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Hemodialysis (5)

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Hemodialysis is a method to purify blood of the toxins which are otherwise excreted by a normal kidney. In essence, it replaces the excretory functions of kidneys.

To read more about Hemodialysis, click here.

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Not at all !!This a common misconception about hemodialysis. The only pain that one gets is the pain of needle insertion. Even that can be overcome by various applications.

Hemodialysis is not a discomfort in itself. In fact it is designed to reduce the patients discomfort !

Following are only some of the expected improvements:

  • Nausea disappears
  • Appetite improves
  • Swelling reduces
  • Sleep is regularized
  • Work efficiency increases
  • BP control is easier.
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At least three times a week, 4 hours each session.
Normal kidneys excrete waste products continuously from the body. If any artificial method to excrete these waste products are employed ( like hemodialysis), that method should also be continuous. Conceptually therefore, hemodialysis should be continuous. However, that is not practical.
The minimum kidney functions that can keep an individual healthy is a GFR of 10 mL/min.
Hence minimum amount of dialysis should be at least equivalent to ( if not more than) a GFR of 10 mL/min.
It has been calculated to find that 4 hrs dialysis, three times a week is close to a GFR of 10mL/min.
For the same reason, hemodialysis will never reduce in frequency. Three times a week is minimum, not ideal.
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It is a connection between artery and vein. This transmits pressure of the arteries to the veins which gradually swell up. These swollen veins can then be used to place needles for hemodialysis.

To read more about AV fistula, click here.

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When the chronic kidney disease enters stage IV i.e. when GFR has fallen to less than 30 mL/min.

The fistula takes 4 to 8 weeks to fully mature and become ‘usable’. That is the reason, it should be constructed well in advance.

To read more, click here.

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CAPD (6)

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CAPD stands for Continuous Ambulatory Peritoneal Dialysis.

It is a modality of dialysis where the peritoneal cavity is utilized for the exchange of waste products and excess fluid.

To read more about CAPD, click here.

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Commonly 15 to 30 min are required for each exchange. The time shortens with experience.

So, if someone is on 4 exchanges, the maximum time to be devoted to exchanges throughout the day is just 2 hrs !! This is substantially less than the time spent on each Hemodialysis session, not counting the time for commuting !

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Not at all !

A small minority of patients experience pain during infusion because of slightly low pH of the PD fluid. This can be overcome by using high pH PD fluid which is costlier.

However, if the pain is new onset and severe especially associated with cloudy drains, do contact your Nephrologist immediately.

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That is the whole objective behind the therapy !! The name itself says it: “Continuous AMBULATORY Peritoneal Dialysis”

You can even travel out of station, provided you have your supplies of PD bags with you

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PET is Peritoneal Equilibration Test. It is a simple test performed on the bed-side that tells us the type of peritoneal membrane of the individual.

The membrane type will determine the amount of ultrafiltration and solute clearance achieved.

To understand more about PET, click here.

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There are several ways.

Your monthly lab checks will tell you the creatinine level which will have stabilized to a lower level.( Remember, it will never come to normal, but should definitely come down once CAPD is started.)

Adequacy test can be performed where 24 hour PD drain fluid is collected and measured for urea and creatinine. Weekly KT/V value should be 1.7 and weekly clearance value should be at least 45 L/week.

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