Hemodialysis
Pedes Orange County is a vascular specialty facility that offers outpatient access to dialysis treatment and management. Our outpatient services specialize in minimally invasive procedures and use the latest ultra-modern imaging, interventional, and diagnostic technology. Our facilities and technologies allow us to meet the needs of dialysis patients providing them with comprehensive dialysis access management and care.
On top of the state-of-the-art facilities, we have highly trained medical professionals with a combined experience spanning over 50 years. Our physicians are skilled and vastly experienced in providing safe and effective outpatient dialysis care. We tailor-make the care through a personalized dialysis management plan. At Pedes County Orange, the focus is on exceptional hemodialysis care from the first evaluation point through treatment and recovery. We seek to help you get back to your daily routine as soon as possible through the most comfortable treatment plan you can find.
Renal Disease
Renal disease is a condition where the kidneys lose their ability to remove waste and excess fluids in the body. This condition leads to a buildup of dangerous electrolytes, wastes, and fluids in the body, causing further health complications.
Dialysis Treatment
Kidneys are responsible for removing excess fluids and wastes from your blood and, in doing so, purifying it. However, when the kidneys are not functioning properly, you have to resort to dialysis. This is a treatment where a machine does the filtering and purification function of your kidneys. It has been in use since the 1940s and keeps your body in optimum balance.
Types of Dialysis: Hemodialysis vs. Peritoneal Dialysis
Hemodialysis
Hemodialysis is one of the management and treatment options for advanced kidney failure. It allows you to lead a productive life even when your kidneys are failing. A machine performs the functions of kidneys by filtering wastes, fluids, and salts from your blood since the kidneys cannot do them properly.
During hemodialysis, you follow a strict treatment plan, and you have to change aspects of your daily diet. You will also have medication that has to be taken regularly. At Pedes Orange County, we understand how vital this treatment is to you and the sacrifices you are making. We will be your health partner so that you do not shoulder this burden alone but with our health care team.
Hemodialysis Access Types
There are three kinds of vascular accesses;
- Arteriovenous fistula: It is a connection between an artery and a vein that is created surgically. It is often on the arm you use less often. Because of the safety and effectiveness levels it offers, it is usually the preferred kind of access.
- Arteriovenous graft: A path between an artery and a vein created using a synthetic tube known as a graft. It is the alternative used if the patient’s vessels are too small to create an AV fistula.
- Central Venous Catheter: It is an option used in cases where emergency hemodialysis is required. Doctors insert a plastic tube known as a catheter in a large vein either in the groin or neck for access. The catheter is only temporary.
Peritoneal
In peritoneal dialysis, doctors surgically implant a catheter in your belly area. They then flow a special purifying fluid called dialysate into your abdomen through the catheter. The dialysate then absorbs the waste from the bloodstream, and it is drawn from the abdomen.
There are different types of peritoneal dialysis, but the two main ones are Continuous Ambulatory Peritoneal dialysis and Continuous Cycler-assisted Peritoneal dialysis. With the first option, your abdomen is filled and drained with dialysate several times each day. With Cycler-assisted peritoneal dialysis, however, a machine is the one cycling the fluid in and out of your body, and it often happens at night as you sleep.
When Does Hemodialysis Become Necessary?
Several factors could necessitate the use of hemodialysis as a treatment option. These include:
- Your overall health
- How your kidneys are performing their functions
- Signs and symptoms you are experiencing
- Your quality of life
- Personal preferences
Some of the conditions which may cause kidney failure include;
- Diabetes
- Hypertension
- Inflammation in the kidneys
- Inflammation of blood vessels
- Kidney cysts
You could also suffer from sudden kidney shutdown or acute kidney injury due to complicated surgery, severe illness, heart attacks, or other severe health issues. Some medications could also cause kidney injury.
Doctors use symptoms and your estimated glomerular filtration rate (eGFR) as part of their diagnosis on whether you need hemodialysis. Examples of kidney failure symptoms include vomiting, nausea, swelling, and fatigue. The eGFR is a measure of your kidney function level. It is calculated using several factors, including age, sex, and blood creatine results. The eGFR helps plan your hemodialysis treatment, including when to start it.
Hemodialysis is not the only treatment option you have for kidney failure complications. Depending on your condition, you can choose other options. For example, you can have Maximal Medical Therapy, also known as Maximum Conservative Management. This is an option for people with chronic kidney failure.
The treatment involves actively managing kidney failure complications like anemia, fluid overload, and high blood pressure. It focuses primarily on managing symptoms of kidney disease that affect the quality of life. Another option is a kidney transplant. Our healthcare team will advise you on the various available options depending on your condition.
Risks of Hemodialysis
Like any other medical treatment option, hemodialysis comes with certain risks. First, it is important to realize that while it does prolong many people’s lives, patients who need it have a generally lower life expectancy than the general population. In the course of your treatment, you could also experience several related complications though not everyone experiences all of them. Our team will help you cope with these issues, which include:
Low blood pressure is a common side effect for patients using hemodialysis and more so among patients with diabetes. It is often accompanied by abdominal cramps, nausea, muscle cramps, and shortness of breath.
Muscle cramps: These are also common in the course of hemodialysis treatment though their cause is not quite clear. Fortunately, they can be alleviated by making adjustments to the hemodialysis prescription and the intake of fluids and sodium in between treatments.
Itching: You can experience itching that gets worse during the procedure or just after the hemodialysis procedure.
Difficulty sleeping: Hemodialysis patients have sleeping problems because of issues like sleep apnea, itching, uncomfortable and restless legs.
Anemia: Failing kidneys reduces erythropoietin, a hormone responsible for stimulating red blood cell formation. Further, the diet restrictions, removal of vitamins and iron through hemodialysis, frequent blood tests, and poor iron absorption contribute to anemia.
Bone diseases: Because of kidney failure, your body cannot process Vitamin D, which affects its ability to absorb calcium as thus, the bones weaken. Also, the failing kidneys cause an overproduction of the parathyroid hormone, which can cause the bones to release calcium.
High blood pressure: If you take plenty of fluids and consume a lot of water, your blood pressure is likely to worsen, which can cause cardiovascular complications.
Fluid overload: Hemodialysis focuses on getting rid of fluids from the body. As a result, if you consume a lot of fluids, you may end up developing complications like pulmonary edema, where fluid accumulates in the lungs. It can also cause heart complications.
Pericarditis: This is a condition where the membrane surrounding the heart becomes inflamed. It happens as a result of insufficient hemodialysis, which affects the heart’s ability to pump blood.
Hyperkalaemia: This refers to a condition where there are high potassium levels in the blood. Kidneys usually excrete potassium, but if you are using hemodialysis, you have to control the amount you consume since high potassium levels could cause heart complications.
Complications on the access site: without proper care, the access site can become vulnerable to complications like infections, blockage, or aneurysms, affecting the quality and safety of your hemodialysis. Your care team from Pedes Orange County will show you how to best care for the site and how to be on the lookout for any signs of a problem.
Amyloidosis: This condition happens when blood proteins are deposited on joints and tendons. It results in stiffness, fluid, and pain in the joints. People who have been using hemodialysis for more than five years are more susceptible to this condition.
Depression: Mood swings are common among kidney failure patients, which could lead to anxiety and depression. If you experience any of these conditions after you start your hemodialysis treatment, our staff will be on hand to guide you on the best treatment and coping options.
What Happens During Hemodialysis Treatment?
During your treatment, you will be seated or reclining. Your blood passes through a dialyzer, a machine that performs the kidney functions of filtering the blood. You can keep yourself engaged by watching television, reading, or talking. If the procedure happens at night, you can sleep through it all. A typical hemodialysis treatment follows the following steps.
- Preparation: The doctors will take several health records before the procedure, including weight, temperature, pulse rate, and blood pressure. They will also clean the skin surface of the access point.
- Commencing the procedure: The doctors insert two needles through the access site and secure them by taping. Each needle connects to the dialyzer through a flexible plastic tube. In one tube, blood passes from your body to the dialyzer, where it is filtered through a cleansing fluid (dialysate), where wastes and extra fluids are removed. Through another tube, the clean blood flows back to your body.
- Symptoms you could experience: Normally, you could experience symptoms such as abdominal cramps and nausea as the excess fluids are removed from your body. These symptoms can be more intense if you only do hemodialysis three times a week and not the frequent shorter sessions. Should you be uncomfortable, inform our care team, who will help minimize them through adjusting your medication or the fluids and speed of the procedure.
- Constant monitoring: In the course of your treatment, your heart and blood pressure will fluctuate, and therefore the healthcare professionals will constantly check on you during each treatment.
- Finishing the procedure: At the end of the treatment, the doctor removes the needle and uses pressure dressing on the access site to prevent any bleeding. Your weight is recorded again, and you are free to continue with your daily activities.
Dialysis Access Procedures
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Endovascular Creation of an Arteriovenous Fistula (EndoAVF)*
One of the latest developments in this field of medicine is the introduction of the EndoAVF, which stands for the Endovascular Creation of an Arteriovenous Fistula. Here’s a simplified but thorough look at some of the key elements you might like to know when it comes to this procedure, including what to expect as a potential client of the vascular experts at Pedes Orange County.
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Surgical Fistula Creation
Fistula creation starts with Vein Mapping, where you undergo physical examination along with non-invasive or minimally invasive tests. These tests determine whether your arteries are sufficiently healthy to support a fistula. Ultrasound and an angiogram can also be used to gauge the size and depth of your veins and arteries. If you pass the tests and are judged to be a candidate for fistula, then an appointment is made for fistula creation.
The actual process starts with a specialist administering local anesthesia on the identified access site. A doctor then makes an incision that provides access to the blood vessels, and he makes a surgical connection between a vein and an artery. As a result of the connection, blood flows from the artery to the vein, and with this increase in blood flow, the vein enlarges, and its walls thicken.
After its creation, the AV fistula is given weeks to months in some cases to mature to the point where it can be used safely for hemodialysis.
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Catheter Placement/Removal
This is a temporal option for hemodialysis, where HD catheters serve as temporal access points. They provide direct access to the bloodstream and have a high infection rate, which is why their use as a temporal solution. The idea is for the patient to eventually have long-term safer access like AV fistula or a peritoneal catheter. The catheters have heparin to help prevent blood clotting while flowing in the tubes though they have to be changed for new ones as a further precaution. HD catheters only serve when one is yet to have permanent access or where the permanent access is being rested or has stopped working.
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PD Catheter Placement/Removal
This is a more permanent option, and it is a minimally invasive procedure that can be conducted in an outside setting. In this procedure, a PD catheter is placed in the peritoneal space through the abdomen. The specialist uses an image-guided technique known as fluoroscopy to achieve the Percutaneous catheter placement. It usually takes less than an hour to complete, and you only need sedation and local anesthesia.
Dialysis Access Care and Maintenance Procedures
Your access point needs consistent care to prevent any infection and blockage. Both you and your physicians have roles to play here. Some of the services we provide as care for the access points are:
Fistulagrams
A fistulagram is essentially a specialized x-ray procedure. It uses an x-ray dye to examine the AV fistula’s blood flow and detect any blockage or narrowing. When a narrowing (stenosis) is detected, the physician will insert a balloon and inflate it inside the path. This action breaks up any scar tissue causing the narrowing allowing for better flow for the dialysis.
Declots
This is a procedure for removing clots should they develop in the AV fistula/graft. Clots happen due to a variety of reasons like low blood pressure or stenosis. Several methods can be used which clear up the path and re-establish the blood flow. This is a procedure for removing clots should they develop in the AV fistula/graft.
How to Prepare for Hemodialysis
Preparing for hemodialysis takes anywhere from weeks to months before your first treatment. Part of the preparation plan is to create vascular access, which provides easy access to the bloodstream. Through it, a small amount of blood can be removed and returned from and to your blood circulation safely. Once it has been created, it will need time to heal before you start the treatment.
It is essential that you, as a patient, care for your access site to prevent any complications and infections. Our team will provide you with the guidelines for proper access site care, and you should follow them diligently.
Where Do You Get Hemodialysis and How Often Will You Need It?
Dialysis is provided at a hospital, dialysis centers, or from your home. How often you receive it depends on your situation. For example, if you have in-center hemodialysis, you will often need your treatment three times a week in sessions that last 3-5 hours each.
There is also an option of daily hemodialysis, which involves shorter but frequent sessions. It is often conducted at home and six or seven days every week, lasting 2-3 hours.
The innovation of simpler dialysis kits has made home hemodialysis more accessible and convenient. With the proper training and a person to help, you can safely do hemodialysis at home. You could even do it during the night as you sleep.
Dialysis services are readily available across the US and in countries worldwide, so you can travel and still get your treatment on schedule. You can have your hemodialysis center contact and make appointments with other centers, or you can do it on your own. If you are traveling, you should make plans well in advance to guarantee space and ensure all arrangements have been made.
What are the Results of Hemodialysis?
If your condition were a sudden kidney injury, you would need hemodialysis for only a short period until your kidneys get back to their optimum functioning levels. On the other hand, if your kidneys had already started dropping their functioning levels before the sudden injury, chances of complete recovery and hemodialysis independence reduce.
While in-center treatments are more common, outpatient home settings are increasingly preferred as more research shows their benefits. These benefits include;
- Better life quality
- Improved wellbeing
- Fewer symptoms associated with hemodialysis side effects
- Improved sleeping patterns, appetite, and concentration
Your assigned care team will regularly monitor your progress and the impact of the treatment through regular tests, including;
- Urea Reduction Rate and Total Urea Clearance blood tests to evaluate the efficiency of hemodialysis in clearing wastes from your body
- Measuring your blood flow through the access site during your treatment
- Evaluating your blood chemistry and assessing blood count
These results will guide any changes to your treatment frequency and intensity.
How to Care for Yourself During Hemodialysis Treatments
It is essential to take care of yourself and follow the doctor’s guidelines in between hemodialysis procedures. Doing so helps prevent any complications and helps you to attain the best possible results from your treatment. Some of the care tips to follow include;
- Eat the right food: Your diet has a significant impact on your health and wellbeing during treatment. It would be best if you watch your intake of fluids and mineral salts. Where possible, a dietitian can create a custom meal plan that considers all your health factors, including medical conditions, weight, preferences, and kidney function.
- Take your medications as per the prescription and follow any treatment instructions from your care team.
- Communicate any concerns you might have to get assistance from your health team. Our physicians will guide you on different available options for you, depending on your circumstances.
What to Expect from Your Visit to Pedes
ULTRASOUND
ULTRASOUND
Your treatment will begin with an ultrasound examination of your veins, arteries, or both, in your legs to diagnose the presence and extent of the disease. Your test results will be immediately available to review with the doctor.
CONSULT
CONSULT
Once we review the results of your diagnostic tests, our physicians will help you develop a plan to provide you with the best treatment for your disease.
TREATMENT
TREATMENT
Depending on the extent of disease in your arteries or veins, our specialists may recommend minimally invasive intervention and/or prescribe medications to help your symptoms.
FOLLOW UP
FOLLOW UP
It is important to make sure that you return for every scheduled follow-up appointment to ensure that your disease is appropriately monitored. If you ever have any questions or concerns, please call or schedule a follow-up appointment with our staff.