Dialysis

Overview and Management

Overview
What is dialysis?
Dialysis is a treatment for people whose kidneys are failing. When there a kidney failure, kidneys don’t filter blood the way they should. As a result, wastes and toxins build up in the bloodstream. Dialysis does the work of the kidneys, removing waste products and excess fluid from the blood.
Who needs Dialysis?
Dialysis may be necessary for those with kidney failure or end-stage renal disease (ESRD). Kidney damage leading to disease can result from injuries or conditions like high blood pressure, diabetes, or lupus. In some cases, the cause of kidney problems is unknown. Kidney failure may be a chronic issue or a sudden onset after severe illness or injury, with the latter potentially reversible.
Kidney disease progresses through five stages. Stage 5 indicates end-stage renal disease or kidney failure, where kidney function is significantly reduced. At this stage, dialysis or a kidney transplant may be required for survival. Some individuals undergo dialysis while awaiting a transplant.
What do kidneys do?
Kidneys, part of the urinary system, are two bean-shaped organs located below the ribcage on each side of the spine. Their primary function is to filter toxins from the blood, returning clean, nutrient-rich blood to the bloodstream. Waste and excess water create urine, which travels from the kidneys to the bladder. Additionally, kidneys play a role in regulating blood pressure.

Procedure Details
What are the types of dialysis?
There are two ways to get dialysis:
Hemodialysis
Peritoneal dialysis

Hemodialysis
Hemodialysis uses a machine to remove blood, filter it through an artificial kidney (dialyzer), and return the cleaned blood to the body. This typically takes 3-5 hours and may occur in a hospital or dialysis center three times a week.
Alternatively, hemodialysis can be performed at home. At-home treatments may be needed 4-7 times a week, with each session lasting for a shorter duration. Some individuals opt for nocturnal hemodialysis while sleeping.

Peritoneal dialysis
Peritoneal dialysis utilizes tiny blood vessels within the abdominal lining (peritoneum) to filter blood with the assistance of a cleansing solution. This solution is a specialized liquid containing water, salt, and additional additives.
Administered at home, peritoneal dialysis offers two treatment methods:
Automated peritoneal dialysis employs a machine known as a cycler.
Continuous ambulatory peritoneal dialysis (CAPD) is performed manually.

Recovery and Outlook
What’s the outlook (prognosis) for someone on dialysis?
Individuals on dialysis can potentially live for 10 to 20 years. The outlook depends on age, overall health, the cause of kidney failure, and additional factors. Receiving a kidney transplant allows for the discontinuation of dialysis once the new kidney functions properly.

Will I have activity restrictions while I’m on dialysis?
Many individuals on dialysis maintain active lives, working, raising families, and traveling. Healthcare providers can assist in arranging dialysis at a new location when traveling. For those on self-dialysis, dialysis solution bags and the portable home dialysis machine (if necessary) can be taken along.
Individuals using peritoneal dialysis may need to temporarily limit exercise or certain physical activities when the abdomen is filled with dialysis solution. Otherwise, exercise is generally acceptable for those on dialysis. Consulting with a healthcare provider about specific activities or sports is recommended.

A note from our specialist
Dialysis is a lifesaving treatment for individuals with kidney failure or end-stage renal disease (ESRD). This treatment may be continued indefinitely or until a kidney transplant becomes available. Several types of dialysis exist, with some preferring at-home dialysis and others opting for treatment at a hospital or dialysis center. Please discuss dialysis options with our doctors to determine the most suitable treatment for each individual.


Treatment: Management of kidney stones depends on their size and location. Small stones typically require hydration and pain medication, while larger stones or those causing complications may necessitate surgical intervention.


Prevention: Preventive measures may be recommended for individuals with a higher risk of recurrent stones, including dietary adjustments and medication.


When to Consult a Doctor: Consultation with a healthcare provider is advised for concerning symptoms. Immediate medical attention is warranted for severe pain, nausea, fever, hematuria, or difficulty urinating.
Risk Factors: The formation of kidney stones can be influenced by an excess of crystal-forming substances in the urine, such as calcium, oxalate, and uric acid, especially when urine lacks substances that inhibit crystal aggregation.
Several factors can increase the likelihood of developing kidney stones:
Family and Personal History: A history of kidney stones in the family or personally increases the risk.
Dehydration: Insufficient water intake, especially in hot climates or among those who sweat heavily, heightens the risk.
Diet: High intake of protein, sodium, and sugar can contribute to stone formation. A diet rich in sodium is particularly impactful.
Obesity: Higher BMI, large waist size, and weight gain are linked to an increased risk.
Digestive Issues and Surgery: Conditions like gastric bypass surgery, inflammatory bowel disease, or chronic diarrhea can alter calcium and water absorption, leading to stone formation.
Medical Conditions: Renal tubular acidosis, cystinuria, hyperparathyroidism, and recurrent urinary tract infections can elevate the risk.
Supplements and Medications: Excessive use of vitamin C, dietary supplements, laxatives, calcium-based antacids, and certain medications for migraines or depression may increase the risk of kidney stones.

Kidney Stone Treatments

Percutaneous nephrolithotomy/ nephrolithotripsy, abbreviated as PCNL, is a surgical technique designed to extract notably large kidney stones or those in the upper ureter through a minimally invasive approach. The procedure entails a small incision in the side of the body, enabling surgeons to either remove the stones or fragment them into smaller pieces, typically with negligible risk of complications. PCNL is particularly advantageous for stones that are too substantial for other treatments to address. It is known for its high rate of completely clearing stones, especially those over 2cm in diameter, often making it a preferable alternative to open surgery.

Retrograde Intrarenal Surgery, or RIRS, is a method of removing kidney stones that utilizes a ureteroscopic approach. This minimally invasive surgery employs the urethra as a channel to access the kidneys without the need for incisions. An optical endoscope is used to navigate to the kidneys, detect the stones, and then a laser is employed to pulverize the stones into dust. RIRS is typically reserved for large or intricate stones that are not suitable for lithotripsy treatment. The procedure boasts a high success rate with an exceedingly low risk of complications.