Even in the best situations, adjusting to the effects of kidney failure and
the time you spend on dialysis can be difficult. Aside from the "lost time," you
may have less energy. You may need to make changes in your work or home life,
giving up some activities and responsibilities. Keeping the same schedule you
kept when your kidneys were working can be very difficult now that your kidneys
have failed. Accepting this new reality can be very hard on you and your family.
A counselor or social worker can answer your questions and help you cope.
Many patients feel depressed when starting dialysis, or after several months
of treatment. If you feel depressed, you should talk with your social worker,
nurse, or doctor because this is a common problem that can often be treated
effectively.
Getting Your Vascular Access Ready
One important step before starting hemodialysis is
preparing a vascular access, a site on your body from which your blood is
removed and returned. A vascular access should be prepared weeks or months
before you start dialysis. It will allow easier and more efficient removal and
replacement of your blood with fewer complications. For more information about
the different kinds of vascular accesses and how to care for them, see the
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) fact
sheet
Vascular Access for Hemodialysis.
Equipment and Procedures
When you first visit a hemodialysis center, it may
seem like a complicated mix of machines and people. But once you learn how the
procedure works and become familiar with the equipment, you'll be more
comfortable.
Picture of a Graft
Dialysis Machine
The dialysis machine is about the size of a dishwasher. This machine has
three main jobs:
pump blood and watch flow for safety
clean wastes from blood
watch your blood pressure and the rate of fluid removal from your body
Dialyzer
The dialyzer is a large canister containing thousands of small fibers through
which your blood is passed. Dialysis solution, the cleansing fluid, is pumped
around these fibers. The fibers allow wastes and extra fluids to pass from your
blood into the solution, which carries them away. The dialyzer is sometimes
called an artificial kidney.
Reuse. Your dialysis center may use the same dialyzer more than
once for your treatments. Reuse is considered safe as long as the dialyzer
is cleaned before each use. The dialyzer is tested each time to make sure
it's still working, and it should never be used for anyone but you. Before
each session, you should be sure that the dialyzer is labeled with your name
and check to see that it has been cleaned, disinfected, and tested.
Dialysis Solution
Dialysis solution, also known as dialysate, is the fluid in the dialyzer that
helps remove wastes and extra fluid from your blood. It contains chemicals that
make it act like a sponge. Your doctor will give you a specific dialysis
solution for your treatments. This formula can be adjusted based on how well you
handle the treatments and on your blood tests.
Needles
Many people find the needle sticks to be one of the hardest parts of
hemodialysis treatments. Most people, however, report getting used to them after
a few sessions. If you find the needle insertion painful, an anesthetic cream or
spray can be applied to the skin. The cream or spray will numb your skin briefly
so you won't feel the needle.
Most dialysis centers use two needles-one to carry blood to the dialyzer and
one to return the cleaned blood to your body. Some specialized needles are
designed with two openings for two-way flow of blood, but these needles are less
efficient and require longer sessions. Needles for high-flux or high-efficiency
dialysis need to be a little larger than those used with regular dialyzers.
Picture of arterial and venous needles
Some people prefer to insert their own needles. You'll need training on
inserting needles properly to prevent infection and protect your vascular
access. You may also learn a "ladder" strategy for needle placement in which you
"climb" up the entire length of the access session by session so that you don't
weaken an area with a grouping of needle sticks. A different approach is the "buttonhole" strategy in which you use a limited number of sites but insert the
needle back into the same hole made by the previous needle stick. Whether you
insert your own needles or not, you should know these techniques to better care
for your access.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
There are several types of kidney cancer, including renal cell cancer (renal adenocarcinoma or hypernephroma), transitional cell carcinoma, and Wilms tumor. Symptoms of kidney cancer include blood in the urine, an abdominal lump or mass, chronic pain in the side, and tiredness. Treatment of kidney cancer--which may include surgery, arterial embolization, radiation therapy, biological therapy or chemotherapy--depends upon the stage of the disease and the patient's overall health.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
Amyloidosis is a group of diseases resulting from abnormal deposition of certain proteins (amyloids) in various bodily areas. The amyloid proteins may either be deposited in one particular area of the body (localized amyloidosis) or they may be deposited throughout the body (systemic amyloidosis). There are three types of systemic amyloidosis: primary (AL), secondary (AA), and familial (ATTR). Primary amyloidosis is not associated with any other diseases and is considered a disease entity of its own. Secondary amyloidosis occurs as a result of another illness. Familial Mediterranean Fever is a form of familial (inherited) amyloidosis. Amyloidosis treatment involves treating the underlying illness and correcting organ failure.
Polycystic kidney disease (PKD) is characterized by numerous cysts in the kidneys. Polycystic kidney disease is a genetic disorder. There are two major inherited forms of PKD, autosomal dominant PKD, and autosomal recessive PKD. Symptoms include headaches, urinary tract infections, blood in the urine, liver and pancreatic cysts, abnormal heart valves, high blood pressure, kidney stones, aneurysms, and diverticulosis. Diagnosis of PKD is generally with ultrasound, CT or MRI scan. There is no cure for PKD, so treatment of symptoms is usually the general protocol.
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
Arsenic comes in two forms, inorganic and organic. Organic arsenic poisoning is usually not poisonous to humans; however, inorganic arsenic in large enough amounts can lead to shock and death. Symptoms of arsenic poisoning include nausea, abdominal pain, diarrhea, dehydration, dark urine, vertigo, delirium, shock, and death. Treatment for arsenic poisoning includes Hemodialysis and a variety of drugs.
Fabry disease (Fabry's disease, alpha-galactosidase-A) is a genetic disorder with symptoms such as burning sensations in the hands, small-raised reddish-purplish blemishes on the skin, fever, decreases sweating, and GI difficulties. Fabry disease patients are at increased risk of heart attack, heart disease, kidney failure, and stroke. Symptoms of Fabry disease can be treated with medication.
Hemolytic uremic syndrome (HUS) is a diseases in which blood clots within the capillaries. Causes associated with HUS include E. Coli, birth control pills, pneumonia, medications such as chemotherapy, Ticlid, and quinine. Symptoms of HUS include gastroenteritis, abdominal cramping, vomiting, and bloody diarrhea. Diagnosis of HUS includes medical history, physical examination, and medical tests. Treatment includes rest, fluids, possible hospitalization for blood transfusion or complications due to kidney failure.
Renal osteodystrophy is a bone disease. The kidneys fail to maintain required levels of phosphorous and calcium in the blood. Renal osteodystrophy is common in patients with kidney disease and affects dialysis patients. Diagnosis is performed with a blood sample, and in some cases a bone biopsy. Medication is the general treatment for renal osteodystrophy.
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
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