Dialysis (FAQ) Frequently Asked Questions. READ THIS IF YOU'RE NEW TO DIALYSIS.

Disclaimer: I am not a doctor or in the medical field, this f.a.q. is just my understanding of kidney failure and all the problems associated with it. You should consult a doctor if you have any concerns. This is not going to be filled with complicated explanations or "Big words" this is going to be explained easy and I am going to try to not use big medical terms often. I want this to be easy to understand by everyone. Feel free to ask any questions you may have or contact me with any mistakes I may have made in creating this f.a.q.

What is Dialysis?

Dialysis is the medical term used to describe the treatment people receive when there own kidneys no longer function. Dialysis is the only way to maintain life until a transplant is given.

What causes Kidney Failure?

The main causes of kidney failure are Diabetes and Poly-cystic Kidney Disease ( A genetic disorder).

There can be many other causes of kidney failure such as:

An Inflammation of the kidney.
Kidney stones.
Kidney cysts.
An immune disorder called systemic lupus erythematosus.
Uncontrolled high blood pressure.
Abuse of drugs.
Many cases of Strep throat as a child or adult.
Cortisone injections.

The list goes on and on unforunately, more and more people are being diagnosed with Kidney Failure.

What types of Dialysis are there?

Here are the types Hemo-dialysis and Peritoneal dialysis:

Hemo-dialysis

Iis the process in which the person Is connected to a machine via two needles, one to remove the blood and the another to return the blood to the patient. The process takes three to four hours and Is done three times a week, during dialysis the patients blood Is cleaned several times and excess fluids are removed since the patient can no longer urinate.

Peritoneal dialysis

Removes toxins from the blood by using the peritoneum, the lining that covers the internal organs located in the abdominal region. Usually conducted by the patient, he or she introduces a solution into the peritoneum, through a surgically implanted catheter, allowing this lining to act like a dialyzing membrane. The main problem with this that it must be done every day and usually every 4-6 hours which is called Continuous Ambulatory Peritoneal Dialysis (CAPD) however it can also be done over night while you sleep, that is called Continuous Cycler-Assisted Peritoneal Dialysis (CCPD).

Home-Hemo

There are a few types of home dialysis other than Peritoneal, one being conventional home hemo and it requires basically a same setup as a convention in-center setup, special water treatments and plumbing and uses a similar sized machine as in-center. Then there is daily hemo dialysis (5-6 times a week) with a machine called the "NxStage" it is small weighs about 75 pounds and needs no special water treatment or plumbing. There are other machines out there that don't require special setups however they do not compare to the NxStage. Then there is Nocturnal Hemo dialysis, which is nightly home hemo while you sleep (6-8 hours). With this type of hemo patients are on little if no special diets or fluid restriction. And the people on it say they have never felt better. Nocturnal is the closest thing (currently) to having working kidneys.

What is a Kidney transplant?

A kidney from either a living relative or a brain-dead person is placed surgically into the patient. Only one kidney needs to be transplanted, which is why living donors are possible and they remain healthy after donation. Patients who have had a transplant will need to remain on medications which will suppress their immunity so that the transplanted kidney will not be rejected by their body's immune system. These medicines will have to be taken for the rest of their life and they can never miss a dose or the kidney could reject. Transplants do not last forever, transplants from living relatives last longest. If a transplant fails the patient can go back to dialysis or have another transplant.

When is Dialysis needed?

When serum creatinine increases to 900 µmol/L, basically when your blood tests come back saying that your kidneys are not cleaning your blood properly. This is where the term ESRD comes from End Stage Renal Disease.

What are the symptoms of kidney failure?

As kidney failure worsens the patient may have one or more of the following:

1. Pale and sallow complexion.
2. Fatigueness.
3. Shortness of breath.
4. Body itch.
5. Poor appetite, sometimes accompanied with nausea and vomiting.
6. Swelling of the face and legs.
7. Frequent urination at night.
8. Passes little urine.

In fact a person may have no symptoms at first but the symptoms will come eventually.

What are the accesses for Hemo-dialysis.

There are 3 kinds:

The AV Fistula:

This access called an arteriovenous fistula, is the most common and preferred hemodialysis route. A fistula can last you many, many years even decades. It is made by connecting a large vein to an artery in your lower or upper arm. The high pressure of artery blood flow allows the vein wall to thicken up and dilate. As the vein enlarges you will see a increase in the size, so much so that it would appear as though a rope is under your skin. Your access will need to mature for about 2 or 3 months in order for the vein to tolerate multiple needle sticks, to get good flow for dialysis, and for the vein to enlarge enough to allow the technicians and nurses to put the large dialysis needles in without infiltrating your fistula. Over time the fistula can get very big from repeated use. Also with some patients it can literally take several months for the fistula to mature, that is why it is very important to exercise your fistula by squeezing a ball for a set amount of time EVERYDAY.

Graft:

Similar to the av fistula is the graft. The difference is that with a graft a piece of synthetic tubing is inserted under the skin and sewn to a vein and an artery. A graft is sometimes used if a patients veins can not support a fistula, they are either too small or thin, or have some other problem. As with the fistula, you will notice the appearance of the graft below the skin. It will resemble a rope.

Catheter:

Catheters are required when your fistula or graft fails to work, or when you need dialysis before you've had a permanent access placed, or before it's had time to mature. A catheter is inserted into a large vein in a patient, usually at the neck, chest, or even groin. One end of the tubing goes under the skin down into the vein, while the other end remains sticking out of your skin. The part sticking out has two lines for inflow and outflow during dialysis. It is very important to keep it covered at all times and clean or an infections will happen.

What is this "Buttonhole Technique" I keep hearing about?

Well that is a technique to only be used on "Fistulas" A buttonhole technique is the process of sticking your needles in the exact same spot EVERY time. A buttonhole is created first by sticking the fistula with "Sharp" needles then after the spot is established "Blunt" needles are used. With this technique there is eventually no pain for the patient or very little and it has been proven to be better for the fistula in the long run. This process has been around for MANY years but is not widely used for in-center hemo in the U.S.A. For Daily hemo it is the preferred method.

What is Clotting?

Clotting is when a clot forms inside the fistula or graft blocking blood flow. A fistula rarely clots which is why it is the preferred access. A graft however is way more prone to clotting. When clotting occurs you must go to the hospital and have it de-clotted. Usually it's an out-patient procedure. Also they may inject declotting medicine to help loosen the clot. If the medicine they inject does not help they will they put in a wire and "clean" it out. Sort of like a plumber will clean your drains out. They may even do an angiogram and insert a little wire that has literally a balloon on the end and enlarge the area that was clotted by pumping up the balloon.

Can you explain the In-Center Dialysis procedure?

The procedure for most patients is as follows, you enter your dialysis unit, and wait to be called into the treatment room or if your chair is ready just go straight to your chair. Then you're weighed to see how much weight you've gained since your last treatment. Your temperature will also be taken. Once your weight has been calculated to see how much fluid needs to be removed, you sit down in your chair. Your blood pressure will be taken, Your arm will be cleaned with alcohol and/or iodine, now it's time for the dialysis needles. Most of the time they go in without a problem. Occasionally a dialysis tech or nurse will miss their mark and you end up being "infiltrated". If this happens blood will form under your skin and a bruise will appear. It can be a small bruise or it can be really bad. Anyway, after the needles are in, the tubing connected at the end of the needles is hooked up to the rest of the lines. Heparin is given (to prevent clotting) via the lines and your tech or nurse will start up your machine and your blood will begin to outflow through the tubing. Now you just wait out the time which can seem like forever sometimes. Your blood pressure will be taken several times throughout the procedure. When it's time to get off, the machine is stopped from filtering your blood and removing excess fluid, and your blood is returned back into your arm and saline is given to flush the lines. After all your blood is given back, the needles are pulled and you hold the puncture sites until they stop bleeding, this depends on the person and varies greatly, some people stop in a couple of minutes but some may take almost 30 minutes or longer. If you're feeling alright and your blood pressure is stable, you're all set to be weighed again. After this you may leave.

Every center is different and each have their own rules. But that is pretty much the way it goes. If you have a chest or neck catheter a nurse must put you on. Also some patients prefer to stick their own needles (I do) by doing so they reduce their chance of a tech or nurse infiltrating their fistula or graft since they can feel and know when they are "in".

Is it true some patients STICK their OWN needles?

Yes, believe it or not some patients stick their own needles! I do and I have been for several years. When a patient gets over their fear of the needle and tries it for themselves they will NEVER let another tech or nurse stick them again. When you stick the needle yourself you know exactly when you're "in" and when you've gone too deep. Plus you control the pain if it hurts, you STOP. Also it is better for your fistula to be stuck by the same person (you) every time instead of multiple techs or nurses with different skill levels. Lets face it some of these techs are terrible at their jobs. Unfortunately many people are scared to death to actually stick themselves, but it is actually very easy and in the long run BETTER for you.

What are the lab results that I should be most concerned about? When I am on Hemo-Dialysis.

Well there are many lab results and they are in many different catagories as you will see when you request a copy of your "Monthly" lab results. Which I suggest you do. DO NOT depend on the nurses or center to watch your labs. Be your own advocate, learn what these numbers mean and watch them closely. Many patients have their labs drawn weekly.

Hematocrit or Hemoglobin:

The higher these numbers are the more energy you will have. For a healthy person that number should be in the range of 42.0 to 52.0 however for a dialysis patient if you get 32.0 to 36.0 you are lucky. I say that because the center will "hold" your Epogen if your number goes above 36.0 now it varies from center to center and your doctor can request that they do not "hold" it. Also most centers ignore the Hematocrit number and just use the HCT CALC which is the Hemoglobin number multiplied by 3. I personally have them "Cut" my Epogen instead of having them "Hold" it. Doing that way avoids a sharp drop in your HCT number. The reason they hold it is, if your results gets too high your insurance will not reimburse them if it gets too high.

Adequacy of Dialysis:

These sets of numbers refer to how well you are being dialyzed. There are a few you really need to keep an eye on, first is: your KT/V that number should be above 1.30 up to about 2.20 if it is lower than that then you need to ask questions like can we increase the "Blood flow" which will allow your blood to get cleaned more times during a treatment. Or maybe you need to run on the machine longer, even 15 extra minutes can increase your KT/V. Also how welll your access is working will affect the KT/V number.

Then there is the BUN "PRE" and "POST". BUN stands for "Blood Urea Nitrogen" You want to have a number between 9 to 28 The lower the number the better. The "Pre" number is the result before the dialysis session and the "Post" is the result from the blood drawn after the dialysis session. For example on one of my results my "Pre" was 70 which is high (not good) but my "Post" was 28 which was good.

Then there is the URR which stands for "Urea Reduction Ratio" that number should be between 68 and 100 (it is a percentage number) the higher the number the better. URR is a number that tells you how hemodialysis is removing waste products from your body or how effective your dialysis treatments are. Urea is just one of the body’s waste products, how effectively it is removed indicates how well other waste products have been removed.

The BIG Three:

Calcium, Phosphorus, and Potassium these 3 numbers are the ones to really watch out for. If any one of these numbers is too high or low it can cause serious problems even death. First lets talk about Potassium a normal number is 3.5 to 5.0 luckily the dialysis machine removes excess potassium rather well and it's a good thing since a high potassium can stop your heart, even too low a potassium can stop your heart. Then there is Phosphorus a normal number is 2.5 to 4.5 this is the dialysis patients hardest number to control since the machine is not efficient enough when it comes to removing Phosphorus. Having a high Phosphorus WILL cause you to have bone problems such as fractures and breaks. Bottomline is don't forget to take your phosphorus binders they prescribe. Finally there is Calcium a normal number is

More coming soon.