Some Dialysis Explanation

Recently, my daughter commented that I do not explain the nuts and bolts of dialysis overly well, which can make it hard to follow exactly what I am talking about. So, below, the nuts and bolts.

There are three methods for dialysis:

In Center - Such as Fresenius or Davita. In this modality, you go to the center three times a week and sit in a chair, where they run your blood through a dialyzor. Typically, you are there anywhere from 2.5 - 4.5 hours, depending on your size and other health issues. To do this, they use your 'access'. (Those will be below as well)
 

Home Peritoneal Dialysis - This is likely the simplest method to learn to do at home. A catheter is surgically placed in your abdomen, with a tube hanging out that is what you use to connect to do dialysis. It's done by filling your cavity with dialysate fluid. This fluid sits in the cavity round the clock (getting changed in the middle, either by a manual exchange, or by using a cycler to do it automatically while you sleep). As the blood vessels surround the cavity pass over it, the fluid pulls the toxins into the cavity and holds it there until you do an exchange, where you drain the existing fluid, and add new. This method is tougher for those who have weight issues, or diabetes, as the fluid you use is a glucose base, and can give you as many as 800 calories a day depending on solution strength.

Home Hemo Dialysis - Like the in center modality, you use an access, and a machine to clean your blood. Two needles are inserted into your veins (A fistula, explanation below) and the dirty blood is drawn out, runs through the machine, and flows back into your body via the second needle. There are photos of these machines in previous posts. With Home Hemo, you can do short daily during the day for a shorter number of hours (3-5 usually) or you can do nocturnal, which is done for longer periods of time (7-8 most often) at a slower rate. This method tends to be easier on your fistula and heart, and tends to offer better cleaning, and less side effects. 

The 'Accesses' typically used for Hemo Dialysis are either a 'port' or a fistula. A fistula is surgically created, within your arm (usually) and it's the joining of a smaller vein with a larger. This causes the smaller vein, over time, to get bigger, and stronger. Once it's mature (usually measured in months) you can repeatedly put in dialysis needles and the vein is large enough to carry the flow of blood. 

A port is typically a more temporary measure. They are not considered a really long term solution because they are much, much easier to infect. This is a photo of an 'IJ Cath' (Inter Jugular Catheter)

Up next: How does doing dialysis affect your day to day life?