End-stage renal disease (ESRD) occurs when your kidney gradually loses its function and can no longer remove waste or excess fluid from your body. It is an advanced stage of renal failure and usually happens when the function of kidneys declined to below 15 percent of its normal function. Patients diagnosed with ESRD often suffer from general weakness, nausea, vomiting, limbs edema, arrhythmia, and dyspnea. When chronic kidney disease develops into ESRD, renal replacement therapy, which includes hemodialysis, peritoneal dialysis, and renal transplantation, is necessary.
Hemodialysis (HD) is a treatment for patients with advanced renal failure. A vascular access is "created" weeks or months before the treatment. HD helps remove fluid and uremic toxins from the patient's blood, and thus maintain the balance of fluid and various minerals. By extracorporeal circulation, blood passes through the dialyzer (artificial kidney). Waste and excess fluid are washed away during the process.
Kidneys function to remove waste products, such as creatinine, urea, and excess water, from the blood. When there is a gradual loss of kidney function due to disease, dialysis is needed to prevent the accumulation of waste products in the body.
An arteriovenous fistula, arteriovenous graft, or a double lumen catheter will be established as a vascular access for HD. Typically, HD is performed three times per week and each session requires 3-4 hours. Blood is drawn out from the vascular access, pumped through the dialyzer, and then pumped back. Uremic toxins and excess fluid will be removed from the blood to the dialysate, which is composed of minerals and high quality water from a water purification system. Blood pressure and heart rate are closely monitored. An anticoagulant like heparin is used to prevent intraluminal thrombosis. At the end of the treatment, puncture site hemostasis is ensured by a dialysis nurse.
Potential risks and complications include:
- Intradialytic hypotension is the most common complication during hemodialysis. Nausea, vomiting, conscious disturbance, chest pain, and abdominal discomfort may develop due to hypotension-related poor organ perfusion.
- Arrhythmia may happen, especially when the patient has underlying cardiovascular disease.
- Bleeding due to anticoagulant use or difficult hemostasis of puncture site
- Muscle cramps
- Infection of vascular access
- Allergic reaction
- Air embolism
The procedure cost is about 12,000 NTD/time, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.