Dialysis in Chronic kidney disease. Why, how and when ?

Dialysis in Chronic Kidney Disease (CKD): An Overview

Dialysis is a life-sustaining treatment for patients with advanced chronic kidney disease (CKD), particularly in end-stage kidney disease (ESKD), where the kidneys lose most of their ability to filter waste and excess fluid from the blood.

Below is a detailed explanation of dialysis in CKD.

When is Dialysis Needed?

Dialysis becomes necessary when:

Kidney function declines to less than 10-15% of normal.

Symptoms of uremia (e.g., nausea, vomiting, fatigue, confusion, swelling, and itching) develop.

Severe electrolyte imbalances, such as high potassium, or fluid overload that is unresponsive to medical therapy.

Types of Dialysis

1. Hemodialysis (HD):

How it works: Blood is removed from the body, filtered through a machine (dialyzer), and returned to the body.

Access: Requires vascular access, such as an arteriovenous (AV) fistula, AV graft, or a central venous catheter.

Frequency: Usually done 3 times a week, lasting 3-5 hours per session.

Pros: Effective in removing waste and fluid; performed at dialysis centers or at home.

Cons: Requires travel to a center (if not done at home), dietary and fluid restrictions, and potential complications like low blood pressure or infections.

2. Peritoneal Dialysis (PD):

How it works: Uses the peritoneum (the lining of the abdominal cavity) as a natural filter. A cleansing fluid (dialysate) is infused into the abdomen and later drained, removing waste and excess fluids.

Types:

Continuous Ambulatory Peritoneal Dialysis (CAPD): Done manually 3-5 times daily.

Automated Peritoneal Dialysis (APD): Performed using a machine (cycler) during the night.

Pros: Can be done at home, more flexible schedule, fewer dietary restrictions.

Cons: Risk of peritonitis (infection), catheter-related issues, and less effective for severe fluid overload.

Choosing the Right Modality

The choice of dialysis type depends on:

Patient preference.

Lifestyle and employment.

Medical factors, such as heart health or risk of infection.

Availability of resources and support for home dialysis.

Preparing for Dialysis

1. Education: Patients are educated about their options and what to expect.
2. Access Creation:

For HD: An AV fistula or graft is surgically created, ideally weeks before starting dialysis.

For PD: A catheter is surgically inserted into the abdomen.

3. Lifestyle Adjustments: Patients may need to adjust their diet (low sodium, potassium, and phosphorus) and fluid intake to match their dialysis regimen.

Benefits of Dialysis

Removes waste, toxins, and excess fluid.

Improves symptoms like fatigue, swelling, and shortness of breath.

Enhances quality of life and prolongs survival in CKD patients.

Potential Risks and Complications

Hemodialysis:

Low blood pressure (hypotension).

Muscle cramps.

Infections at the vascular access site.

Peritoneal Dialysis:

Peritonitis.

Catheter site infections.

Hernias due to increased intra-abdominal pressure.

Alternatives to Dialysis

1. Kidney Transplant: The best long-term solution for ESKD; requires a suitable donor.
2. Conservative Management: Focuses on symptom relief without dialysis, suitable for patients who choose not to pursue aggressive treatment.

Psychosocial and Emotional Support

Dialysis can significantly impact mental health and quality of life.

Support groups, counseling, and therapy may help patients cope with the emotional and physical demands of treatment.

Summary: Dialysis is a crucial treatment option for advanced CKD patients, providing life-sustaining support. The choice between hemodialysis and peritoneal dialysis depends on individual medical conditions, lifestyle, and preferences. Regular monitoring and collaboration with a healthcare team are essential to manage the complexities of dialysis and ensure the best outcomes. Follow at a good , well equipped centre .