Aside from patients who are on dialysis or who have a loved one on dialysis, very few individuals know much about this treatment and what it does for the body. This is unfortunate since dialysis is a life-saving treatment for countless patients who have end-stage kidney failure and have not yet found a donor.
Dialysis helps take over some of the functions of healthy kidneys, allowing the body to continue working even during end-stage kidney failure. These functions include removing waste, salt, and excess water to prevent build-up, controlling blood pressure, and maintaining a safe level of specific chemicals in the body, including potassium and bicarbonate.
Continue reading to learn about what patients can expect while living on dialysis, including cost, location, comfort, and life expectancy. Let’s start with breaking down the two major types: hemodialysis and peritoneal dialysis.
Hemodialysis uses an artificial kidney, called a hemodialyzer, to remove waste as well as excess chemicals and fluid from the blood. A doctor will perform minor surgery on one arm or leg to create an access point into the blood vessels, which will allow the blood to get into the hemodialyzer. This access point will be made in one of three ways. Either by joining an artery to a vein, creating a larger blood vessel known as a fistula, using a soft plastic tube to join an artery and vein, called a graft, or through a catheter inserted into a large neck vein. The latter form of access is often temporary, although it does occur more often with long-term treatment.
Hemodialysis typically takes four hours per session, and most patients have three sessions per week. However, these numbers can change based on kidney function, fluid weight gained between sessions, the quantity of waste in the body, the type of artificial kidney used, as well as the patient’s size. Though hemodialysis is typically done in a hospital setting or dialysis center, patients can also receive it at home. Patients and their caregiver can be trained on the machines, though this will take weeks to months to do. In addition to the traditional three sessions per week, patients may also work with shorter but more frequent sessions or treatments at night, both of which must be discussed with a doctor beforehand.
Understanding Peritoneal Dialysis
Peritoneal dialysis cleans the blood outside the body rather than inside. A doctor will perform surgery and insert a catheter into the abdomen, creating the access point. The abdominal area, also referred to as the peritoneal cavity, will slowly fill with dialysate through the catheter and the blood will remain in the arteries and veins lining the abdomen. Any extra fluid and waste will be drawn out of the blood and into the dialysate.
Peritoneal dialysis has two major sub-categories: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). Instead of using a machine, the patient performs CAPD themselves, typically four to five times a day. Here, they insert a bag of dialysate into the catheter, where the dialysate will remain for four to five hours before it drains back into the bag and is thrown out. This process is called an exchange, and a new bag is required for each exchange. While this process is going on, patients can resume their regular activities. APD, on the other hand, uses a special machine called a cycler, where each exchange, or cycle, lasts approximately one and a half hours. Additionally, APD typically occurs at night while the patient is sleeping.
With kidney failure, dialysis is necessary for the rest of a patient’s life, or until they can obtain a kidney transplant. Life expectancy on dialysis varies widely, as other medical conditions and how well the patient follows the treatment plan must be taken into account. Typically, a patient can expect to live five to ten years on dialysis, although there are documented cases of patients living up to twenty or even thirty years. Patients must consult with their health care teams to determine how to extend their life expectancy on dialysis while still taking care of themselves and remaining healthy.
Comfort During Treatment
Patients can expect a relatively normal and comfortable life between dialysis sessions. During sessions, patients may experience mild discomfort when the needle is inserted into their access point, but many do not. The treatment itself is typically painless, though some may find their blood pressure drops, which does have potential side effects. These side effects include nausea, vomiting, headaches, and cramps. The good news, however, is frequent dialysis helps make these issues disappear. Hospitals will typically make the rooms in which patients receive dialysis as comfortable as possible. Patients doing these treatments at home can also make their stations comfortable.
Cost Of Treatment
Unfortunately, due to the nature of dialysis as well as its frequency, this treatment does cost quite a lot. With that said, private health insurance and some government healthcare programs can greatly assist with the cost for qualifying patients. However, the treatment itself is not the only cost many patients must take into account. Depending on where they live, some patients will have to travel long distances to receive their dialysis treatment, so travel expenses also come into the equation. Thus, the exact cost of dialysis changes from patient to patient, since frequency, type of dialysis, insurance or funding, and location of the treatment must all be considered.
Work And Travel
The simple answer to whether or not dialysis patients can continue working and traveling is yes. However, there is a little more to it than what the rest of the population has to consider. When they first go on dialysis, most patients will need to take some time off work to get used to the treatment. Once this happens, they are free to return to their jobs provided they continue their treatments. The only major exception is if the job in question requires a lot of physical labor, such as lifting heavy objects, construction, digging, and anything similar. In this case, most doctors will recommend patients seek alternative employment.
Travel is also entirely possible for dialysis patients, though once again there are additional things to take into account. Specifically, the patient must be able to continue with treatments while they are traveling. Dialysis centers are available in every state in the United States, so traveling there is simple. Most foreign countries also have dialysis centers, but not all of them. Regardless of where they wish to go, patients must consult with their healthcare team prior to departure to determine how and where they will receive treatment and put emergency plans in place.
How To Cope With Challenges
The most common challenges individuals face when they first go on dialysis include seeing their blood leave their body, having the needle remain in their body, meeting a team of specialists, feeling limited in what they can do, and soreness. However, patients who have been receiving treatment for multiple years report they did adjust to all of these common issues. For the most part, it is simply a matter of learning a new routine. Many of these patients also report doing research and obtaining as much information as they could before treatment began, which helped quite a lot during their adjustment period.
Other significant challenges for some patients may be in-hospital treatments or depression. Though dialysis often starts this way, patients can do their treatments at home, even during the night. So if going to the hospital is too much of a challenge, patients are encouraged to speak with their doctors to investigate the ability of at-home dialysis instead. Depression occurs in up to sixty percent of dialysis patients. The best way of coping with this particular hurdle is for patients to discuss the situation with the doctor leading their healthcare team and how they can go about treating it. The most common solution is to engage in the services of a mental health professional, such as a psychologist or psychiatrist.
Eating A Healthy Diet
Everyone should be eating a balanced and healthy diet to be in the best possible health. However, there is a lot of flexibility for individuals without serious medical issues. When on dialysis, a patient’s diet becomes more of a concern. The golden rule is, of course, for patients to talk to their healthcare team before making changes. However, a common recommendation for dialysis patients is to reduce their intake of foods high in saturated fats and cholesterol, such as fried foods, eggs, whole milk, and the majority of cheeses. Patients often also want to limit their consumption of foods high in potassium and phosphorus, such as bananas, as too much of these minerals can be harmful to them.
For the best possible results and health, dialysis patients should focus on foods rich in omega-3 fatty acids. Popular choices include cold-water fish, such as sardines, salmon, and lake trout, walnuts, as well as flaxseed and canola oil. Individuals with kidney disease who require dialysis are at an increased risk for developing anemia, which means they have a low red blood cell count and the flow of oxygen throughout the body is compromised. Some cases of anemia require prescription medication, but others may be treated with iron. Iron can be taken in pill form, but patients are also encouraged to include iron-rich foods in their diet, such as spinach, red meat, whole grains, Greek yogurt, and many nuts and seeds.
Treatment Support System
Having a good support system is perhaps the most important thing for patients on dialysis. Many of them report their support system is what makes dealing with every other aspect of treatment much more manageable. Support systems can range in size and can include medical professionals, loved ones, patient advocacy groups, co-workers, and even other dialysis patients. Having other dialysis patients in a support system is particularly helpful, especially if they have been receiving treatment for an extensive period. This is because they have developed practical experience and may have knowledge no one else does in regards to this form of treatment. However, it is important to assess each patient individually and use common sense, as some may not want to or be in a position to help.
Living on dialysis is certainly a significant adjustment from life without it. It may even sound overwhelming at first, particularly to those who started out not knowing anything about it, but rest assured, living on dialysis is manageable. Patients are encouraged to ask their healthcare team as many questions as they like. They are there to help!