By: Adam Rosin, Bio-Medical Electronics Student, Western Technical College, La Crosse, WI
More than 400,000 people are on dialysis and the number is estimated to more than double in the next decade. Dialysis is a method of removing toxic substances (impurities or wastes) from the blood when the kidneys are unable to do so. This paper will inform you about the two types of dialysis treatment, the complications associated with dialysis, and the reasons why people choose to stop treatment. There are two types of dialysis: peritoneal and hemodialysis.
Peritoneal dialysis uses a network of tiny blood vessels in the abdomen, or peritoneal cavity, to filter blood. This can be accomplished manually throughout the day or with a machine at night. The machine will run for 10-12 hours at night. Peritoneal dialysis is typically done at home and the workplace. A patient who undergoes peritoneal dialysis will have a plastic tube called a catheter inserted into their abdomen. This catheter connects to a cassette called an automated cycler. The cassette contains several tubes that connect to bags of dialysis solution inside the cycler and also to a sterile drainage bag.
Hemodialysis is the most common type of dialysis. During hemodialysis, a needle is inserted into your arm through a special access point. Your blood is then directed through the needle and special tubing to a machine called a dialyzer, which filters your blood a few ounces at a time. The filtered blood returns to your body through another needle.
Most people receive hemodialysis three times a week in a dialysis center. Each session takes about three to five hours. Some people choose more frequent — but shorter — dialysis sessions.
When you arrive at the dialysis center, a member of your health care team will check and record your weight, blood pressure, pulse and temperature. If you choose to do so, you may be able to do this yourself.
Then the skin covering your venous access site — the point where blood leaves for cleansing and then re-enters your body during treatment — will be cleansed, and the two needles used during treatment will be inserted.
Dialysis is a serious responsibility. If you need hemodialysis or peritoneal dialysis to treat kidney failure, you'll work closely with your health care team to manage your health. Understand the possible complications — and what you can do to prevent them.
Complications may be related to dialysis or the underlying kidney disease itself.
- Anemia. If you have anemia, you don't have enough red blood cells in your bloodstream. This may leave you feeling weak and tired. Lack of the hormone erythropoietin, which is made by healthy kidneys to stimulate production of red blood cells, often causes anemia. In other cases, low levels of iron or vitamins in your blood — caused by diet restrictions, poor absorption of iron, or removal of iron and vitamins by dialysis — cause anemia. Blood loss from dialysis or routine blood sampling can have the same effect.
- Bone diseases. If your damaged kidneys are no longer able to use vitamin D to absorb calcium, your bones may weaken. If your parathyroid glands produce too much parathyroid hormone — a common complication of kidney failure — calcium may be stripped from your bones.
- High blood pressure (hypertension). High blood pressure is a leading cause of kidney failure. If you eat too much salt or drink too much fluid while being treated for kidney failure, your high blood pressure may only get worse — which takes a toll on your remaining kidney function. Left untreated, high blood pressure can lead to a heart attack or stroke.
- Fluid overload. If you drink more fluids than recommended, you may retain enough fluid to cause life-threatening complications, such as heart failure or fluid accumulation and swelling in the lungs (pulmonary edema).
- Inflammation of the membrane surrounding the heart (pericarditis). Insufficient dialysis can lead to inflammation of the membrane surrounding the heart, which can interfere with your heart's ability to pump blood to the rest of your body.
- High potassium levels (hyperkalemia). The kidneys normally excrete excess potassium from the body. If your kidneys are failing and you eat more potassium than recommended, your potassium level may become higher than normal. In extreme cases, too much potassium can cause your heart to stop.
- Nerve damage. Chronic kidney failure can damage your nerves. Damage to your peripheral nerves — also known as peripheral neuropathy — may cause pain, numbness or tingling in your legs, feet or hands.
- Infection. Depending on the type of dialysis you receive, potentially dangerous infections at the venous access point or peritoneal catheter are possible.
- Other complications. Other difficulties associated with dialysis include sleep disorders, anxiety and depression.
Many individuals undergoing treatment do not like all the complications and burdens dialysis has caused them so they elect to stop treatment.
Choosing to stop dialysis can have deadly consequences. Kidney dialysis can be life sustaining. Sadly, most individuals who make the decision to stop dialysis die within just a few weeks. However, adults have the right to make medical decisions for themselves, and many choose to stop dialysis. In fact, in the United States, approximately 25% of those dealing with kidney failure make the decision to stop receiving dialysis treatments.
Sometimes people stop dialysis for happy reasons. If a person with kidney failure receives a successful transplant, he or she can stop dialysis. Unfortunately, most individuals do not stop dialysis for this reason. Donor kidneys are in short supply, and the majority of individuals who choose to end dialysis are, essentially, making the decision to die.
Often, the reason for choosing to stop dialysis is an emotional one. Many individuals choose to stop dialysis because they are either not likely to receive a transplant or ill suited for one. When faced with the need to continue receiving dialysis for the rest of their lives, many find the prospect unhappy and intolerable. For some, the quality of life with regular dialysis treatment is far less than desirable. As such, they would rather live a few weeks on their own terms than have the potential to live years with dialysis.
Sometimes, the decision to end dialysis is made for health reasons. An individual may choose to end dialysis because of the side effects and complications common to the treatment. Possible complications can range from low blood pressure and fever to infection and allergic reactions. Even diet may be affected by dialysis, as loss of appetite is common in those undergoing dialysis treatments.
The decision to stop dialysis is often related to cost. While it is true that most insurance programs cover dialysis treatments, many individuals still find dialysis expensive. Stopping dialysis allows individuals to alleviate this expense.
Before an individual makes the decision to stop dialysis, he should discuss the possibility with loves ones and his treatment team. In some cases, adjustments can be made to improve the patient’s quality of life, while allowing for continued dialysis treatments. If such adjustments are not enough to make continuing dialysis desirable, the treatment team may be able to provide advice and support for ending treatment.
76,584 people undergoing end-stage renal treatment died each year in the US 2001. In this paper the basics of dialysis were uncovered: the two types of dialysis, the complications associated with treatment, and the reasons why people choose to stop treatment. I hope this paper made you more aware of the basics of dialysis.
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