Due to start Dialysis- questions

[ihateittoo]

I'm writing on behalf of my mother who was yesterday told that she will need to start dialysis within 2 weeks. Her kidney functioning has dropped to 6%.

After reading some of the threads in the forum, I feel really nervous about her starting dialysis and have some questions that I hope people can shed some light on.

Kidney functioning after dialysis

After starting dialysis my understanding is that the kidneys continue to work.

Does the dialysis process in anyway contribute to a drop in kidney functioning?

The reason I ask is because in one of the threads about what people hate the most about dialysis someone mentioned 'decreased urine output.'

Does dialysis cause you to pee less or is this due to a continued drop in kidney functioning which would have happened even without the dialysis?

Fistula

My mother had her fistula operation about 4 weeks ago and has very thin / weak veins (the nurses always have trouble getting blood for tests).

I read in the FAQ thread that it can take 2-3 months for the fistula to mature so that it can handle the large needles and blood flow.

What should my mum do given hers has only been in for 4 weeks and is relatively fresh? Is there an option for a smaller needle? Lower blood flow speed to lessen the pressure on her viens?


What to expect

Can anyone tell me what hemodialysis was like the first time they went on dialysis?

No one in the family knows what to expect and the needles look so large and scary.

Sorry for all the questions....I just feel so lost and seek answers from people who are actually on dialysis as opposed to a nurse.

[RichardMEL]

Hi there ihateittoo.

A very scary time for you, your mother, and the rest of your family.

HOWEVER

it need not be.

To answer some of your questions as well as I can:

First the issue of urine output decreasing is related to the dialysis process and most people do decrease output after some time on dialysis. Some do not, but most do. The result is fluid restrictions that need to be taken by the patient so they don't overload on fluid (very dangerous). If your mother spends most of her time on hemo it is more likely than not that she will be faced with that particular thing.

Yes, residual kidney function often remains while under dialysis. I have been going for over 3 years and am at 5-6% of functilon myself (like your mother, I started at 6% GFR). There are various threads though on the best ways to maintain as much RRF (residual renal function) as possible.

Yes the needles are big and scary. My solution? I don't look! I turn my head and think about something else, or I talk to the nurses (who are well practiced at chatting at patients to distract them!).

Your mother's first session most liley will only go for say 2 hours at the start with no fluid taken off. That's the standard we do here - a gentle sort of clean/introduction if you will - then over the next few sessions the time is ramped up. This may be done differently in other places/parts of the world though.

Your mother will be introduced to the "routine" of dialysis - in the case of hemo it usually goes something like this:

* Come in and weigh yourself
* wash access (fistula if being used)
* set up in the chair
* get needled
* be bored for however long the session is
* needles taken out
* (fistula) hold access points till they clot
* weigh again
* get on with life

The main thing that you should know is that the actual dialysis process itself is, in the main, painless for the patient. Well yes, obviously the needles are painful when they go in - but most units will give numbing cream, or a local injection to help with that - specially initially. After a while the fistula hardens up and most people don't need anything for the needles - you really don't feel it. If everything is going A-OK you don't feel anything while the machine is doing its thing.

Try to not be so apphrensive. Ask questions and become informed - that's your greatest help.

Oh yes fistulas take 4-6 weeks, sometimes longer, to mature enough to be used. Given she had the op a month or so ago it will be 6 weeks by the time she starts - I'm sure they'll give the fistula a go, but if it doesn't work she may need a catheter/line in (or they may wait a little more till they can use the fistula).

Hope this helps a little. Others will add to this I am sure, and as your mother starts I am sure you will have many more questions - that's what IHD is here for.

Welcome!

Of course this all depends on your mother's specific condition and her situation may be different.

[Rerun]

Richard answered your questions very well as he always does.  Would you please go introduce yourself to us in the Introduction section?  Thank you and welcome to IHD.

Rerun, Moderator

[willowtreewren]

RichardMell has given great information as usual. :-)

Your mother was probably told to do exercises to help her fistula mature. This involves squeezing a soft ball several times a day. It is important for her to do this to help the fistula get bigger and stronger. The bigger she can get it to grow, the easier it will be to get the needles in.

Those fresh fistulas are very "tender" and easy to infiltrate (have the needle poke through it where it isn't supposed to). Ask that the most experienced sticker handle her needles at first. Using the fistula will toughen it up, too, making infiltration less likely.

They start with smaller needles and work up to larger ones. At our center they spent about a week at each needle size before using the next size.

Patients on dialysis often get cold from sitting for extended periods (and having the warm blood be removed and cycled through the machine). It is a good idea to take a blanket to help keep warm.

Tell your mom to take a deep breath and become as informed as possible. The more she knows the less there is to worry about.

Take care,

Aleta

[Hanify]

When I started haemo they started with only a couple of hours and gradually increased.  So the first couple were really easy and no problem.  Hope your mum finds that too.
Cheers
Bern