Sarita (name changed), a 58-year-old from Bengaluru, is a month into being on dialysis for her non-functional kidney . “I was apprehensive about undergoing the procedure initially,” she says. “I thought it would be painful, and the fear led me to put it on the back burner. My health deteriorated as a result and hence began my tryst with dialysis.”
After one month and 15 sessions, her fear seems to have evaporated, and she feels much more at peace. “It is a painless procedure and I have grown comfortable with it now,” she says.
Dr Sujeeth Reddy, consultant nephrologist at the Asian Institute of Nephrology and Urology, Hyderabad, says dialysis is a form of renal replacement therapy. “A person with a non-functional kidney has to resort to a course of treatment called dialysis where it performs the functions of the kidney,” he says.
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What kidney functions does dialysis ape?
Dr Rajiv EN, consultant nephrologist and transplant physician, BGS Gleneagles Global Hospital, Kengeri, Bengaluru, says the kidneys mainly perform two major functions: filter excess water in the body and get rid of waste products.
“A defect in the normal functioning of the kidney leads to the retention of excess water and waste products, which can affect a lot of bodily functions,” he says.
Doctors present people undergoing dialysis with two options: haemodialysis and peritoneal dialysis.
Artificial kidney in blood dialysis
In haemodialysis (also called blood dialysis), the person’s blood is purified using an artificial kidney known as a dialyzer.
According to Dr Nithin J, consultant nephrologist, BGS Gleneagles Global Hospital, the blood from the person enters the dialysis machine via a blood pump. It flows through the artificial kidney or dialyzer where it is mixed with a solution called dialysate which aids in the removal of toxins and fluids from the blood. The purified blood is then sent back to the patient.
“This cycle is repeated for a duration of four hours,” he says. “It is a completely painless procedure where the patient just has to lie down.”
Dialysis @ home
Peritoneal dialysis (also called stomach dialysis or home dialysis) doesn’t require a visit to a dialysis centre – it can be done at the convenience of a person at home.
“Home dialysis can be done by the person or their attenders,” says Dr Nithin. “This is a relatively simple procedure wherein the dialysate (cleansing fluid) is introduced into the abdomen through a tube. Once the cleansing is done, the fluid is drained out. There is no pricking or blood involved in the process.”
Creating access to the body
“Before beginning haemodialysis, access is created in the body [via] AV [arteriovenous] fistula,” Dr Nithin. “This is a simple surgery where the artery and the vein are joined under local anaesthesia. The impure blood flows from the patient’s body through the AV fistula into the dialysis machine. The purified blood enters the patient’s body via the same AV fistula.”
When do you need dialysis?
Dr Nithin says kidney disease is of two types: acute kidney disease and chronic kidney disease.
“Chronic kidney disease (CKD) is divided into five stages based on the percentage of kidney function,” he says. “The fifth stage, where the functioning of the kidney drops below 15 per cent, is called end-stage renal disease. This is when the patient will need renal replacement therapy, which is either in the form of dialysis or a kidney transplant.”
According to him, in the case of acute kidney injury kidney function usually gets restored. “The person may require dialysis for a short period and discontinue it once their kidney resumes function,” he says. “CKD is irreversible, and the person may remain on lifelong dialysis or undergo a kidney transplant. Depending on the condition of the person with CKD, the frequency of dialysis also varies. For some it could be once in a week and for some once in every three days.”
Early detection is key
Dr Rajiv emphasises the importance of picking up the early signs of kidney disease. “Blood pressure is often neglected among youngsters,” he says. “If hypertension is detected in a person below 40 years, it needs to be thoroughly investigated. Many a time elevated blood pressure is associated with problems of the kidney or heart.”
He also talks of the need to be wary of any swelling in the leg, especially when travelling for long hours. “Do not neglect any swelling in your legs as this could be a sign of protein leakage, which can be an indicator of kidney disease,” Dr Rajiv says. “Also, blood in the urine may indicate stones or infection and needs monitoring by a clinician.”
He recommends regular checks for hypertension and a urine test every two to three years to assess creatinine and protein levels and other parameters that indicate kidney health.
Dr Nithin agrees. “Diabetes, hypertension, certain genetically inherited diseases and a condition called glomerulonephritis can put one at risk of developing CKD,” he says. “Early detection can halt the progression of the disease to dialysis stage.”
Living with chronic kidney disease
Dr Reddy says people with chronic kidney failure are usually advised a low-protein diet. “But those on dialysis tend to lose 5-10gm of protein and are advised to minimise the restriction in comparison to their counterparts who are not on dialysis,” he says. He also recommends cutting down on salt. Water intake must be reduced in those having end-stage renal disease.
Dr Rajiv advises keeping a check on diabetes, hypertension and weight. “Weight can put a lot of metabolic stress on the kidney,” he says.
He strictly forbids the use of painkillers, unless very necessary and under supervision. “There are people who pop painkillers every day,” Dr Rajiv says. “[Painkillers] contain chemicals which can cause severe harm to the kidney.”
Bengaluru-based Dr Pradip Kamath, a 72-year-old who has been on dialysis for the past five months, stresses the importance of psychological preparation of patients before dialysis. “People undergoing dialysis and their family members need to be counselled about the demands dialysis entails, and any fear and apprehensions should be aptly dealt with,” he says. “They need to be reassured with stories of survival so that hope is kept alive.”