What is hemodialysis?
Hemodialysis is a method of treating kidney failure that involves using a machine to remove blood from the body, filter it and return it to the blood stream free from toxins. It’s performed on a regular basis to keep the blood healthy—usually three times per week.
Why it's done
The kidneys are the filters of the body, so when they aren’t doing their job, your body is essentially being poisoned. The machine used in hemodialysis temporarily functions as your kidneys, allowing us to remove toxins and return healthy blood back to your body. We typically perform hemodialysis when your kidneys reach less than 15 percent of their normal function.
Patients at risk for kidney disease are those who have had diabetes or high blood pressure for an extended period of time, those who suffer from kidney cysts or inflammation in the kidneys, and those who suffer an injury to the kidneys which warrants emergent care.
When it comes to issues related to kidney failure, we believe that early detection is key, as it helps us ensure a smooth and seamless treatment approach. Our vascular surgeons are dedicated to taking the steps to prepare you for hemodialysis before it’s required. Often, this means working with your nephrologist closely and having a fistula, or a joining of your vein and artery, put in before you actually need hemodialysis. This practice gives the fistula time to mature properly, which means we won’t have to use a catheter or graft to perform dialysis down the road. Though a seemingly small step, it goes a long way for preventing infection, protecting your quality of life and ensuring the treatment is both safe and effective should you need it. It’s important to note that having a fistula inserted does not mean you will have to undergo hemodialysis. Instead, it simply ensures you are prepared if that need presents itself.
With the right preparation, the chance for any major complications is minimal. However, issues you may encounter related to the treatment include:
- Changes in blood pressure
- Muscle cramping
- Trouble sleeping
In severe cases, an infection, aneurysm or blockage could develop at the dialysis access site. However, having a fistula inserted early on significantly diminishes the risk for these complications.
Types of hemodialysis
In order to filter the blood, we need an access point. The dialysis access can come in one of three forms:
- Fistula. This is a connection we create between an artery and vein in your non-dominant arm. The connection takes time to strengthen, so we need to insert this early in order for it to be ready when dialysis is started.
- Graft. This is a synthetic tube that functions similarly to a fistula; however, it does not last as long.
- Catheter. This is a plastic tube that must be inserted into a large vein and is only meant to be used on a temporary basis. We try to avoid this method when possible, though it can be useful in emergency situations.
What to expect
We’ll begin the treatment process months in advance by performing a vein mapping. This helps us analyze the size and quality of your veins to determine whether you are a candidate for a fistula. Once we’ve determined if a vein or graft will be the most effective access, we’ll consult with your doctor to confirm you are at optimal health before moving forward. This involves a surgical procedure where we either connect your own vein and artery to create a fistula, or insert a graft that connects the two. You can expect to spend about a half a day in the hospital for this procedure.
When undergoing hemodialysis treatment, we’ll insert two needles into the access to pump your blood through the hemodialysis machine into the dialyzer, where a solution filters toxins out of your blood. Clean blood returns to your body in the same manner. You can expect to undergo several sessions per week, with treatments lasting a few hours. Our experts can perform hemodialysis at the hospital, in our access center, or from the comfort of your home. Many of our patients read, watch television or even sleep while hemodialysis is performed. At the end of the day, your comfort is our top priority.
How to prepare
Leading up to the insertion of the fistula or graft, we ask that you avoid having blood drawn and blood pressure measured via your arm. This protects the area where we will be putting the dialysis access in. We may also suggest you make some changes to your diet or lifestyle to help avoid side effects during treatment.
Following the insertion of the fistula or graft, you may experience some swelling and pain in the arm. Discomfort is more likely when a graft is put in, as more surgical manipulation is required. If we used a block to numb the arm during surgery, we might ask you to wear a sling until your arm function returns, usually same day.
Hemodialysis is incredibly successful, especially when the need for it is identified early. That’s why it’s important that your nephrologist connect you with an experienced vascular surgeon well before hemodialysis is needed. Developing a relationship early doesn’t mean you’ll definitely need hemodialysis, but it does improve the chances that you’ll be able to receive the treatment safely and effectively should it be needed as part of your treatment.
We’ll see you two weeks after the access procedure to ensure the incision has healed and everything is going smoothly. From there, we’ll check in again after eight weeks if you have a fistula to make sure it is functioning properly. If a graft was inserted, we’ll schedule a follow-up at the beginning of hemodialysis treatment (which can occur after three weeks) to make sure it’s performing as needed.
In most cases, hemodialysis will be performed on an ongoing basis, so we develop a long-lasting relationship with you and your nephrologist to ensure everything is functioning properly and your quality of life doesn’t suffer.
Possible side effects
Side effects are relatively short-lived, but might include nausea, cramping, dry or itchy skin, low blood pressure and fatigue.