Discovering that you need dialysis or a transplant can feel life-altering. Fortunately, there are treatment options and medications that can replace kidney function and help you maintain your quality of life. One option is hemodialysis (HD), and it could be a treatment that’s right for you.
In hemodialysis, a machine removes blood from the body and filters it through a man-made membrane called a dialyzer, or artificial kidney, to clean out toxins that your kidneys can no longer remove. The filtered blood is then returned to the body. Only a small amount of blood (less than two cups) is outside of the body at any time. To perform hemodialysis there needs to be an access point created to get the blood from the body to the dialyzer and back to the body. The type of access a person has is important for getting the best dialysis possible. There are three types of access: catheter, arteriovenous (AV) graft and arteriovenous (AV) fistula.Typically, an arteriovenous (AV) fistula or an AV graft will be surgically created, usually in your non-dominant forearm, to act as the access point for dialysis. Your doctor will determine the right type of access for you.
For dialysis, a catheter is inserted into a large vein in either the neck or chest. A catheter is usually a short-term option; however, in some cases a catheter is used as a permanent access. With most dialysis catheters, a cuff is placed under the skin to help hold the catheter in place. The blood flow rate from the catheter to the dialyzer may not be as fast as for an AV graft or AV fistula; therefore, the blood may not be cleaned as thoroughly as with an arteriovenous access.
Catheters have a greater tendency to become infected than the other access types because the device is both inside and outside of the body. A catheter must always be kept clean and dry; swimming or bathing are usually restricted. Getting dressed may disturb the catheter at the exit site, so care needs to be taken.
A fistula used for hemodialysis is a direct connection of an artery to a vein. Once the fistula is created it’s a natural part of the body. Once the fistula properly matures, it provides an access with good blood flow that can last for decades. It can take weeks to months before the fistula is ready to be used for hemodialysis.
An arteriovenous (AV) graft is created by connecting a vein to an artery using a soft plastic tube. After the graft heals, hemodialysis is performed by placing one needle in the arterial side and one in the venous side of the graft. The graft allows for increased blood flow.
Dialysis experts generally agree that the safest and longest lasting of the access types is the AV fistula. Because a fistula is made by connecting a vein to an artery, the vein becomes bigger allowing for increased blood flow. The fistula is created from natural parts of the body and can be repeatedly “stuck” to perform hemodialysis treatments.
A fistula is the preferred because:
While the AV fistula is the preferred access, there are some people who are unable to have a fistula. If the vascular system is greatly compromised, a fistula may not be attempted. Some people have had fistulas surgically created, but the fistula never matured; therefore, could not be used. Some of the drawbacks of fistulas are:
People who do in-center hemodialysis usually dialyze three times a week, for about three to four hours each treatment.
Hemodialysis is an effective treatment when you have end stage renal disease (ESRD). However, HD is only one component of your comprehensive treatment plan, and you will need to make some adjustments to your everyday life. Be sure to follow your prescribed diet and fluid restrictions as well as your prescriptions, which may replace other functions of the kidney, such as regulating blood pressure and stimulating production of red blood cells to prevent anemia.
All dialysis treatments have their advantages and disadvantages. Based on your lifestyle and medical needs, you and your doctor can discuss your options and decide which one is right for you.
Once you arrive at the dialysis center, the healthcare team—from the nurse to the facility administrator—will take care of all aspects of treatment.
First, your access area will be washed by a patient care technician (PCT). Once that’s complete, you will be weighed and escorted to your dialysis chair. Your standing and sitting blood pressure will be taken and a dialysis nurse will check your vitals before connecting you to the dialysis machine.
The typical dialysis session is four hours. During that time your care team will monitor your blood pressure and the dialysis machine’s performance. When the dialysis treatment time is up, they will disconnect you from the dialysis machine and record your vital signs again.
You are free to read, watch television, work or play on your laptop, talk to other patients and care team members, sleep—whatever activity you can do from the dialysis chair. All DaVita® dialysis centers offer free Wi-Fi for people who want to be online during in-center treatments.
You spend a lot of time—and place a lot of trust—with the people who care for you. A supportive kidney healthcare team can help make your experience more pleasant. At DaVita®, you’ll receive personal care and attention from a highly trained team of professionals that wants to help you maximize your quality of life.