A Closer Look at Hemodialysis 

Is it the right treatment option for me?

There are two different treatment options for Dialysis: Hemodialysis and Peritoneal Dialysis. But you may be asking yourself; what is the difference? Or maybe you are wondering which treatment may be best for you or a loved one?

In this article, we will give an overview of what hemodialysis is, how the treatment works, and even give you some additional tips and resources. We hope this article helps you understand hemodialysis, so that you can select the treatment that best suits you or your loved one's needs. 

If you are interested in learning more about PD or Peritoneal Dialysis, click here to learn more read our in depth article.

What is Hemodialysis?

Hemodialysis is a procedure where a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood. The dialyzer, or filter, has two parts: one for your blood and one for a washing fluid called dialysate. 

Dialysate, also called dialysis fluid, dialysis solution, or bath; is a solution of pure water, electrolytes, and salts (such as bicarbonate and sodium). The purpose of dialysate is to pull toxins from the blood into the dialysate. The way this works is through a process called diffusion. 

This process of diffusion happens in the dialyzer where a thin membrane separates these two previously mentioned parts (blood and dialysate). In diffusion, blood cells, protein, and other important components remain in your blood because they are too big to pass through the membrane. Likewise, smaller waste products in the blood, such as urea, creatinine, potassium and extra fluid pass through the membrane and are washed away by the dialysate. 

This may all sound a little overwhelming in technical terms, but we promise it is not too complicated. To put it simply hemodialysis is a process where your blood is filtered and purified outside the body through a special machine called a dialyzer, rather than internally through your kidneys.

What does treatment look like?

Hemodialysis is typically done at a dialysis clinic or hospital, usually 3 days a week. These in clinic or hospital dialysis treatments typically last about 4 hours and a nurse or dialysis technician will set up and perform the dialysis treatment. In some cases, hemodialysis can even be done at home. 

The difference for at-home hemodialysis treatment is instead of making 3 trips to a clinic each week, the patient instead undergoes treatment at home 4 - 7 times a week for shorter durations (typically only a couple hours). 

One thing we must note is that there can be special requirements to be able to do hemodialysis at home, so before you decide on which method is right for you, make sure you talk with your doctor to figure out which treatments are available and recommended for you personally. 

Hemodialysis Access Points

Whether you choose hemodialysis at home or at a clinic, for both options you will need to first decide which one of the 3 hemodialysis access points is best for you. The three access points/methods are done are the AV fistula, graft, or port access catheter. 

However, there are only 2 options recommended for long term use, and those are the AV fistula or an implanted under the skin access graft. Both of these access points are made possible through vascular surgery. Consult your doctor to learn more about which will best suit you.

Each method has varying amounts of preparation time and necessary procedures to be ready for dialysis treatment. For example, the AV fistula needs to be done about 6 months before beginning regular dialysis treatment (which we will explain more shortly) whereas an implanted fistula or graft can be used much sooner.  The other short-term option is a port access catheter.

Port Access

The port access catheter or the venous catheter—is an access point designed for short-term use. This involves a tube or catheter inserted into a vein in the neck, chest, or leg (near the groin) for vascular access. This option is usually preferred when a patient's kidney function is decreasing rapidly and their kidney disease has progressed quickly. 

In these cases, a patient may not have time for placement of an AV fistula or AV graft before starting hemodialysis treatments. Typically in cases like these, a surgeon, (usually a nephrologist who is a doctor specialized in the kidneys) or potentially an interventional radiologist (a doctor who uses medical imaging equipment to perform operations) will surgically perform the venous catheter placement procedure in a hospital or an outpatient center. 

Again this option is usually only recommended when there may not be enough time for a fistula or graft to be surgically implanted. The venous catheter is not ideal because a patient may develop a blood clot, an infection, or a scarred vein, causing the vein to narrow. 

However, if a patient needs to start hemodialysis right away (as we mentioned earlier), a venous catheter will work for several weeks or months until a surgeon can perform a long-term access surgery and the AV fistula or AV graft has time to mature.

AV Fistula or arteriovenous fistula

An AV Fistula or arteriovenous fistula is a connection, made by a vascular surgeon, of an artery to a vein. Vascular surgeons specialize in blood vessel surgery, so it is not an overly complicated procedure. 

The surgeon usually places an AV fistula in the forearm or upper arm of the patient, so that hemodialysis can be performed. An AV fistula is simply an artificially created connection between an Artery and a Vein in the arm. An AV fistula, once placed, causes extra pressure and extra blood to flow into the vein, making it grow large and strong over a period of time. This larger vein provides easy and reliable access to blood vessels. Without this kind of access, regular hemodialysis sessions would not be possible.

As mentioned earlier, it is of the utmost importance to plan to have your AV Fistula surgery at least 6 months before beginning regular dialysis treatment. This is important because as we described above the vein needs to grow in both size and strength to make dialysis possible. 

Untreated veins cannot withstand repeated needle insertions, because they would collapse the way a straw collapses under strong suction, making regular dialysis near impossible.

Some of the pros of getting a fistula are that it provides good blood flow for dialysis, it lasts longer than other types of access, and is less likely to get infected or cause blood clots than other types of access. 

There are a lot of benefits to fistula access, however one of the disadvantages can be the amount of time the vein takes to strengthen and mature. An AV fistula typically requires 2 to 3 months to develop, or mature, before the patient can use it. 

Depending on the patient, they may not have time to wait for the fistula to mature, so it is important to discuss whether a fistula is right for you with your doctor.

AV Graft or Arteriovenous Graft

Another vascular access type is an AV graft. An AV graft is very similar in function to an AV fistula, with the exception of a looped tube that is used to connect an artery to a vein. 

The tube graft is usually made from a medical grade of Gortex material.  A vascular surgeon performs AV graft surgery, much like an AV fistula surgery, and is performed in an outpatient center or a hospital. 

Unlike the AV fistula, one of the major advantages with the AV graft is it can usually be used 2 to 3 weeks after the surgery. However, with an AV graft, there is potential for infection or clotting, but it is important to note that a well-cared-for graft can last several years. 

Again, it is important to discuss with your doctor the advantages and disadvantages of each access point to discern which may be right for you.

Conclusion

We hope you found this article helpful and now have a better grasp on what Hemodialysis is, how it works, and whether or not it may be right for you or your loved one. 

For more information on all things dialysis, including other treatments such as PD; click here!

Click here for resources and Dialysis apparel to help with treatments, comfort, and activities of daily living. 

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