Dialysis

Dialysis does the filtering work in place of the kidneys. Blood is drawn out a little at a time, passed through a filter, and returned, and over a session it removes the waste chemicals that have built up since the last one, takes off excess fluid, and corrects the salts.

In haemodialysis, the filter is a cartridge in a machine, containing thousands of fine hollow fibres. Your blood flows inside the fibres and a fluid flows around them, and waste moves across the fibre wall. In peritoneal dialysis, fluid is run into the abdomen through a soft tube and the body's own lining acts as the filter, with exchanges done at home several times a day or overnight by a machine.

Getting the blood in and out needs an access, and for haemodialysis this is built in advance. A fistula, made by joining an artery to a vein in the arm so the vein thickens and enlarges over two to three months, is the most durable option. A tunnelled tube in a neck vein is used when treatment must start sooner.

Dialysis replaces part of what the kidneys did. It does not replace the hormones they made, and those are given separately.

A haemodialysis session is a Day Care treatment and needs no anaesthetic. Most people come to a centre three times a week for a session of about four hours, and both the number and the length are set for you and matter to how well you do.

You are weighed on arrival, since the difference from your target weight tells the nurse how much fluid to take off. Two needles are placed in the fistula, one to take blood out and one to return it. If the needles bother you, ask for a local anaesthetic cream and apply it an hour before. Where a neck tube is used, it is simply connected and no needles are involved.

You then sit in a reclining chair for the session, with your blood pressure checked regularly. You can read, sleep, use a phone or eat, and one arm stays still.

At the end the blood in the circuit is returned, the needles come out, and firm pressure is held on the sites for ten to twenty minutes. Plan on about five hours in the unit door to door.

There is no recovery in the usual sense; this is an ongoing treatment and the question is how each session leaves you feeling. Many people feel washed out for a few hours afterwards, sometimes with a headache or cramps, and prefer to go home and rest. That commonly eases over the first weeks as the body adjusts, and a good number of people go straight back to work from the unit.

The days in between are where the work sits. Fluid intake is restricted, because everything you drink stays until the next session and taking off a large volume quickly is what causes the cramps and the low blood pressure. Your dietitian will set limits for potassium, phosphate and salt, and these matter more on dialysis than they did before.

Protect the fistula arm. No blood pressure cuffs, no blood samples and no drips in it, no tight sleeves or watches, no sleeping on it, and check daily that you can feel the buzz along the vein.

Many people continue working, and the schedule is built around the three sessions.