Dialysis is a process of artificially removing excess water, toxins, solutes from the blood of the people using a machine, in patients whose kidneys are unable to perform these functions naturally.

When kidneys cannot remove enough wastes and excess water from the body, it may be necessary to initiate dialysis. This usually happens when you only 10 to 15 percent of kidney function is left. There is no defined cut-off value of creatinine when dialysis should be initiated. Based on your symptoms such as difficulty in breathing, poor appetite, recurrent vomiting, your doctor will decide if dialysis is needed.

Hemodialysis is performed using a machine which enables the blood to pass through an artificial filter (dialyzer). Waste products are cleared by the filter and the “clean” blood is then returned to the body. In order to ensure adequate amount of blood gets cleared, it is necessary to create an access or entry into your blood vessels. This access is called a ‘fistula’, which is a minor surgery in your arm / forearm.

During dialysis the blood passes through the dialyzer. The dialyzer, or filter, has two compartments, one for your blood and one for a washing fluid called dialysate. A thin membrane separates these two parts. This membrane prevents removal of important constituents of blood such as blood cells, protein etc and only removes smaller waste molecules namely creatinine, urea.

There are multiple options. Dialysis can be performed in hospital, in a dialysis centre and even at home. However, this needs to be decided after considering the patients condition and needs and requires a joint decision by you and your doctor.

Hemodialysis is commonly done 3 times a week with each session of 4 hours on average. Those who choose to do dialysis at home, may get dialysis done more frequently, with shorter sessions each time.

Your dialysis prescription needs to be decided by doctor after taking into consideration your symptoms, reports and the amount of urine passed per day. Studies have shown that getting the right amount of dialysis improves your overall health, keeps you out of the hospital and enables you to live longer.

It is possible to do dialysis at home, but this needs to be decided on case-by-case basis.

Patients with kidney disease who are not on dialysis are usually on lot of dietary restrictions. This changes once the patient starts dialysis. The patients are then advised to increase their protein intake and limit the amount of potassium, phosphorus, sodium, and fluid in their diet. Additional dietary changes may be applicable to patients with diabetes or other health conditions. It’s important to talk with you dietitian about your individual diet needs.

Dialysis is a modality which substitutes kidney function in times of failure. It removes toxins which are otherwise removed by the kidneys. Dialysis thus clears off toxic waste from the body which can otherwise become life-threatening.  However, dialysis in itself, alone, cannot cure your underlying condition.

In cases of sudden or acute kidney failure, dialysis may be needed for a short time until the kidneys start working better. However, when kidney disease progresses to kidney failure over a longer period of time, your kidneys do not get better and you will need dialysis for the rest of your life unless you receive a kidney transplant.

The common discomforts faced by patients on dialysis are –

Needle pricks – needles inserted in fistula or graft at every dialysis. However, most patients get used to this over few days. Local anesthetic creams may be used prior to needle insertion which may reduce the discomfort. Your dialysis team will make you as comfortable as possible.

Symptoms like cramps, headaches, nausea or dizziness can occur and these often be managed easily.

Some of the steps that could help you include:

• Slowing down your fluid removal, but this could increase your dialysis time / frequency.
• Increasing the amount of sodium in your dialysate.
• Adjusting your dry weight, or target weight.
• Cooling the dialysate a little.

Many symptoms can be mitigated by following your diet and fluid allowances. The need to remove too much fluid during dialysis is one of common things that causes problems and discomfort during dialysis.

Dialysis treatment can be expensive. However, the Indian government’s Ayushman program, Rajiv Gandhi Yojana and other schemes help cover costs of dialysis for many patients. Several charitable centres and NGOs help provide dialysis at reasonable rates. Corporate centres and hospitals exist too, however the dialysis rates even at these centres (in Mumbai) are one of the cheapest in the country. Private health insurance or state medical aid may also help with the costs.

Yes. Dialysis centres are located in every part of India and many foreign countries. You can access the dialysis directory which lists all the dialysis centres in the country on the website – www.mumbaikidneyfoundation.in

Yes. Many patients continue to or return to active work once they are on regular dialysis.