. This access method is done if the patient's blood vessels are too small so that it is difficult to form a fistula.
- Hemodialysis catheter. There are 2 types of catheters that are used as access, namely:
-Non-cuffed catheter, or commonly called a double lumen catheter, is an access made for patients who need dialysis in an emergency. The doctor will insert a sterile plastic catheter into a large vein in the neck or groin. The catheter is usually only temporary (less than 3 weeks) and will be removed when the patient is not required to undergo dialysis, or has had more permanent access, such as cimino.
-Cuffed catheter (tunneling) is a catheter that is placed under the skin and then connected to a large vein. Depending on the type of catheter, tunneling can last up to 1-2 years. This is done if cimino or arterial-venous grafts cannot be done or are not ready for use.
Keep in mind that access to these blood vessels must be kept clean, so as not to cause infections and other complications that can endanger the patient and interfere with dialysis procedures. In addition to access preparation, patients will also be examined for possible diseases that can be transmitted through blood, such as hepatitis B, hepatitis C, and HIV.
Dialysis Procedure
The first step taken by the doctor to begin the dialysis procedure is to check the health condition of the patient's body. Doctors and nurses will conduct physical examinations of patients such as blood pressure, body temperature, and body weight. After that, access to dialysis that has been previously made is cleaned for needle placement. Two needles connected to the dialysis tube were then installed at the access point that had previously been made at the preparation stage. One needle will drain blood to the dialysis machine, while another needle will drain blood from the dialysis machine into the body.
Blood will flow through the sterile tube to the dialysis device. Excess body fluids and metabolic wastes will be removed after passing a special membrane. Blood that has undergone the process of dialysis is then returned to the body using a special pump. During dialysis procedures, patients are allowed to do relaxing activities, such as watching television, reading, or sleeping, but must remain in bed. Patients can notify the doctor or nurse about the discomfort felt during dialysis procedures. During dialysis, doctors and nurses will monitor the patient's condition regularly.
The dialysis procedure usually lasts around 2.5 to 4.5 hours, and is done 2-3 times a week. After dialysis is complete, the needle will be removed from the location of the dialysis access, and the needle prick is closed tightly and tied tightly so that the patient does not experience bleeding. To determine how much fluid is discharged, doctors and nurses will re-weigh the patient's weight.
After Washing Blood
Despite dialysis, patients are encouraged to maintain their health. Patients can maintain their health by eating healthy foods so that fluid, protein, and salt intake remains balanced. In managing healthy eating patterns, patients are encouraged to discuss with nutritionists. In addition, patients also still have to take drugs given by doctors in internal medicine, hypertension kidney consultant (KGH).
To ensure that metabolic remnants are removed properly, the doctor will monitor the patient's condition before, during, and after dialysis. Once a month, the doctor will conduct several tests to monitor the patient's condition, namely:
- Urea reduction ratio test (URR) and total urea clearance through blood tests. Both of these tests can monitor the process of dialysis taken, whether it is effective and reaches the target or not.
- Measure blood flow from access.
- Blood cell count and chemical tests in the blood.
Acute or chronic kidney failure will determine how long a person must undergo dialysis.
Dialysis is one of the 3 kidney replacement therapies, in addition to continuous ambulatory peritoneal dialysis (CAPD) or dialysis through the stomach, and kidney transplants. In people who have experienced irreversible kidney damage (chronic kidney failure), given a choice of 3 kidney replacement therapy. Some people who are still eligible for kidney transplants can undergo dialysis as a temporary treatment to get a kidney donor. After getting a kidney donor, the patient will undergo a transplant or kidney transplant operation so there is no need to undergo dialysis procedures again.
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