Hemodialysis

What You Need to Know

What is Hemodialysis?

Hemodialysis is a process where your blood is filtered through a machine and then returned to your body. This happens when your kidneys (which filters waste and fluids from blood) are not functioning as well as they should be- acute renal failure or chronic renal failure. Acute renal failure is typically reversible and has a quicker onset, whereas chronic renal failure is long-term and irreversible.

Why do I need it?

Because of your genetic disorder, you have developed Acute Renal Failure, which causes your kidneys to not work as they should so the fluid and the "waste" doesn't get filtered out by your kidneys and then into your urine. Because of this, you could become very sick, which is why we will be filtering your blood for you through dialysis. When you first noticed symptoms of Acute Renal Failure, you may have felt very tired. You also may have noticed not needing to urinate as much as usual, that is because your kidneys weren't pulling the fluid and waste from your blood.
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If untreated:


  • The blood tests that are used to measure how well your kidneys are functioning increases (BUN & Creatinine) meaning that your kidney function would decrease even more and create further damage.
  • Nausea, vomiting, headache, muscle twitching, lethargy (extremely tired), or seizures could occur.
  • Since the kidney's would be worsening, you would be at a high risk for getting electrolyte imbalances. Electrolytes are important and they aid in several bodily functions. If your Potassium levels get too high- it can cause serious issues. You could have an irregular heart beat, weakness, diarrhea, and cardiac arrest.
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How does the blood get to the dialysis machine?

Your blood will most likely be accessed through what is called a "AV Fistula". What that is, is when the doctors make a spot in your arm or leg (usually on the forearm) that joins the artery and the vein together. Arteries bring oxygenated blood (meaning there is oxygen in the blood) from the heart to the body and tissues, and veins bring the blood back to the heart to become re-oxygenated. And the AV Fistula is accessed by two needles and tubing that leads to the dialysis machine, one is bringing the blood that needs to be cleaned to the dialysis machine and the other is bringing the clean blood back to the vein to be brought back to the heart.
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How often will I have to do this?

Dialysis is usually done three times a week, and each session lasts about 4 hours depending on the person. You will have to continue dialysis for a few weeks until your kidneys start working better and you urinate more. The average time for patients to make very small amounts of urine with acute renal failure is about two weeks, which is called the oliguric phase. Then after that, kidney function starts to improve and more urine will be produced, which is the diuretic phase. After that is the recovery phase, which can take 6-12 months, where the kidney function improves more.
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What is a typical treatment?

  1. First, you will arrive to the dialysis center and check in with the front desk, then a nurse will take your weight and vital signs- blood pressure, heart rate, temperature, oxygen level, and respirations.
  2. Then the nurse will assess your arm and listen to your fistula to hear a swooshing sound, which means that the fistula is still working. They will also feel for a buzzing feeling at the site of the fistula.
  3. Once your fistula is accessed, the nurse will be there with you to monitor you and make sure you are comfortable and if you need anything. They will check your blood pressure throughout the dialysis treatment. Sometimes because the dialysis is removing extra fluids in your blood can cause your blood pressure to drop a little bit which can make you have a headache or become nauseous. It is important to let the nurse know how you are feeling so that they are able to help you!
  4. Then after the site is cleaned, the two needles will be inserted into the fistula- one on the venous side and the other on the arterial side. From there the blood will go into the dialyzer and be filtered of all of the waste and excess fluid and the cleaned blood will return to the body through the venous access site and return to the heart.
  5. The process lasts for about 4 hours and during that time you can study or do homework, listen to music, watch TV, read, sleep, play on your laptop, watch Netflix, play on your phone, whatever you'd like to do! You will also be in a comfortable recliner with pillows to make it even better.
  6. After the session is done, the nurse will take out the needles and make sure they are no longer bleeding, then they will take your weight again to measure how much fluid was taken out of your blood.
  7. The nurse will take your vitals once more and if everything is all set, out the door you go!

How is this going to affect my life?

Well, dialysis can alter your life in some ways but there are many resources as well as different ways of doing things and we can help you figure out what works best for you! For example, because of the fistula, you need to be aware of anything that constricts or puts pressure on your arm. You shouldn't wear constrictive clothing or watches, or carry any bags on that arm. You also should make sure you do not get your blood pressure taken on that arm, or any blood drawn, or lie on that arm. Also, if you lift weights, it is not recommended to do so while you are receiving dialysis. You will still be able to go to school and even do your homework (sorry about that part) as long as you're feeling up to it! You will be able to go hang out with friends, and continue on as you normally would, just making a few adjustments here and there. One thing that you will have to adjust is your diet.

What do I have to change in my diet?

Diet is very important in the healing process for your kidneys.


  • Eat more Protein
  • Eat less foods that have salt, phosphorus, and potassium in them.


Protein:

Eat a high protein diet, including- fish, chicken, fresh pork, eggs, beef, seafood, veal, and turkey. You should have 8-10 ounces of protein per day.


  • One egg is equivalent to 1 ounce
  • A piece of meat that is the size of a deck of cards is equivalent to 3 ounces.


Grains: 6-11 servings per day.


Dairy: 1/2 a cup of milk (4 ounces), 1/2 a cup of yogurt, or 1 ounce of cheese.

Phosphorus: AVOID- dairy foods, limit to one 4 ounce serving per day. MUST take a phosphate binder when you do have it!! (Your doctor will give you a prescription for this)

Instead use:


  • butter, cream cheese, heavy cream, brie, sherbet, ricotta cheese.

Fruit: 2-3 servings of low potassium fruit per day.

Vegetables: 2-3 servings of low potassium vegetables per day.

Potassium: AVOID: oranges, orange juice, raisins, dried fruit, bananas, kiwis, melons, prunes, prune juice, nectarines. Potatoes (unless soaked before making them), tomatoes and tomato sauce, avocado, cooked spinach, pumpkin, asparagus, winter squash.

Instead use:


  • Apple, berries, cherries, watermelon, peach, grapes, plums, tangerine.
  • broccoli, cabbage, carrots, lettuce, onion, celery, cauliflower, cucumber, radishes, watercress, garlic, eggplant, zucchini, yellow squash, peppers, green and wax beans.


Sweets: You can have: doughnuts, cookies- ginger snaps, shortbread, sugar, vanilla wafers, pie- apple, berry, cherry, lemon, peach.


Drinks/fluids: This is one of the most important things to abide by, the doctor is going to set a restriction on how many fluids you can have in one day. It will most likely be around 32-36 ounces per day. It is best if you break it up into small drinks throughout the day so you are able to relieve thirstiness.

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I know that this may seem like a lot of things that you cannot eat, but if you go to page 9 & 10 on this article posted below, it gives you a good representation of all of the yummy foods that you can still have!!


This article is also a good resource to better understand how different foods affect your kidneys and different recipes as well!

References