Hemodialysis

Patient Education

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What Is Kidney Failure? Why Do People Need Dialysis?

Kidney failure can be a result of a multitude of things, such as; illness, damage to the kidneys or chemical exposure. When your kidneys aren't working as well as they should, dialysis can be used as artificial kidneys. During dialysis, blood is removed from the body, filtered through a machine called a dialyzer, and clean blood is returned to your body. This process mimics that of the kidneys.
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*Your GFR number is an indication of how well your kidneys are functioning. Your GFR number will decrease as kidney function deteriorates.


When kidney disease progresses to stage 5, dialysis treatment or a kidney transplant is required.

Preparing for Hemodialysis

Creating an access:
  • A fistula is typically the first choice when creating an access. Your provider can create a fistula by joining an artery (carries oxygenated blood) to a vein (carries deoxygenated blood) in your arm to make one bigger blood vessel.
  • A graft can be used if your blood vessels are not suitable for a fistula. This procedure is done by joining an artery and vein with a tube made of synthetic material, and placing it under the skin.
  • A central venous catheter may be placed in a large vein in the chest. This is typically placed in patients who need dialysis for a short period of time.


All access point placements require a minor surgery, and will be placed several weeks to months before treatment to ensure proper healing.

What Is The Time Commitment for Hemodialysis?

Length and frequency of hemodialysis treatments depend on:
  • The functioning of your kidneys
  • Type of dialyzer used
  • How much waste is in your blood
  • How much fluid weight is gained between treatment


Treatments typically last about four hours and are performed three times a week.


How long will you have to be on dialysis?


  • Kidney damage from chemicals may be acute or chronic. The severity of kidney damage will determine how long dialysis is needed. In acute cases, dialysis may be needed while the kidneys heal. In chronic kidney failure, dialysis will be needed until a kidney transplant is preformed or for the rest of your life.

Side Effects That Might Happen To You

Common side effects of hemodialysis include:

  • Low blood pressure
  • Lightheadedness
  • Shortness of Breath
  • Abdominal Cramps
  • Nausea/Vomiting

Caring For Your Dialysis Access

  • Wash your access point with warm water and soap daily.
  • Check the area for signs of infection (redness, swelling, drainage, warmth, and pain).
  • Do not wear constrictive clothing over the access point, and avoid sleeping on the extremity.
  • Check your access point daily for a vibration to ensure proper blood flow.
  • Do not allow blood to be drawn, an IV to be inserted, or blood pressure to be taken on the extremity with the dialysis access.

Maintaining A Safe And Healthy Lifestyle

Protect Remaining Kidney Functioning:
  • Making sure other health conditions are well-managed.
  • Taking medications prescribed by your provider, such as diuretics and blood pressure medications.
  • Smoking cessation

Travel:

  • If you are interested in traveling you may set up an appointment at a transient center. Appointments can be made six to eight weeks prior to travel to ensure space is available.

Blood Testing:

  • Since dialysis treatment is patient-focused, it is important to get your blood drawn at least once per month. This allows your provider to make adjustments to your dialysis treatment, which aids in improving overall health as well as avoiding complications.

Body Weight Monitoring:

  • Weight should be monitored before and after dialysis treatments as well as on a daily basis to assess fluid retention.

Work and Exercise:

  • Normal activities can be continued. It is important to avoid activities that may damage the dialysis access.

How Will Your Diet Be Affected?

Monitor or limit your intake of the following:


  • Sodium (2-3 g/day)
  • Fluids (equal to daily urine output + 500-800 ml/day)
  • Potassium (1.5-2.7 g/day)
  • Phosphate
  • Protein (1.2-1.3 g/kg/day)


Why do you need to be on a special diet?

  • Your kidneys are unable to get rid of enough waste products and fluids to maintain electrolyte levels. It is important that you have the right amount of vitamins, minerals, protein and fluids each day.

Sodium

What is it?
  • A mineral found naturally in foods, typically seen in table salt.

Why is it important?

  • When your kidneys aren't working correctly, extra sodium and fluid can build up in your body causing swelling, a rise in blood pressure, and fluid around your heart or lungs.

Examples of foods that have sodium:

  • Table salt
  • Sauces (barbecue sauce, soy sause, teryaki sauce)
  • Chips
  • Cured foods (bacon, ham, olives, pickles)
  • Lunch meats
  • Processed foods

Low-sodium substitutes:

  • Use other spices such as basil, curry, ginger, and rosemary.
  • Eat natural, unprocessed foods.

Potassium

What is it?
  • A mineral found in foods that helps maintain a regular heartbeat, and allows the nerves and muscles to work properly.


Why is it important?

  • Your kidneys are the main organ that controls the level of potassium in the blood.


Examples of foods that have high-potassium:

  • Bananas
  • Oranges
  • Avocados
  • Beans
  • Leafy greens
  • Potatoes
  • Yogurt


Low-potassium substitutes:

  • Blueberries
  • Applesauce
  • Cauliflower
  • Angel cake
  • Coffee (8 oz)
  • Rice

Phosphorus

What is it?

  • A mineral needed for building strong, healthy bones.

Why is it important?

  • Your kidneys filter and remove excess phosphorus. If your kidneys aren't functioning properly, phosphorus levels can rise causing too much calcium to leave the bones. If your bones do not have enough calcium they can become very fragile.

Examples of foods that have phosphorus?

  • Cheese, milk, oysters, ice cream, beans, bran cereals and seeds

Low-phosphorus substitutes:

  • Sherbet, pudding, hard candies, jelly beans, cream of wheat, and mixed vegetables.


Protein

Why do you need protein in your diet?
  • Protein helps our bodies heal, and fight infection


Why do you need an increased amount of protein during hemodialysis?

  • Dialysis removes protein and amino acids from the blood. This requires you to increase your daily protein intake to replace lost protein.


Foods high in protein:

  • Meat
  • Milk
  • Eggs

Sample Dialysis Diet

Breakfast:

  • Cranberry Juice, 4 ounces
  • Eggs (2)
  • 2 slices of toasted white bread, with butter


Lunch:

  • Roast beef sandwich (with lettuce and mayo)
  • Pretzels (no/low salt)
  • Canned fruit, 1/2 cup
  • Sprite, 8 ounces

Dinner:

  • Fish
  • Salad (1 cup)
  • Lemonade, 8 ounces


Snacks/Dessert:

  • Sherbet Ice Cream
  • Hot Apple Cider, 4 ounces

References:





  • Pellico, L, (2013), Focus on adult health medical surgical nursing, (1st ed.), Wolters, Kluwer Health/Lippincott, Williams, & Wilkes: Philadelphia