Understanding Different Types of Dialysis

Definition of Dialysis

Dialysis is a medical procedure that replaces kidney function when it is severely impaired. It cleanses the blood of toxins and excess fluid. Renal replacement therapy usually begins when kidney disease reaches stage 5, or end-stage renal disease (ESRD), meaning the kidneys have lost approximately 90% of their function (GFR <15 ml/min/1.73 m2).

The decision to start dialysis depends on the patient's overall health, including blood pressure, bicarbonate and potassium levels, nutritional status, and the absence of uremic complications. However, dialysis is life-saving, as untreated advanced kidney failure is fatal.

What are the different types of dialysis?

Hemodialysis

Hemodialysis involves drawing blood, passing it through a machine with a semi-permeable membrane to filter it, and then returning the cleaned blood to the body. Access is typically via an arteriovenous fistula, designed to increase blood flow and pressure. Alternatively, venous catheters can be used. Hemodialysis is usually performed three times a week for four hours per session, in a hospital or dialysis center. Home hemodialysis is also an option with proper training. Contraindications are limited to patients with increased bleeding risk (due to medication or coagulation disorders).

Peritoneal Dialysis

Peritoneal dialysis uses the peritoneal membrane (the lining of the abdominal cavity) as a filter. A catheter surgically implanted into the abdomen allows the injection of a sterile dialysis solution containing glucose and ions, which draws toxins from the blood.

Peritoneal dialysis is a daily home treatment and comes in two forms:

• Continuous ambulatory peritoneal dialysis (CAPD): The patient exchanges 2 liters of solution four times a day.
• Automated peritoneal dialysis (APD): A machine regulates fluid exchange overnight (8-11 hours).

Peritoneal dialysis is contraindicated in patients with:

• Bowel or abdominal resection surgery.
• Large abdominal masses.
• Recent abdominal surgery.
• Conditions predisposing to abdominal infections (e.g., colostomies, urostomies).
• Immunosuppressive therapy.

Both hemodialysis and peritoneal dialysis remove harmful substances from the blood, but cannot replace the kidney's hormonal functions (renin, erythropoietin, active vitamin D, prostaglandins). These functions can be supplemented with medication or diet. Barring clinical, social, or logistical limitations, treatment choice is patient preference.

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Complications Related to Dialysis

Complications Related to Hemodialysis

Hemodialysis complications include blood cell damage from the machine, coagulation problems related to heparin use, imbalances in water and electrolytes, and infection risks (HIV, HCV, HBV). Cardiac arrhythmias from insufficient potassium removal, venous access infections, and post-dialysis coagulation deficits can also occur.

Complications Related to Peritoneal Dialysis

Peritoneal dialysis complications include bacterial peritonitis (requiring immediate antibiotics), catheter site infections, abdominal hernias, and protein malnutrition.

Diet and Dialysis

Dialysis patients shouldn't restrict protein intake. Fluid intake should be moderate, and potassium-rich foods (nuts, bananas, apricots) should be consumed in moderation. Medication should account for the kidney's reduced filtration capacity.

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