Dialysis therapy

Information about dialysis and kidney transplantation

Dialysis and kidney transplantation are the two main treatments for severe kidney failure, also known as end-stage renal disease (stage five PChN). Dialysis, including hemodialysis and peritoneal dialysis, replaces part of the kidney's function, removing excess fluids and metabolic products from the body. Kidney transplantation, when possible, can more effectively restore kidney function.

Dialysis or kidney transplantation is necessary when the kidneys stop functioning properly, causing harmful substances to accumulate in the body. Typically, a doctor recommends starting dialysis when kidney function drops to about 10% of normal or when symptoms such as fatigue, lack of appetite, nausea, vomiting and trouble concentrating appear. It is important to start treatment before serious complications occur.

Hemodialysis involves pumping blood through a dialysis machine, which removes metabolic products and excess fluids. The procedure usually takes place at a dialysis station 3 times a week, with each session lasting 3 to 5 hours. It requires the creation of a vascular access, which can be an arteriovenous fistula, a vascular graft or a catheter.
Peritoneal dialysis is usually performed at home. Dialysis fluid is introduced into the abdominal cavity to filter toxins through the peritoneal membrane. It requires specialized equipment and regular fluid changes, which can be done during the day or at night.

Both methods have their advantages and disadvantages, and the choice between them depends on your health, lifestyle and preferences.

Advantages: kidney transplantation often leads to a better quality of life and longer survival than dialysis, as it eliminates the need for regular dialysis treatments.
Cons: Transplantation is a major operation, and afterwards you must take immunosuppressive drugs for life to prevent transplant rejection, but they can have side effects such as infections, diabetes or cancer.

Advantages: hemodialysis is a relatively simple procedure, performed under the guidance of specialists, so you don't have to manage the equipment yourself.
Cons: Can cause low blood pressure, dizziness and other discomforts. It also requires regular trips to dialysis stations and can affect your daily activities.

Advantages: peritoneal dialysis gives you more freedom, as you can perform treatments at home. It is less disruptive to your daily life and often allows you to continue working.
Cons: Requires learning how to use the equipment and regular monitoring, which can be a challenge. Can also increase the risk of infection and hernia.

Kidney transplantation is usually the preferred option when it is available and there are no contraindications. When transplantation is not an option, the decision between hemodialysis and peritoneal dialysis depends on your health, lifestyle and availability of home support. Together with your doctor, you can decide which option is best for you.

Some people, especially the elderly or chronically ill, may choose to forgo dialysis. It is important that you discuss this decision with your doctor and your family, taking into account the benefits and risks of this choice. If you do decide to forgo dialysis, it will be crucial to provide appropriate palliative care to help you maintain your comfort and dignity of life.

Yes, traveling is possible. If you choose peritoneal dialysis, you can take your equipment with you and continue your treatment elsewhere. In the case of hemodialysis, you will need to find a dialysis center in advance in the place you plan to visit. Your doctor or nurse can help you arrange such a trip.

Hemodialysis

Dialysis is a treatment method used for advanced kidney failure. The kidneys filter and clean the blood, removing unnecessary metabolic products, toxins, excess salts, electrolytes and water. When the kidneys stop performing their function, dialysis is necessary. There are two types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis: During this procedure, blood is drawn from the body, filtered through a dialysis machine, and then purified blood is returned to the body.
Peritoneal dialysis: Uses the peritoneal membrane inside the abdominal cavity, which acts as a natural filter.

Hemodialysis most often takes place at a dialysis station, where medical personnel monitor the procedure.
Peritoneal dialysis can be performed at home with prior training. There is no home hemodialysis program in Poland.

You make the decision to start dialysis together with your doctor based on your kidney function, symptoms of failure and overall health.

How often is dialysis performed? Hemodialysis is usually performed 3 times a week, with each session lasting between 3.5 and 5 hours.

Arteriovenous fistula: The best vascular access in terms of health and safety.
Graft fistula: An artificial connection between blood vessels.
Dialysis catheter: Used when a fistula is not possible.

During dialysis, the following may occur:

Vascular access problems (infections, loss of function),
Dizziness,
Decrease in blood pressure,
Muscle cramps,
Fatigue after dialysis sessions.

If you experience any discomfort, tell your doctor or nurse

Wash your fistula hand before each dialysis.
Do not touch or scratch the area.
Do not allow blood to be drawn or blood pressure to be measured in this hand.
Examine the fistula daily - it should make a noise and vibrate.

The dressing on the catheter should be changed during each dialysis session.
Do not attempt to remove or change the dressing yourself.
Do not immerse the catheter in water.

With kidney failure, fluids accumulate in the body. Notify your doctor if you notice a sudden increase in weight between dialysis sessions.

Yes, it is important to limit fluids and avoid foods rich in sodium, potassium and phosphorus, which can accumulate in the body.

When symptoms of infection occur: fever above 38°C, chills, redness, discharge or pain at the site of vascular access.

Bleeding from access that does not stop after 20 minutes of pressure.

Can I travel during dialysis? Yes, it will most likely be possible. If you are using peritoneal dialysis, you can bring your equipment with you. For hemodialysis, you will need to find a dialysis center in the place you plan to visit.

Peritoneal dialysis

Peritoneal dialysis is a method of treating kidney failure in which a special dialysis fluid is introduced into the abdominal cavity. This fluid removes excess water, salts and metabolic products from the blood and is then drained from the body. Peritoneal dialysis replaces kidney function in people whose kidneys are not working properly.

Peritoneal dialysis is performed at home. This procedure needs to be performed daily, so the patient is properly trained to be able to perform it safely on his or her own.

The doctor decides when to start dialysis based on an assessment of the patient's kidney function and general health. Before starting treatment, surgery is required to insert a catheter into the abdominal cavity through which dialysis fluid will be delivered and removed. The wound after the operation heals about two weeks before dialysis begins.

During peritoneal dialysis:

You connect the catheter to the dialysis system.
You introduce dialysis fluid into the abdominal cavity, where it stays for a specified period of time and then is drained outward
After pouring, you drain the used fluid and introduce new fluid. Each fluid change is called a "replacement."

There are two main types of peritoneal dialysis:

Continuous ambulatory peritoneal dialysis (CADO) - the patient performs 3-5 fluid exchanges per day, and the fluid remains in the abdominal cavity at night.
Automated peritoneal dialysis (ADO) - exchanges are performed automatically by a device called a cycler, usually at night while you sleep.

Your doctor will help you choose the method that works best for you.

The following problems may occur during peritoneal dialysis:

Skin infection around the catheter: Manifested by redness, pain, hardening of the skin or discharge. Treatment consists of antibiotics in the form of creams or tablets.
Peritonitis: An abdominal infection that causes abdominal pain, fever, nausea or cloudy dialysis fluid. Treatment includes antibiotics administered through the dialysis fluid.
Abdominal hernia: Can occur when the abdominal muscles weaken, causing a bulge. In some cases, surgery is required.

Contact your doctor if you notice:

Redness, pain or discharge around the catheter.
Abdominal pain or fever.
Cloudy dialysis fluid.
Bulge in the abdominal cavity (may indicate a hernia).

- Control your weight - This is important to monitor whether dialysis is working properly.

- Take care of hygiene around the catheter - Wash the skin around the catheter every 1-2 days, apply antibiotic cream and cover with a dressing. If you notice any changes or injury, contact your doctor.

- Follow a special diet - You may be required to limit your intake of fluids and foods rich in sodium, potassium and phosphorus, which can accumulate in the body if you have kidney failure.

Preparing to go to HD for the first time

Dialysis referral: if you are a patient starting dialysis treatment or going to another dialysis station for a guest treatment you should have a dialysis referral with you.
Medical records: always carry up-to-date medical records, including your dialysis card, lab results and a list of medications you are taking.
ID and health insurance card: remember to bring your ID and health insurance card, which may be required when you register at the dialysis station.
Medications: before you leave, make sure you bring with you all the medications you need to take before or after dialysis. Consult with your doctor about which medications you need to take before the procedure.
Comfortable clothing: dress in loose, comfortable clothing that will not obstruct access to the fistula or catheter.
Snacks: take a light snack with you that is allowed in your diet. This can be important, especially if your dialysis session lasts several hours.
Personal accessories: bring along your glasses, hearing aid or other medical devices, and hygiene products that you may need during your stay at the dialysis station.
Phone and charger: remember to bring your cell phone and charger with you so that you can contact loved ones or health services in case of emergency.
Entertainment for the duration of dialysis: take along a book, tablet, headphones or other permitted forms of entertainment to pass the time during the procedure.
Pillow or blanket: if you feel more comfortable with extra accessories, consider bringing a small pillow or light blanket that can make you more comfortable during dialysis.
Transportation: plan your transportation to the dialysis station in advance and make sure you arrive on time. If you use medical transportation, confirm its availability in advance.
Inform the dialysis station of changes in your health: if there are any changes in your health, such as fever, infection, changes in blood pressure, or new symptoms, inform the staff before treatment.
Weight control: before going for dialysis, measure your weight and make a note of it. This is important for assessing the amount of fluids to be removed during dialysis.
Communicate with staff: be prepared to discuss any questions or concerns you may have about your dialysis, treatment or diet. Regular communication with medical staff is crucial to your safety and comfort.
Personal hygiene: wash yourself before going to the dialysis station, wear clean clothes. Wash your hands and your fistula before you sit on the dialysis chair.

Preparing to go to HD

Medical records: always carry up-to-date medical records, including new test results, consultations, hospital information sheets
Medications: before you leave, make sure you take with you any medications you need to take before or after dialysis, such as inhalation drugs, insulin, pills. Consult with your doctor about which medications you need to take before the procedure.
Comfortable clothing: dress in loose, comfortable clothing that will not obstruct access to the fistula or catheter.
Snacks: take with you a light snack that is allowed in your diet.
Personal accessories: bring along your glasses, hearing aid or other medical devices, and hygiene products that you may need during your stay at the dialysis station.
Phone and charger: remember to bring your cell phone and charger with you so that you can contact loved ones or health services in case of emergency.
Entertainment for the duration of dialysis: take along a book, tablet, headphones or other permitted forms of entertainment to pass the time during the procedure.
Pillow or blanket: consider bringing a small pillow or light blanket that can improve comfort during dialysis.
Transportation: plan your transportation to the dialysis station in advance and make sure you arrive on time. If you use medical transportation, confirm its availability in advance.
Inform the dialysis station of changes in your health: if there have been any changes in your health since your last treatment, such as fever, infection, diarrhea, changes in blood pressure, or new symptoms, inform the staff before your treatment.
Weight control: before going for dialysis, measure your weight and make a note of it. This is important for assessing the amount of fluids to be removed during dialysis.
Communicate with staff: be prepared to discuss any questions or concerns you may have about your dialysis, treatment or diet. Regular communication with medical staff is crucial to your safety and comfort.
Personal hygiene: wash yourself before going to the dialysis station, wear clean clothes. Wash your hands and your fistula before you sit on the dialysis chair.

Exercises during hemodialysis

During your dialysis session, you can do a variety of physical exercises that are safe and don't put too much strain on your body. Here are some examples:

1. breathing exercises: deep inhalations and exhalations will improve lung ventilation and relaxation.

2. leg exercises: gentle leg movements such as raising and lowering or foot circulation are beneficial for strengthening and flexibility of muscles and joints.

3. hand exercises: simple hand exercises, such as tensing and relaxing your hands, circulating your hands, keep your muscles fit and coordinated. You can squeeze a small rehabilitation ball. Do not do exercises with a hand with a punctured fistula.

4. muscle tensing: isometric exercises, such as tensing the muscles of the legs, arms, abdomen, back, without moving them, can help maintain muscle strength and proper posture.

5 Stretching: gentle muscle stretching, such as reaching up or stretching the arms, can improve flexibility and comfort.

6. head and neck movements: gentle movements of the head and neck, such as turning or tilting, can help reduce tension and improve comfort.

All exercises should be tailored to your individual abilities and consulted with medical personnel to ensure the safety and effectiveness of the therapy.

Diet of a person on dialysis

Yes, most people undergoing dialysis need to pay special attention to what they eat and drink. Your doctor, nurse or dietician will let you know if there are foods and drinks that should be limited or avoided.

The right diet for you depends on:

Your health condition and any other medical conditions you may have
Type of dialysis - There are two types of dialysis: hemodialysis and peritoneal dialysis. People undergoing hemodialysis at a dialysis station should pay the most attention to their diet. They must limit or avoid more products than people undergoing peritoneal dialysis
Dialysis frequencies

Your kidneys are not working as they should, which means their function of filtering the blood is impaired. Healthy kidneys remove excess water, salt and other minerals and nutrients from your body that you consume with food and drink.

Dialysis replaces the work of the kidneys, but is not as effective as healthy kidneys, which work around the clock. Typically, hemodialysis is performed only three times a week. So if you take in too much water, salt or other nutrients, they can build up in your body, which can lead to disease and other problems.

Being careful about what you eat and drink:

You will maintain the best possible health by avoiding excessive weight gain.
Do not allow excessive fluid accumulation between treatments. Too much fluid can raise blood pressure and put strain on the heart, as well as cause edema, weight gain or breathing problems.
You will maintain proper levels of nutrients in the body. Certain foods can raise levels of certain components, which can lead to health problems.

As a person on dialysis, you need to pay special attention to the nutrients in the food and drink you consume, such as:

Sodium - This is the main component of table salt. Most people on dialysis need to limit their sodium intake because excess sodium can cause thirst, and this leads to the consumption of too much fluid. It can also raise blood pressure. Check product labels and choose those low in sodium or those labeled "sodium-free."
Fluids - Most people on dialysis need to limit their fluid intake. Remember that not only beverages, but also some foods (e.g., ice cream) and vegetables (e.g., melons, cucumbers) contain a lot of water.
Potassium - This is an ingredient that affects heart function. Too much potassium in the body can lead to heart rhythm problems. Avoid potassium-rich foods and choose those low in potassium.
Phosphorus - Found in many foods, such as milk, nuts, beans and chocolate. Excess phosphorus in the body can weaken bones. Your doctor may prescribe medications to help keep your phosphorus levels low.
Protein - Protein is important for maintaining strong muscles. People undergoing peritoneal dialysis may need extra protein because you lose a certain amount during each treatment. Your doctor or nutritionist may recommend protein supplements.

Your doctor will also likely recommend that you take vitamins to supplement those components that may be missing from your diet.

Your doctor, nurse or nutritionist can help you determine which foods are worth eating and which should be avoided. They can also advise you on how much food to eat for each serving.

Working with a dietitian can be especially helpful, especially if you find it difficult to judge which foods are safe - some may be low in potassium but high in phosphorus, or vice versa.

Limiting sodium intake is the best way to reduce thirst. However, if you still feel thirsty, try the following:

Rinse your mouth with water or mouthwash, but do not swallow the liquid.
Instead of drinking, suck on ice cubes - ice melts more slowly than liquids. Remember, however, that ice also counts as a liquid.
Chew gum or suck hard candy.
Eat cold fruits low in potassium, such as frozen grapes.

Flu vaccination - hemodialysis

As a person on dialysis, you have a lowered immune system, which makes you more susceptible to infections, including the flu. Flu vaccination is important because it can effectively protect you from serious complications such as pneumonia, stroke and heart attack.

Vaccination reduces the risk of flu-related health complications. Studies show that vaccinated dialysis patients have a significantly lower risk of hospitalization and serious health problems. For example, the vaccine reduces the risk of heart attack by 26% and the risk of stroke by 24%.

Flu season typically runs from October through May, with the highest incidence between December and February. It is best to get vaccinated between late October and mid-November to ensure adequate protection throughout the season.

Many may not vaccinate due to a lack of knowledge about the benefits of immunization or concerns about side effects. It is important to know that the flu vaccine is safe, and adverse reactions, such as pain at the injection site, are usually short-lived and rarely lead to serious complications.

Vaccination not only reduces the risk of contracting influenza, but is also associated with lower medical and hospitalization costs. It also reduces the number of days of incapacity, which is economically important for dialysis patients.

Contact the medical team at your dialysis center for more information on available vaccinations.

Failure to vaccinate against the flu can lead to serious health complications and even hospitalization. Dialysis patients who do not vaccinate have a significantly higher risk of contracting the flu compared to those who regularly vaccinate.

Remember that flu vaccination is an essential part of preventive health care, and regular immunization can significantly improve your health outcomes.

Vaccination against hepatitis B - hemodialysis

Protection against infection: Dialysis patients are at increased risk of hepatitis B virus infection, which can lead to serious health problems such as cirrhosis and liver cancer.
Prevention of complications: Hepatitis B infection can significantly worsen the condition and hinder further renal replacement therapy.

Base dose:
- First dose: administered at any time.
- Second dose: 1 month after the first dose.
- Third dose: 6 months after the first dose.
Monitoring of antibody levels:
- After vaccination, a test to determine the level of antibodies to hepatitis B virus (HBsAb test) is recommended.
- Values above 10 mIU/ml indicate an effective immune response.
Booster dosage:
- For those who have not achieved an immune response, the doctor may recommend additional booster doses.

In case of insufficient response: Those who do not achieve antibody levels above 10 mIU/mL may require modification of the vaccination schedule.
Enhanced monitoring: Dialysis patients who are at higher risk of infection may need more frequent monitoring and booster vaccination every 5-10 years, depending on antibody levels.

Reporting side effects: Any worrisome symptoms after vaccination, such as fever, pain at the injection site or allergic reactions, should be reported to your doctor.
Regular consultations with your doctor: It is a good idea to discuss your vaccination schedule and any health concerns with your health care provider.

Vascular access for hemodialysis

The best vascular access for dialysis is an arteriovenous fistula (t-¿) created from the patient's own vessels. It provides the best quality and length of life for the dialysis patient.

The t-fistula allows a high blood flow to the venous vessel (more than 400-600 ml/min), which allows for efficient blood purification in the dialyzer.

There are three main types of vascular access for hemodialysis:

Arteriovenous fistula (t-¿) - produced surgically by connecting an artery to a vein, usually in the upper limb.
Vascular fistula with an artificial prosthesis - sewn under the skin and connected to the body's own vessels.
Permanent vascular catheter - inserted into large venous vessels, most often into the internal jugular vein.

The t-fistula becomes well palpable under the skin and allows multiple punctures, which is beneficial for long-term treatment.

During the entire hemodialysis procedure, a total of up to 100 liters of blood is purified, which means that the total volume of blood flows several times through the artificial kidney.

By creating a t-fistula, you can enjoy a better quality of life and a longer period of effective dialysis treatment.

Any vascular access carries some risk of complications, such as infections or blood clots, so it is important to follow hygiene rules and have regular medical check-ups.

Once the vascular access is created, it is important to regularly monitor its function and report any worrisome symptoms to the doctor.

The t-fistula is designed for long-term use, allowing effective dialysis for many months or even years, depending on individual circumstances.

Management of arteriovenous fistula

Perform a fistula assessment each day using the three senses:

Sight: Check for redness, swelling, or new worrisome changes.
Hearing: Place the limb with the fistula against the opposite ear or use a stethoscope to assess the murmur of flowing blood.
Touch: Feel the tremor and murmur of blood along the length of the fistula to make sure it is working properly.

Fistula training is crucial to thicken, visualize and strengthen the fistula, which reduces the risk of complications and enables safe multiple punctures. Begin training after suture removal and evaluation by the medical team. Exercise regularly for at least 3 months, performing appropriate exercises using a stance and a rubber ball.

Avoid the following situations to minimize the risk of fistula damage:

Extreme temperatures (saunas, sunbathing).
Wearing jewelry on the hand with a fistula.
Use of compression bandages.
Sleeping on your hand with a fistula.
Carrying heavy objects (more than 3 kg).
Any cuts or injuries in the fistula area.

Wash your fistula hand with soap and water daily, and additionally before each hemodialysis procedure. Avoid dirt and sneezing or coughing toward the fistula puncture site. Taking care of hygiene reduces the risk of serious infections.

Before the procedure, wear loose clothing that will make access to the fistula easier. During dialysis, keep your hand in a relaxed position so that the needles do not move. After dialysis, apply pressure to the bleeding site with a gauze pad until the bleeding stops.

Report the following symptoms:

Hand pain with fistula.
Tingling, numbness or cold sensation in the fingers.
Nodules within the fistula.
Changes in the appearance of the skin, such as ulceration or bruising.
Swelling in the fistula area.
Increased hand warming or fever.

If the fistula noise stops, sudden hemorrhage or prolonged bleeding after dialysis, immediately go to the nearest hospital.

Stopping blood flow in the fistula.
Arm ischemia.
Aneurysmal fistula.
Venous hypertension.
Nerve damage.
Fistula hemorrhage.
Fistula infection.

Remember: You are the most important guardian of your fistula. Regular evaluation, proper hygiene and avoidance of risky situations are key to its proper functioning.

Management of the dialysis catheter

A permanent catheter is used for people who do not have adequate vessels for a vascular fistula. It is also used in situations of prolonged maturation of a vascular fistula or in cases of thrombosis.

The permanent catheter is inserted into the jugular or femoral vein. Approximately 10-15 cm of the catheter extends into the skin and is positioned to grow into the subcutaneous tissue. On a daily basis, the catheter is located under clothing.

The most common complications are thrombosis and infection, the most serious of which is sepsis from splenomegaly.

Symptoms of infection can include exudate, pain, swelling, and a warm feeling around the catheter's mouth.

Wash your hands with soap and water before the hemodialysis procedure and wear a mask over your nose and mouth while connecting and disconnecting the dialysis catheter.

After dialysis is completed, the catheter outlet should be covered with a sterile dressing, which should remain clean, dry and intact until the next treatment.

When showering, the catheter should be secured with a waterproof cover. Bathing in a bathtub should be avoided.

If the dressing is damaged, it should be carefully removed and replaced with a fresh, sterile dressing. Before replacing the dressing, wash your hands and disinfect the catheter outlet with a suitable disinfectant, and then apply a new dressing.

Avoid unnecessary manipulation of the catheter, do not twist or pull it. Regularly check that the catheter clamps and plugs are in place.

If there are signs of infection or any worrisome changes, contact the medical staff of the dialysis station immediately.

By following these rules, you can ensure your safety and reduce the risk of dialysis catheter-related complications.

Monitoring fluid balance in the dialysis patient

Fluid balance refers to the balance between the amount of fluids taken in by the body and the amount of fluids excreted. The purpose of monitoring fluid balance is to maintain adequate fluid levels in the body to prevent health problems such as edema, high blood pressure and heart problems. Here are recommendations for monitoring and maintaining a fluid balance:

Noting fluid intake:
Record and log all fluid intake, including drinks, soups and liquid foods, to assess total fluid supply. Follow your doctor's recommendations for daily fluid intake limits. You can use a measuring cup to accurately measure the amount of fluids in your diet.
Record fluid excretion:
Monitor and record the amount of fluid excretion, including urine, to assess daily fluid balance and long-term trends.
Fluid balance assessment:
After each dialysis session, compare the total amount of fluid removed (known as ultrafiltration) with the amount of fluid taken in and excreted to assess the effectiveness of therapy.
Adjust dialysis plan and intensity:
Based on fluid balance monitoring, adjust the dialysis plan in consultation with the medical team. Changes in dialysis duration, dialysis intensity, or additional dialysis may be necessary. Any missed dialysis generates a fluid backlog and should be made up.
Daily weight monitoring:
Regularly measure and record your body weight before and after each dialysis session. Any significant changes in weight may indicate an abnormal fluid balance.
Monitor clinical signs:
Regularly check for the presence of swelling, especially in the lower extremities, abdomen and around the eyes. Swelling may indicate excessive fluid retention. Watch for clinical signs such as shortness of breath, accelerated heart rate or headaches, which may suggest fluid balance disorders
Blood pressure monitoring:
Measure and record blood pressure before, during and after each dialysis session. Pressure fluctuations can be an indicator of abnormal fluid balance.
Dietary recommendations:
Follow dietary recommendations, especially limiting fluid and sodium intake, which can help better control fluid balance
Diuretic treatment:
Determine with your doctor whether you need diuretics that affect fluid balance. If urine volume is reduced, consult your doctor, as this may affect fluid balance
Systematic reviews:
Conduct regular systematic fluid balance reviews with the dialysis station's medical team to ensure that the methods used are effective and tailored to your health needs.