Dialysis

Dialysis

Healthy kidneys remove waste from your blood and produce hormones your body needs. If your kidneys fail, you either need a kidney transplant or dialysis. Dialysis is a procedure that uses a machine to perform many of the functions of the kidney. Dialysis can help prevent problems resulting from kidney failure and it allows people with kidney failure to live productive lives. Dialysis filters your blood, and like a health kidney, removes waste from your blood. Patients using dialysis are also required to follow a strict diet in order to stay healthy. There are two types of dialysis: hemodialysis and peritoneal dialysis. There are different advantages and disadvantages with both hemodialysis and peritoneal dialysis. Talk to your doctor about which type of dialysis would work better for you.

Recently Answered

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    The following foods are usually restricted for children on hemodialysis:
    • sodium (in canned, processed and packaged foods, and table salt)
    • potassium (found in many vegetables and fruits)
    • fluid (anything that is liquid at room temperature)
    • phosphorus (found in dairy products and meats)
    Protein may also be limited, depending on your child’s appetite. It is important that your child eats enough protein, but not too much. Your dietitian will tell you what to feed your child based on his needs. Your child may need a special vitamin supplement made for people on dialysis.

    Your child’s appetite may vary. Regular eating times and snacks are needed so your child will eat enough calories.
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    With peritoneal dialysis, your child's diet should include more protein and limit certain foods high in phosphorus. Since most high-protein foods (dairy products and meats) are also high in phosphorus, your dietitian will help you in choosing foods to use. Usually, there is no need to limit potassium, sodium or fluid. A special vitamin supplement made for people on dialysis may be needed. Infant formula may need to have extra protein or calories added to it.

    Children on peritoneal dialysis may not have a good appetite. The extra fluid in the abdomen can make them feel full. Your dietitian may suggest high-protein, high-calorie supplements and frequent, small meals.
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    Before dialysis, some diet changes may be needed for your child. Phosphorus usually is limited at this time, which means less dairy products. Your child’s appetite may begin to decrease, making it important to encourage him or her to eat. Infants will probably need a special formula to increase calories.

    Sometimes the amount of fluid your child may have is limited. Despite your best efforts at helping your child meet her nutritional needs within necessary diet restrictions, it may be necessary to start supplemental enteral feedings or “tube feedings” to help your child with chronic kidney disease grow and gain weight appropriately.

    Don’t be discouraged if this happens to your child. It does not mean you are a bad parent or can’t provide your child with an appropriate diet. It is just sometimes very difficult for children with chronic kidney disease to find enough foods they are allowed to eat that they actually like. Often, once tube feedings are started, some of the conflict that may occur between a parent and a child related to diet is decreased. As kidney function decreases before starting dialysis, nausea and vomiting may become more common. If this happens, tell your child's doctor and dietitian.

    Although your child may be meeting his or her nutritional needs adequately, it is not uncommon for children with chronic kidney disease to be much smaller than other children of the same age. Therefore, it is sometimes necessary to consider the use of recombinant growth hormone to optimize your child’s growth. This requires a shot daily or weekly to stimulate better growth. Talk with your child’s doctor and/or renal dietitian about any concerns you may have about your child’s height.

    Prior to starting dialysis, your child with kidney disease may also need extra iron and erythropoietin (or EPO) to treat the anemia frequently seen in people with chronic kidney disease. When children are anemic or have “low blood counts,” this can affect their energy level and appetite. It is important to treat the anemia so that your child will have more interest in eating.
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    Most home hemodialysis programs ask you to have a care partner who is willing to be with you to help during each treatment. Your care partner can be a family member or friend. This person goes through the training with you so he or she can learn what to do. Sometimes, people hire a nurse or technician to be their care partner. Medicare and some other insurance companies do not pay for these helpers, however.
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    Many reports indicate that people using short daily and nocturnal home hemodialysis:
    • take less medication to control blood pressure and anemia
    • take less medication to keep phosphorus under control (this helps prevent bone disease)
    • have improvements in neuropathy (nerve damage) and less restless legs syndrome
    • feel better during dialysis and less “washed out” after treatments
    • have more energy for daily tasks
    • sleep better
    • have fewer and shorter hospital stays
    • have better quality of life
    • live longer
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    With proper cleaning, it is generally safe to reuse your dialyzer each dialysis treatment. Before you reuse your dialyzer, your dialysis center cleans it according to careful guidelines. Before each treatment, your dialyzer must be tested to make sure it is still working well. If your dialyzer no longer works well, it should be discarded and you should be given a new one. Ask your dialysis care team if they have tested your dialyzer and if it still works well.

    If you do not wish to reuse your dialyzer, your center may be willing to provide you with a new dialyzer for each treatment. Ask about the center's policy on reuse.
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    Dialysis is expensive. However, the federal government's Medicare program pays 80% of all dialysis costs for most people. Private health insurance or state medical aid may also help with the costs. 
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    When you begin hemodialysis, the needles put in your fistula or graft may feel uncomfortable. Most people get used to this with time. Your dialysis care team will make sure you are as comfortable as possible during your treatment. Symptoms like cramps, headaches, nausea or dizziness are not common, but if you do have any of them, ask your dialysis care team if any of the following steps could help you:
    • Slowing down your fluid removal, which could increase your dialysis time.
    • Increasing the amount of sodium in your dialysate.
    • Checking your high blood pressure medications.
    • Adjusting your dry weight, or target weight.
    • Cooling the dialysate a little.
    • Using a special medication to help prevent low blood pressure during dialysis.
    You can help yourself to feel better by following your diet and fluid allowances, since the need to remove too much fluid during dialysis is one of the things that can make you feel uncomfortable during treatment.
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    One of the measures your dialysis care team may use is called urea reduction ratio (URR). Another measure is called Kt/V (pronounced kay tee over vee). Ask your dialysis care team what measure they use and what your number is. To make sure that you are getting enough dialysis, your Kt/V should be at least 1.2, or your URR should be at least 65%.
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    A dialyzer, or filter, has two parts that are used to clean your blood in hemodialysis. One part is for your blood and the other is for a washing fluid called dialysate. A thin membrane separates these two parts. Blood cells, protein and other important things remain in your blood because they are too big to pass through the membrane. Smaller waste products in the blood, such as urea, creatinine, potassium and extra fluid, pass through the membrane and are washed away.