What is hemodialysis?
In advanced kidney failure, harmful substances and excess water, which are formed during the breakdown of our food in our body and are normally excreted in the urine, cannot be excreted and accumulate in our body.
Hemodialysis is a form of treatment that removes these substances from our body.
The patient's blood is passed through the tubes made of thin membranes (dialyzer) and is mixed with a liquid (dialysis solution-dialysate) passing through the other side of the membrane to be removed from the body.
The patient's blood is most often supplied through a "fistula" formed by the joining of one of the arteries and one of the veins of the patient's forearm. The fact that patients have this fistula "before they need hemodialysis" helps dialysis start immediately and perfectly for the patient when the time comes.
Fistula formation is performed with a small surgical intervention and the fistula is ready for use in about a month. When dialysis is required in patients without fistula, a catheter will need to be placed in the thick veins in the neck or chest cavity and the fistula operation will then be performed.
You need dialysis when one or more of the following signs and symptoms occur, or when your doctor warns you based on your laboratory tests.
- Sleeping disorders
- Weakness
- Swelling in the legs, face
- Shortness of breath
- nausea
- Loss of appetite
- Hiccups
- Weight loss
- Abnormal bleeding
"Hemodialysis", "peritoneal dialysis" and "kidney transplantation", which are another dialysis method and that you can apply at home by going to the hospital or dialysis center once a month by placing a catheter in the abdominal cavity, will help to completely or partially eliminate these symptoms. If the above and all your complaints are reported regularly to the physicians responsible for the maintenance of your dialysis, necessary changes will be made in your treatment and your physicians will be able to advise you.
What Does Adequate Dialysis Mean?
It is important that you have adequate dialysis:
It makes you feel healthier and helps you to meet your and your family's needs more effectively.
- Allows you to live a long and quality life
- It ensures that all kinds of medical problems that may cause you to be hospitalized are prevented before they occur.
The most reliable way of getting enough dialysis is for your dialysis team to calculate it. The main calculations that show you are receiving an adequate dose of dialysis are the Kt/V, URR, or urea reduction rate. Your dialysis team takes your blood once a month and makes these measurements. Sometimes you may also be asked to collect urine.
It is useful to know that the Kt/V value should be at least 1.2 and the URR value should be at least 65% to ensure that you are getting adequate dialysis. We need to get enough dialysis to realize these values. Hemodialysis is usually performed 3 times a week. If your doctor's advice is not different, each session usually lasts 4 hours or more, shortening your dialysis time will reduce your dialysis competence and put your health at risk.
What can be done if your dialysis is not sufficient?
If your measured values are not at the desired level, ask your dialysis team what to do. If Kt/V or URR is below target, your dialysis team will check the following points.
-Can your vascular access provide sufficient blood flow velocity for adequate dialysis?
-Is the dialyzer suitable for you? Is it possible to use a larger dialyzer?
-Is your dialysis time sufficient, or are you a patient who tends to leave early?
-Can your dialysate speed be increased further?
-Were your blood samples taken properly?
Even a single interruption of your hemodialysis sessions can have very negative effects on your dialysis proficiency.
Programming Your Dialysis:
Your dialysis team will make a specially planned program just for you. The goal of this plan is to give you access to normal Kt/V or URR.
This program gives you:
-What type and size of dialyzer do you need?
-How fast should blood and dialysate circulate during your treatment?
-Determines how many times a week and how many hours each treatment should be.
Calculation of Dialysis Dose Given to You:
The most accurate and frequently used method for calculating the dialysis dose sufficient for you is the "urea kinetic model or UKM". To do this, your dialysis team takes blood samples during dialysis. You may also be told to collect urine.
With these tests, it is calculated how much your dialysis reduces the urea in your blood. Another important criterion to consider is your weight before and after dialysis. Kt/V is calculated by uploading all the information to the computer. The required dialysis dose calculated with this method will help your dialysis team in the following matters:
- To be able to plan your treatment better
- Moderate error in reaching the targeted dialysis dose