Dialysis, broken down

Dialysis and How It Works: 

 

Hi there!

Today I'll break down the different types of dialysis and basically, how dialysis works. Its a watered down explanation, but it should help you understand the process.

The three primary types of dialysis are in-center and home hemodialysis and peritoneal dialysis. 

How It Works: They perform the job of failing kidneys by removing waste, toxins, and extra fluid from the blood.[1, 2]

1. In-Center Hemodialysis:

This is the most common and traditional form of dialysis.

• How it works: Blood is pumped out of your body, circulated through a specialized machine with a filter (dialyzer) to clean it, and then returned to your body.[1, 2, 3, 4]
• Where it happens: You visit a dedicated dialysis center.
• Schedule: Typically requires about 3 to 4 hours per session, 3 times a week.
• Who runs it: Trained medical staff(nurses and CCHT/PCTs) manage the equipment and oversee your treatment. 

2. Home Hemodialysis:

This method utilizes the same filtration process as in-center hemodialysis but gives you independence and flexibility.

• How it works: You (or a trained care partner) hook yourself up to a portable hemodialysis machine at home.
• Where it happens: In the comfort of your own home, following comprehensive training from your healthcare team.
• Schedule: Depending on your doctor's orders, it can be done more frequently for shorter durations or even overnight while you sleep.

• The Process: Blood is pumped outside the body through a special filter called a dialyzer (the artificial kidney).[1, 2, 3, 4] During hemodialysis, only about 1 pint (around 2 cups) of blood is outside your body at any one time. Because the average person has 10 to 12 pints of blood in total, this small circulating volume ensures the filtration process is continuous but safe (no cramping, dizziness or nausea).

• Fluid Removal: The dialysis machine controls pressure so that the pressure inside the blood compartment is higher than the pressure in the fluid (dialysate) compartment. This hydrostatic pressure pushes the excess water across the semi-permeable membrane to be drained away.[1, 2, 3, 4]
• Setup: This is usually done 3 times a week for about 3–5 hours at a clinic, though home options exist with more flexibility.[1, 2]

3. Peritoneal Dialysis:

Rather than using an external machine, this method uses the inside lining of your own abdomen (the peritoneum) as a natural filter.

• How it works(for hemodialysis only): A cleansing fluid (dialysate) flows into your abdomen through a permanent catheter. The fluid sits inside your abdominal cavity, absorbing waste and excess fluid, it is then drained out.[1, 2, 3, 4, 5]
• Where it happens: At home, while traveling, or even at work.
• Schedule: It is an ongoing, daily process that can either be done manually throughout the day (Continuous Ambulatory Peritoneal Dialysis*) or automatically at night using a machine (Continuous Cyclic Peritoneal Dialysis*).[1, 2, 3, 4, 5]

• The Process: This daily, at-home treatment does not involve blood filtering through a machine. Instead, a cleansing solution (dialysate) is infused into your abdominal cavity through a permanent catheter.[1, 2, 3]

• Fluid Removal: The lining of your abdomen (the peritoneum) acts as a natural filter. To pull excess water and wastes out of the body, a sugar (dextrose) is added to the dialysate solution. This creates a natural process called osmosis, where the fluid shifts from the blood into the high-concentration solution in the abdomen.[1, 2, 3]

• Setup: The fluid dwells in the abdomen for several hours before being drained out in a process called an "exchange".
• *The specific mechanics of this fluid removal depend on the type of dialysis you are referring to.

Learn how to manage your dialysis by going to the National Institute of Diabetes and Digestive and Kidney Diseases. [1]

My personal thoughts:

My dry weight,when I left on this past Tuesday, was 60.7k. Thats around 133lbs. I like my home scale better. This morning after I used the facilities and before eating or drinking anything, I weighed 129lbs( I took 2 lbs off for clothing). We will see how much fluid I've retained tomorrow.

I do on-site hemodialysis. There are many reasons why I chose this modality. It gets me out of the house and forces me to interact with others(otherwise, I tend to hole up at home.) I've met people that I wouldn't have necessarily met in other situations(many are great friends and comrades). And the original reason for my choice of DCI, inc. In Hawthorne, NY is that my nephrologist is there. She is awesome!!

So, when I arrive, the first thing I do is get weighed. That will dictate how much fluid needs to be removed from my body that day. I don't usually have a lot of fluid retention because I still urinate a good amount.

Then I go to the chair I'll be at for the duration of the treatment. I set up all my junk on the little(and I mean little) table they provide you. My stuff usually consists of 1-2 blood/sugar raising gel packs(I use the brand, "Transcend"-the strawberry is better than the orange, IMHO), 2 snacks (keeps my blood sugar up because dialysis tends to lower it), my tablet(I do challenges, blog posts and other stuff since the center has wifi) and some other items. 

Then they take a standing blood pressure. I have a special cushion that helps align my spine and alleviate any pressure on my behind for the long sit. Plus I have a blanket to put over me to keep me warm. The room is always cold 71-72° for medical reasons. I also have some goodies that are made for dialysis or infusion patients with zippers up the arms. They are really helpful with the cold. I also have a glove for my right hand because I have a condition called Peripheral Cyanosis. Its has to do with vascular circulation.(I have atherosclerosis) 

Now I sit and a nurse takes my vitals; temperature, breathing(to make sure there isn't any fluid rattling around in my lungs.)and my heart rate. They also check my legs for swelling/edema(which is common in ESRD patients). Then they take a sitting blood pressure and the cuff stays on my left arm for the rest of the treatment. I get situated and then they insert the needles. It usually doesn't hurt like when I have to get blood drawn. These CCHT'/PCTs are excellent at what they do and rarly do I even feel them inserting the needles. And let me tell you, I can be a challenge because my access (AV) tends to roll. But they get it every time. 

After they get me all hooked up, the lower  needle - red is the)  and check my blood sugar, as well as draw from my tubes for bloodwork, the nipurse decides how much fluid they are going to take off me, based on my gain and my blood pressure's stability. Then I can do almost anything I need to do. Its not all that restrictive. I can answer the phone, read, do typing on my tablet, or surf the web. 

When my 3.5 hours are up my machine makes a noise like what you hear when you hit jackpot at a casino. I almost always say that "I'm a winner!" (I know its dumb, but it m as kes me smile.) Then they take out the needles and bandage me up. I weighed myself again to see where I'm at and then I'm free to go home. 

That's probably all you can take out of me today. Talk to you tomorrow about something else! I hope thr sun shines for you regardless of what mother nature has in store for us today!

Tina

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