Hemodialysis of health problems

HemodialysisMost people who require hemodialysis have a variety of health problems.

Hemodialysis prolongs life for many people, but life expectancy for people who need it is still less than that of the general population.
While hemodialysis treatment can be efficient at replacing some of the kidney’s lost functions, you may experience some of the related conditions listed below, although not everyone experiences all of these issues. Your dialysis team can help you deal with them.
  • Low blood pressure (hypotension) of health problems. A drop in blood pressure is a common side effect of hemodialysis, particularly if you have diabetes. Low blood pressure may be accompanied by shortness of breath, abdominal cramps, muscle cramps, nausea or vomiting.
  • Muscle cramps. Although the cause is not clear, muscle cramps during hemodialysis are common. Sometimes the cramps can be eased by adjusting the hemodialysis prescription. Adjusting fluid and sodium intake between hemodialysis treatments also may help prevent symptoms during treatments.
  • Itching. Many people who undergo hemodialysis have itchy skin, which is often worse during or just after the procedure.
  • Sleep problems. People receiving hemodialysis often have trouble sleeping, sometimes because of breaks in breathing during sleep (sleep apnea) or because of aching, uncomfortable or restless legs.
  • Anemia.of health problems. Not having enough red blood cells in your blood (anemia) is a common complication of kidney failure and hemodialysis. Failing kidneys reduce production of a hormone called erythropoietin (uh-rith-roe-POI-uh-tin), which stimulates formation of red blood cells. Diet restrictions, poor absorption of iron, frequent blood tests, or removal of iron and vitamins by hemodialysis also can contribute to anemia.
  • Bone diseases. If your damaged kidneys are no longer able to process vitamin D, which helps you absorb calcium, your bones may weaken. In addition, overproduction of parathyroid hormone — a common complication of kidney failure — can release calcium from your bones.
  • High blood pressure (hypertension). If you consume too much salt or drink too much fluid, your high blood pressure is likely to get worse and lead to heart problems or strokes.
  • Fluid overload. Since fluid is removed from your body during hemodialysis, drinking more fluids than recommended between hemodialysis treatments may cause life-threatening complications, such as heart failure or fluid accumulation in your lungs (pulmonary edema).
  • Inflammation of the membrane surrounding the heart (pericarditis). Insufficient hemodialysis can lead to inflammation of the membrane surrounding your heart, which can interfere with your heart’s ability to pump blood to the rest of your body.
  • High potassium levels (hyperkalemia). Potassium is a mineral that is normally removed from your body by your kidneys. If you consume more potassium than recommended, your potassium level may become too high. In severe cases, too much potassium can cause your heart to stop.
  • Access site complications. Potentially dangerous complications ― such as infection, narrowing or ballooning of the blood vessel wall (aneurysm), or blockage ― can impact the quality of your hemodialysis. Follow your dialysis team’s instructions on how to check for changes in your access site that may indicate a problem.
  • Amyloidosis. Dialysis-related amyloidosis (am-uh-loi-DO-sis) develops when proteins in blood are deposited on joints and tendons, causing pain, stiffness and fluid in the joints. The condition is more common in people who have undergone hemodialysis for more than five years.
  • Depression. Changes in mood are common in people with kidney failure. If you experience depression or anxiety after starting hemodialysis, talk with your health care team about effective treatment options.
How you prepare
Preparation for hemodialysis starts several weeks to months before your first procedure. To allow for easy access to your bloodstream, a surgeon will create a vascular access. The access provides a mechanism for a small amount of blood to be safely removed from your circulation and then returned to you in order for the hemodialysis process to work. The surgical access needs time to heal before you begin hemodialysis treatments.
There are three types of accesses:
  • Arteriovenous (AV) fistula. A surgically created AV fistula is a connection between an artery and a vein, usually in the arm you use less often. This is the preferred type of access because of effectiveness and safety.
  • AV graft. If your blood vessels are too small to form an AV fistula, the surgeon may instead create a path between an artery and a vein using a flexible, synthetic tube called a graft.
  • Central venous catheter. If you need emergency hemodialysis, a plastic tube (catheter) may be inserted into a large vein in your neck or near your groin. The catheter is temporary.
It’s extremely important to take care of your access site to reduce the possibility of infection and other complications. Follow your health care team’s instructions about caring for your access site.
What you can expect
You can receive hemodialysis in a dialysis center, at home or in a hospital. The frequency of treatment varies, depending on your situation:
  • In-center hemodialysis. Many people get hemodialysis three times a week in sessions of three to five hours each.
  • Daily hemodialysis. This involves more-frequent, but shorter sessions — usually performed at home six or seven days a week for about two to three hours each time.
Simpler hemodialysis machines have made home hemodialysis less cumbersome, so with special training and someone to help you, you may be able to do hemodialysis at home. You may even be able to do the procedure at night while you sleep.
There are dialysis centers located throughout the United States and in some other countries, so you can travel to many areas and still receive your hemodialysis on schedule. Your dialysis team can help you make appointments at other locations, or you can contact the dialysis center at your destination directly. Plan ahead to make sure space is available and proper arrangements can be made.
The procedure
During treatments, you sit or recline in a chair while your blood of health problems. flows through the dialyzer ― a filter that acts as an artificial kidney to clean your blood. You can use the time to watch TV or a movie, read, nap, or perhaps talk to your “neighbors” at the center. If you receive hemodialysis at night, you can sleep during the procedure.
  • Preparation. Your weight, blood pressure, pulse and temperature are checked. The skin covering your access site — the point where blood leaves and then re-enters your body during treatment — is cleansed.
  • Starting. During hemodialysis, two needles are inserted into your arm through the access site and taped in place to remain secure. Each needle is attached to a flexible plastic tube that connects to a dialyzer. Through one tube, the dialyzer filters your blood a few ounces at a time, allowing wastes and extra fluids to pass from your blood into a cleansing fluid called dialysate. The filtered blood returns to your body through the second tube.
  • Symptoms. You may experience nausea and abdominal cramps as excess fluid is pulled from your body — especially if you have hemodialysis only three times a week rather than more often. If you’re uncomfortable during the procedure, ask your care team about minimizing side effects by such measures as adjusting the speed of your hemodialysis, your medication or your hemodialysis fluids.
  • Monitoring. Because blood pressure and heart rate can fluctuate as excess fluid is drawn from your body, your blood pressure and heart rate will be checked several times during each treatment.
  • Finishing.of health problems.When hemodialysis is completed, the needles are removed from your access site and a pressure dressing is applied to prevent bleeding. Your weight may be recorded again. Then you’re free to go about your usual activities until your next session.
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