Hemodialysis and Diabetes

A guide to hemodialysis

Hemodialysis acts as an artificial kidney by removing excess water and toxic waste.


Hemodialysis for chronic kidney failure is a long term commitment for 3 days each week. Each treatment takes about 3-5 hours. This may seem like a long time but remember the kidney's work 24/7 and hemodialysis needs to get the job done in roughly 12 hours a week.

The process of Hemodialysis

  • Blood is removed from the body through the access site and filtered through a dialyzer which is a man-made membrane
  • The dialyzer filters the blood using three main functions:
Osmosis removes the excess water from the blood. The water in the blood flows to where there is less water which in this case is into the dialyzer.

Diffusion removes the toxins and wastes in the blood. The blood is filled with toxins and wastes and it wants to move to where it is lower and therefore they diffuse out of the blood into the dialyzer.

Ultrafiltration squeezes the extra fluid out of the blood by using pressure. The pump applies pressure and pushes the blood through the dialyzer.

Types of Access

Vascular access is necessary for the blood to be removed and returned to the body.


AV Fistula: A form of permanent access that is surgically created and usually placed in the forearm. It is created by joining an artery to a vein. The fistula needs 14 days to heal and mature before using however 4-6 weeks is preferable.


AV Graft : A form of permanent access created by inserting synthetic graft material through the skin between an artery and vein. This type of access is often used in diabetics. This type needs to be placed before therapy is started and takes 2-4 weeks until it can be used.


Central venous catheter: This access is not permanent and often used until the other forms of access are created and healed.

What to expect during Hemodialysis

  • Upon arrival the nurse checks your blood pressure, heart rate, temperature, respiratory rate, and oxygen level. Your weight is measured each time to help determine extra fluid that may be in your body. Labs may be drawn before starting.
  • The nurse will look at your access site. She is looking for redness, swelling, and may ask if it causes pain.
  • AV fistulas and AV grafts are felt by the nurse for a vibrating sensation called a thrill. The nurse also listens with a stethoscope over the area for a swishing sound called a bruit. These should both be present.
  • You will then be hooked up to the machine. The nurse with either place two needles into your AV fistula or AV graft, or connect 2 tubes onto the central venous catheter.
  • One line takes the blood out and into the machine, the other line puts blood back in after.
  • The nurse would then program the machine and the 3-5 hour process starts.
  • It is important to note that the machine has many safety alarms to alert the nurse and therefore you may hear alarms.

Responsibilities of the Patient

  • Access site must be checked DAILY for a vibrating or buzzing sensation, if absent contact provider
  • Look at access site DAILY for redness, swelling, warmth, bleeding, drainage, or if painful, if these occur contact provider
  • Avoid compression to the site: No tight clothing over site, Don't carry bags on the side, Don't lie or sleep on that area
  • NO blood pressures, lab draws, or IV's on the extremity
  • Must follow diet, fluid restriction, and medication treatment! Hemodialysis alone will not work
  • Prevent infection by frequently washing hands, inspecting site daily, and keeping bandages intact after treatment for a period of time

Diet

Potassium, Sodium, and Phosphate are electrolytes found in certain foods that will have to be restricted and monitored

Phosphate should be limited to 1 serving of 7-8 ounces a day. Meats, poultry, dairy and fish are the sources of phosphate that should be consumed.

Avoid:

  • Beans (Lima, black, red, white, garbanzo)
  • Dark, whole or unrefined grains
  • Refrigerator doughs such as Pillsbury
  • Dried vegetables and fruits
  • Chocolate
  • Dark colored soda

*Phosphorus content is the same for all types of milk

Sodium

Avoid:

  • Table salt and any seasoning ending in salt
  • Salt substitues
  • Salty meats: Ham, bacon, sausage, hot dogs, lunch meat, canned meats, bologna
  • Salty snacks: Nuts, salted crackers, chips
  • Canned soups, frozen dinners, instant noodles
  • Bottled olives, sauces, pickles

Potassium

Avoid:

  • Bananas
  • Avocado
  • Oranges
  • Prunes
  • Tomatoes
  • Melons (Cantaloupe, Honeydew melon)
  • Nuts
  • Chocolate
  • Beans (red, white, lima, black, garbanzo, baked)
  • Lentils
  • Milk
  • Raisins and dried fruit

Fruits to eat: 2-3 servings each day, 1 serving = 1/2 cup

  • Apple
  • Berries
  • Grapes
  • Peach
  • Watermelon
Fluids need to be restricted. It is important to not drink any more water than the doctor orders which is normally around 4 cups of fluid each day. Anything that melts at room temperature is considered a fluid such as ice cream, Jell-o, and popsicles.


The amount of protein in your diet needs to be limited to 8-10 ounces per day. Good sources of protein come from beef, pork, chicken, turkey, fish, seafood, and eggs. It is important to note that 1 egg is equal to 1 ounce of protein. Three ounces of protein is about the size of a deck of cards.

Tips for controlling Diabetes

  • Work with a dietician to help you create a balanced diet that contains high quality proteins and balanced carbohydrates and fats.
  • Carbohydrate intake needs to remain tightly controlled to manage blood glucose levels
  • Eat three meals a day plus snacks to prevent low blood sugars
  • Avoid high calorie fried foods such as french fries
  • Substitue sugar with sugar free such as Splenda

It is important to maintain a well balanced diet, check blood sugars, continue insulin regimen and take prescribed medication and continue with physical activity. Diet and treatment cannot reverse the damage done to the kidneys. Although it can help you continue to live your life, feel well, and reduce the chances of complications.

Special Considerations

Hemodialysis can be done in the home or in a center. Most often patients choose to do it in a center but a plan can be worked out with your doctor if in home may work better.

In center hemodialysis can contribute to work limitations and traveling to and from the center can be difficult. Advantages to In center treatment is that trained professionals are there and during treatment you can take the time to read, sleep, watch TV, catch up on your favorite show, or listen to music.


In home has the advantage of being performed at night while you are sleeping so you have more flexibility to continue working. However you are more responsible for the treatment and often need family member assistance.


Talk with your doctor to find out which route is best for you and your family!

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