The How-To Hemodialysis Guide

Diabetes and Hemodialysis Management!

An Overview of Hemodialysis

Hemodialysis is a treatment that does the normal work of the kidneys when the body's own kidneys cannot. This includes: removing waste, salt, and extra fluid from the body, maintaining safe levels of chemicals in the blood, and maintaining normal blood pressure. Chronic renal failure is an example of when the kidneys cannot perform their normal function, and hemodialysis is needed. The doctor determines hemodialysis is needed when kidney function is decreased by 85-90%, and there is a glomerular filtration rate of less than 15.

Glomerular Filtration Rate: A test that tells how well the kidneys are working


How Does Hemodialysis Work?

Hemodialysis uses an artificial kidney outside the body called a hemodialyzer, to remove the waste, fluid, and chemicals from the blood. Blood is removed from the body, put through the hemodialyzer, and clean blood is returned to the body. To get the blood into the hemodialyzer there needs to be vascular access via a fistula or triple lumen central line.


Fistula: Requires minor surgery, to create vascular access, by joining an artery to a vein under the skin. After surgery, the fistula vibrates which is normal.

Triple Lumen Central Line: Creates vascular access, by placing a catheter into a large vein under the skin, that goes into the heart. There are (3) lumens also known as ports to access outside the skin for treatment.



  • Hemodialysis does not cure chronic renal failure, it manages the condition by performing the normal functions of the kidneys



How Long Does Hemodialysis Last?

The time depends on: how well kidneys work, how much fluid needs to be removed, how much waste and chemicals need to be removed, and patient size.

Hemodialysis Treatment: Typically lasts about (4) hours each treatment, and is done (3) times per week.


(National Kidney Foundation, 2015)

https://www.kidney.org/atoz/content/dialysisinfo

SAFETY FIRST: Hemodialysis and Infections

It is very important to prevent infections when receiving hemodialysis



  • Check vascular access (fistula or triple lumen central line) daily: redness, pus or drainage, swelling, and warmth are signs of infection *call your healthcare provider if you notice these signs
  • Keep bandage clean and dry always *if bandage gets wet, call your healthcare provider
  • Monitor your temperature: Check your temperature frequently, especially when not feeling well. Normal- 98.6 degrees F *call your healthcare provider if temperature above 100.4 degrees F
  • The best way to prevent infection is: Hand Hygiene, always wash hands with soap and water, or alcohol-based hand sanitizer. Ensure that all healthcare providers perform hand hygiene every time!


(Centers for Disease Control, 2016)

http://www.cdc.gov/dialysis/patient/

Diabetes and Dialysis: Diet

Diet is an important part to effectively manage diabetes and dialysis.


The dialysis diet requires you to eat: more high protein foods, and less high salt & sodium, high potassium, and high phosphorus foods. This diet also requires fluid adjustment


  • Salt & Sodium: When preparing food use less salt, and eat fewer salty foods. Do not use salt substitutes made with potassium, instead use herbs, spices, and flavor enhancers. This maintains blood pressure, and prevents weight gain between dialysis sessions.
  • Protein: Eat more high protein foods such as - fish, poultry, fresh pork, eggs, and meat - to equal 8-10 ounces of high protein everyday. This maintains blood protein levels, and overall health.
  • Grains, Cereals, & Bread: Type 1 Diabetics need to maintain a low-carbohydrate diet, to help control blood sugar levels. Avoid whole wheat bread, or brown rice to limit phosphorus intake. Instead eat white bread, unsalted crackers, or pasta that follow the type 1 diabetic diet.
  • Dairy: Most dairy products are very high in phosphorus, which needs to be limited. Limit intake of milk, yogurt, and cheese to: 1/2 cup of milk or 1/2 cup of yogurt or 1 ounce of cheese per day.
  • Fruit: All fruit have potassium, Avoid cantaloupe, mangos, kiwi, oranges, pomegranate. Instead eat - berries (1/2 cup/day) or grapes (15/day) or cherries (10/day) or apples (1/day) or plums (1-2/day)
  • Vegetables: All vegetables have potassium, Avoid spinach, potatoes, artichokes, tomatoes. Instead eat - cauliflower, onions, asparagus, eggplant, carrots. 2-3 servings per day, one-serving = 1/2 cup.
  • Fluid Intake: Fluid intake allowance is individual based, and calculated by your nephrologist. The calculation is: urine output + 500mL, (which covers fluid loss from skin and breathing)


(America Diabetes Assoc., 2016)

http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/

(National Kidney Foundation, 2015)

https://www.kidney.org/atoz/content/dietary_hemodialysis

For More Information:

America Diabetes Assoc. (2016). What Can I Eat? Retrieved March 30, 2016, from https://www.diabetes.org/food-and-fitness-food/what-can-i-eat/


Centers for Disease Control. (2016). Patient Information. Retrieved March 30, 2016, from http://www.cdc.gov/dialysis/patient/


National Kidney Foundation. (2015). Dialysis. Retrieved March 30, 2016, from https://www.kidney.org/atoz/content/dialysisinfo


National Kidney Foundation. (2015). Dietary Guidelines for Adults Starting on Hemodialysis. Retrieved March 30, 2016, from https://www.kidney.org/atoz/content/dietary_hemodialysis