What is Hemodialysis?

Hemodialysis is a life-sustaining medical procedure used to filter waste products, toxins, and excess fluid from the blood when the kidneys are no longer able to perform this vital function adequately. Think of it as an artificial kidney that steps in to clean your blood. This process is crucial for individuals with chronic kidney disease (CKD), kidney failure, or other conditions that severely impair kidney function. Without dialysis, these harmful substances would build up in the body, leading to serious health problems and eventually death.

Hemodialysis involves diverting blood from the body, passing it through a special filter called a dialyzer (artificial kidney), and then returning the cleaned blood back into the body. This process requires a vascular access point, usually created in the arm, that allows for easy and repeated access to the bloodstream. While hemodialysis is not a cure for kidney disease, it significantly improves quality of life and extends lifespan for those who need it. It's a commitment, usually requiring multiple sessions per week, but it's a vital lifeline for many.

Key Facts:

• Hemodialysis is a blood-filtering treatment when kidneys fail.
• It removes waste, toxins, and excess fluids.
• It requires a vascular access point.
• It’s typically performed 3 times a week.
• It significantly improves the quality of life for kidney failure patients.

Why is Hemodialysis Performed?

Hemodialysis is performed when the kidneys can no longer effectively filter waste and excess fluid from the blood. This can occur due to various reasons, including chronic kidney disease, acute kidney injury, or other medical conditions that affect kidney function.

Main Conditions/Indications:

• Chronic Kidney Disease (CKD)
• Kidney dysfunction or kidney failure (Acute Kidney Injury - AKI)
• Intractable hyperkalemia (high potassium levels)
• Acidosis (excess acid in the blood)
• Therapy-resistant fluid overload (excess fluid in the body)
• Uremic symptoms (symptoms caused by toxins in the blood) such as nausea, vomiting, fatigue, loss of appetite, and confusion.

When Doctors Recommend It:

Doctors typically recommend hemodialysis when kidney function has declined to a point where the body can no longer maintain a healthy balance of fluids and electrolytes, and waste products are accumulating to dangerous levels. This is often determined by blood tests that measure kidney function, such as creatinine and blood urea nitrogen (BUN) levels. Doctors also consider the patient's overall health and symptoms when making this decision. If conservative treatments like diet changes and medications are no longer sufficient to manage the condition, hemodialysis becomes necessary.

Preparation for Hemodialysis

Proper preparation is crucial for successful hemodialysis treatment. This involves several steps, including creating a vascular access, undergoing pre-dialysis assessments, and understanding what to expect during the procedure.

Essential Preparation Steps:

1. Vascular Access Creation: This is the most important step. A surgeon will create a vascular access point, usually in the arm, to allow for easy and repeated access to the bloodstream.
   • Arteriovenous fistula (AVF): The preferred option, created by connecting an artery and a vein. This takes several weeks or months to mature before it can be used.
   • Arteriovenous graft (AVG): Uses a synthetic tube to connect an artery and a vein. This may be used if the patient's veins are not suitable for an AVF.
   • Central venous catheter: A temporary option, a tube inserted into a large vein in the neck, chest, or groin. This is typically used for patients who need immediate dialysis.
2. Pre-dialysis Assessment: The medical team will assess your overall health, including:
   • Blood pressure and heart rate
   • Weight
   • Review of medications
   • Discussion of any existing medical conditions
3. Dietary Adjustments: Your doctor or a registered dietitian will provide specific dietary recommendations to help manage your kidney disease. This may include limiting your intake of potassium, phosphorus, sodium, and fluids.
4. Medication Review: Inform your doctor about all medications you are taking, including over-the-counter drugs and herbal supplements. Some medications may need to be adjusted or avoided before dialysis.

India-Specific Tips:

• Fasting: Discuss with your doctor whether you need to fast before your dialysis session. This may be necessary for certain blood tests.
• Documents: Always carry your medical records, including your dialysis schedule, medication list, and any relevant test results. Your Ayu app can help manage this.
• PCPNDT Act: This act doesn't directly apply to dialysis, but be mindful of ethical practices and avoid any practices that discriminate based on gender.
• Accessibility: Plan your travel to the dialysis center, especially if you live in a rural area. Many patients in India have to travel long distances to access dialysis.

What to Expect:

• Expect the vascular access site to be examined before each dialysis session.
• Expect to be weighed before and after dialysis to monitor fluid removal.
• Expect to have your blood pressure and other vital signs monitored during the procedure.
• Expect to receive education and support from the dialysis team.

The Hemodialysis Procedure

The hemodialysis procedure involves several steps to effectively filter waste and excess fluids from the blood.

Step-by-Step (Concise):

1. Preparation: You will be weighed and your vital signs will be checked. The dialysis technician will examine your vascular access site.
2. Connection: Two needles will be inserted into your vascular access. One needle will draw blood from your body to the dialysis machine, and the other needle will return the cleaned blood back to your body. If you have a catheter, the two lines of the catheter will be used.
3. Dialysis: Your blood will flow through the dialyzer, where waste products and excess fluid are removed. The cleaned blood is then returned to your body.
4. Monitoring: During the dialysis session, your blood pressure, heart rate, and other vital signs will be monitored closely.
5. Completion: Once the dialysis session is complete, the needles will be removed from your vascular access. Pressure will be applied to the access site to stop the bleeding. Bandages will be applied.
6. Post-Dialysis: You will be weighed again and your vital signs will be checked. You may be given instructions for post-dialysis care, such as monitoring your access site for bleeding or infection.

Duration, Comfort Level:

• A typical hemodialysis session lasts about 3-4 hours.
• Hemodialysis is generally not painful, but some people may experience discomfort at the access site or during needle insertion. You might experience a drop in blood pressure leading to dizziness or nausea. Muscle cramps are also common. It's important to inform the dialysis staff if you experience any discomfort during the procedure.

What Happens During the Test:

During hemodialysis, your blood is continuously filtered through a dialyzer. The dialyzer contains a semi-permeable membrane that allows waste products and excess fluid to pass through, while keeping important components like blood cells and proteins in your blood. The dialysis machine also monitors the flow rate of your blood and adjusts the dialysis fluid (dialysate) to ensure that the correct amount of waste and fluid is removed.

Understanding Results

Hemodialysis doesn't produce "results" in the same way a blood test does with specific numerical values. Instead, its success is measured by improvements in your overall health and well-being, as well as by monitoring certain blood parameters over time.

Normal vs. Abnormal Ranges (If Applicable):

There aren't "normal" ranges directly after hemodialysis. The goal is to achieve a reduction in waste products. Key indicators monitored regularly include:

• Creatinine: Aim for a significant reduction after dialysis compared to pre-dialysis levels. The target reduction varies from person to person.
• Blood Urea Nitrogen (BUN): Similar to creatinine, a significant reduction is the goal.
• Potassium: Maintaining potassium levels within a safe range (typically 3.5-5.0 mEq/L) is crucial to prevent heart problems.
• Phosphorus: Controlling phosphorus levels (typically 2.5-4.5 mg/dL) is important for bone health.
• Fluid Overload: Monitoring weight and blood pressure to minimize fluid retention.

What Results Mean:

• Improved Blood Chemistry: Effective dialysis leads to lower levels of creatinine, BUN, potassium, and phosphorus. This reduces uremic symptoms and improves overall health.
• Stable Blood Pressure: Hemodialysis helps control blood pressure by removing excess fluid.
• Reduced Fluid Overload: This can alleviate swelling, shortness of breath, and other symptoms of fluid retention.
• Improved Quality of Life: Successful hemodialysis can improve energy levels, appetite, sleep, and overall well-being.

Next Steps:

• Regular Monitoring: Continue to monitor your blood pressure, weight, and access site.
• Follow Dietary Recommendations: Adhere to your prescribed diet to help manage your kidney disease.
• Medication Adherence: Take all medications as prescribed by your doctor.
• Regular Dialysis Sessions: Attend all scheduled dialysis sessions.
• Communicate with Your Healthcare Team: Report any new symptoms or concerns to your doctor or dialysis team.

Costs in India

The cost of hemodialysis in India can vary depending on several factors, including location, type of hospital, and the patient's condition.

Price Range in ₹ (Tier-1, Tier-2 Cities):

• Cost per session: ₹1,500 to ₹4,000.
  • Tier-1 cities (Delhi, Mumbai, Bangalore): ₹2,500 - ₹4,000 per session.
  • Tier-2 cities (Pune, Ahmedabad, Kolkata): ₹1,500 - ₹3,000 per session.
• Monthly cost (12 sessions): ₹18,000 to ₹48,000.
• Annual cost: ₹2,16,000 to ₹5,76,000.

Government vs. Private:

• Government Hospitals: Generally offer dialysis at a lower cost compared to private hospitals. Some government schemes may subsidize or cover the cost of dialysis for eligible patients.
• Private Hospitals: Tend to have higher costs, but may offer more amenities and personalized care.

Insurance Tips:

• Check with your health insurance provider to see if hemodialysis is covered under your policy.
• Some government schemes, such as the Pradhan Mantri National Dialysis Programme (PMNDP), provide free or subsidized dialysis services to eligible patients.
• Explore options for financial assistance from NGOs or charitable organizations.

Additional Costs:

• Laboratory tests: ₹500 to ₹2,000 per test (periodic blood tests to monitor kidney function and overall health).
• Medications: ₹2,000 to ₹5,000 per month (e.g., erythropoietin injections to treat anemia, iron supplements, phosphate binders).
• Hospitalization: ₹50,000 to ₹2,00,000 for emergencies or complications (e.g., infections, blood clots).

How Ayu Helps

Ayu is a simple way to keep track of your medical records, especially important when undergoing treatment like hemodialysis.

• Store Results Digitally: Securely store all your dialysis-related reports, including blood test results and dialysis session summaries, within the Ayu app.
• Track Over Time: Easily track your progress over time by comparing your blood test results and monitoring your dialysis sessions.
• Share Via QR: Share your medical records with your doctor or dialysis team by generating a QR code directly from the app.
• Reminders: Set up reminders for your dialysis appointments and medication schedules.

FAQ

Here are some frequently asked questions about hemodialysis:

Q1: Is hemodialysis a cure for kidney disease?

No, hemodialysis is not a cure. It is a treatment that helps to filter the blood when the kidneys are no longer able to function properly.

Q2: How long will I need to be on hemodialysis?

Most people who start hemodialysis need to continue it for the rest of their lives, unless they receive a kidney transplant.

Q3: Can I travel while on hemodialysis?

Yes, but you will need to make arrangements for dialysis at a dialysis center in your destination. Discuss this with your dialysis team well in advance.

Q4: What are the common side effects of hemodialysis?

Common side effects include low blood pressure, muscle cramps, nausea, and fatigue. These can often be managed with medication and lifestyle changes.

Q5: Can I eat whatever I want while on hemodialysis?

No, you will need to follow a special diet that is low in potassium, phosphorus, and sodium. You may also need to limit your fluid intake. A registered dietitian can help you create a meal plan that meets your needs.

Q6: How can I care for my vascular access site?

Keep your access site clean and dry. Avoid wearing tight clothing or jewelry around your access arm. Monitor your access site for signs of infection, such as redness, swelling, or pain. Report any concerns to your dialysis team immediately.

Q7: What are the alternatives to hemodialysis?

The main alternative to hemodialysis is peritoneal dialysis. Kidney transplantation is another option for some patients.

Q8: What happens if I miss a hemodialysis session?

Missing a dialysis session can lead to a build-up of waste products and excess fluid in your body, which can cause serious health problems. If you miss a session, contact your dialysis team immediately.