Hemodialysis Procedure in Hyderabad | Indications and Cost

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Dialysis Care Team

Dr. A Kishore Kumar

10+ years of experience

MD (Medicine) (JIPMER), DM (Nephrology) (AIIMS, New Delhi)

Consultant Nephrologist and Renal Transplant Physician

Dr. Vishwambhar Nath

40+ years of experience

MBBS, MS (General Surgery), DNB (Urology), M.Ch (Urology)

Senior Consultant Urologist & Renal Transplant Surgeon

Contraindications of hemodialysis

Haemodialysis is an absolute contraindication in patients with an inability to secure vascular access. In addition to this, the relative hemodialysis contraindications include the presence of the following:

• Cardiac failure
• Coagulopathy (abnormality in bleeding cessation, leading to either excessive bleeding or clotting)
• Fear of needles

How to prepare for hemodialysis?

The patient needs to start his preparations several weeks (4 to 8) or months prior to the first haemodialysis procedure. The Nephrologist / Surgeon performs a minor surgery prior to the first hemodialysis to have vascular access to inject or remove blood while undergoing hemodialysis.

These are generally placed between blood vessels (artery and vein) of the patient’s arm or above the wrist, which helps in safely collection of a small amount of blood from the patient’s body circulation to the dialyzer and returning the same from the dialyzer to the patient’s body. Patients should maintain their access site properly, which can help prevent infection and other complications.

There are three types of accesses:

1. Arteriovenous (AV) fistula
2. Arteriovenous (AV) graft
3. Central venous catheter

Arteriovenous (AV) fistula

An arteriovenous (AV) fistula is a setup in which an artery and veins are connected surgically, which is done typically in the less-used arm. This method is highly favoured because of:

• maximises dialysis blood flow
• reduces infection and clotting
• lasts longer

AV graft

Surgeons may use an arteriovenous graft, a flexible synthetic-tube, to connect an artery and a vein when the patient's blood vessels are too small for an AV fistula.

• This method can be used immediately after surgery.
• More chances of infection and clotting.

Central venous catheter

A plastic-tube (catheter) may be inserted into a major vein in the patient’s neck in the event of an emergency requiring hemodialysis. The catheter is only meant to be used temporarily.

Fluid and diet restrictions

Patients will be on strict fluid restrictions on hemodialysis, as the dialyser is unable to remove 2 to 3 days of excess fluid within 4 hours, which further leads to fluid accumulation in the blood, lungs, and tissues. 

• The patient is allowed to drink less than 1L fluid per day.
• The patient needs to have a limited intake of salt, potassium, and phosphorus, as these can rapidly accumulate harmful levels in the patient’s body.
  

Hemodialysis procedure step by step

On the day of the haemodialysis procedure, the patient’s weight, blood pressure, pulse and temperature will be checked. The patient will be asked to rest on a bed. The arteriovenous fistula site will be cleaned thoroughly. 

• During haemodialysis, two needles are inserted into the patient's arm via the access site (fistula/graft placed on the arm) and safely placed to remain secure, post that the dialyzer will be connected with each plastic tube. Through one tube, blood from the body goes into the dialyzer where the filtration of blood happens and the filtered blood returns to the body via the second tube. 
• The dialyzer consists of a series of membranes, which act as a filter (artificial kidney) and a special liquid known as dialysate. 
• The dialyzer filters the waste products and excess fluids in blood into a dialysate. The physician or the technician might inject an anticoagulant into the first tube to prevent blood coagulation. Through the second tube, the blood is reintroduced to the patient’s body after being purified.
•  The patient’s blood pressure and heart rate are continuously monitored throughout the procedure. During the process, the patient can take rest, read, watch television, or speak with the caretaker or neighbours. 
• When the treatment is completed, the needles will be removed from the patient's access site, it will be cleaned, and a pressure dressing will be applied to stop any bleeding. The patient’s weight will be checked after the completion of the procedure.
• When a lot of fluid has been filtered out, the patient may experience nausea, back pain, muscle cramps during the process, as the patient has put on more fluids between appointments. The patient needs to report to the physician about their symptoms so that they can be alleviated either by adjusting the speed of the dialyzer or by providing medication.
  

What happens after hemodialysis?

A patient may face complications post-haemodialysis, such as low blood pressure, dizziness, or faintness. In addition to these, they may also experience the following difficulties:

• Pain in the chest 
• Restless legs syndrome   
• Headache 
• Skin itchiness   
• Cramps in the muscle
  

Most haemodialysis patients have many health issues. Although haemodialysis helps many individuals live longer, but those who undergoes hemodialysis have been observed certain complications.

Although hemodialysis is effective in restoring some kidney function, it is associated with a number of complications which will be managed by the dialysis staff. They are as follows:

• Hypotension (low blood pressure)
• Muscle cramps
• Vitamin deficiencies
• Low blood sugars (Hypoglycemia)
• Access site complications
• Cardiac disease

Hypotension (low blood pressure): During the hemodialysis procedure, fluid is removed by ultrafiltration. The amount of fluid to be removed is determined by the weight gain of the patient in between dialysis sessions. If there is excess weight gain, the patient is prone to hypotension in the process of removal of that extra fluid from the body. 

Muscle cramps: Hemodialysis patients frequently experience muscle cramps due to the changes in the fluid balance and electrolytes in the blood. Regulating fluid and sodium intake in between hemodialysis sessions may be useful for reducing symptoms experienced during treatment.

Vitamin deficiencies: Dialysis filters out water-soluble vitamins. In addition, the patient experiences bone loss as the damaged kidneys are unable to convert vitamin D (which absorbs calcium) to its active form. Therefore, dialysis patients are at risk of fractures and bone pains.

Low blood sugars (Hypoglycemia): Dialysis patients are prone to hypoglycemia during the dialysis procedure. Glucose monitoring during the procedure and management accordingly will prevent this complication.

Access site complications: The effectiveness of a patient’s hemodialysis treatment can be negatively impacted by complications like infection, the occurrence of an aneurysm (narrowing of the blood vessel wall), or blockage of the dialysis catheter of the arterio venous fistula.

Cardiac Disease: Some patients are prone to heart related complications like fluctuations in heart rate, heart attacks etc. This is due to:

• The effects of chronic anaemia, hypertension, and fluid overload on the heart's myocardium are almost certainly to blame.
• Pre-existing conditions like atherosclerotic cardiovascular disease in patients with renal failure.
• Retaining too much phosphate can lead to aortic and mitral valve calcification in patients.

Difference between hemodialysis and peritoneal dialysis can be catergorised under area of dialysis access, membrane used, complications and psychosocial considerations.