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Dialysis

Dialysis is the artificial process of eliminating waste (diffusion) and unwanted water (ultrafiltration) from the blood. Our kidneys do this naturally. Some people, however, may have failed or damaged kidneys which cannot carry out the function properly - they may need dialysis.

HOW IT'S DONE

There are two main types of dialysis: haemodialysis and peritoneal dialysis.

  • Haemodialysis involves diverting blood into an external machine, where it's filtered before being returned to the body
  • Peritoneal dialysis involves pumping dialysis fluid into the space inside your abdomen (tummy) to draw out waste products from the blood passing through vessels lining the inside of the abdomen

Haemodialysis

Before haemodialysis can start, you'll usually need to have a special blood vessel created in your arm, called an arteriovenous fistula (AV fistula). This blood vessel is created by connecting an artery to a vein. Joining a vein and an artery together makes the blood vessel larger and stronger. This makes it easier to transfer your blood into the dialysis machine and back again. The operation to create the AV fistula is usually carried out around four to eight weeks before haemodialysis begins. This allows the tissue and skin surrounding the fistula to heal. If your blood vessels are too narrow to create an AV fistula, an alternative procedure known as an AV graft may be recommended. A piece of synthetic tubing (graft) is used to connect the artery to the vein. As a short-term measure, or in an emergency, you may be given a neck line. This is where a small tube is inserted into a vein in your neck..

Peritoneal dialysis

There are two main types of peritoneal dialysis:

  • continuous ambulatory peritoneal dialysis (CAPD) – where your blood is filtered several times during the day
  • automated peritoneal dialysis (APD) – where a machine helps filter your blood during the night as you sleep

Both treatments can be done at home once you've been trained to carry them out yourself. They're described in more detail below. Before you can have CAPD or APD, an opening will need to be made in your abdomen. This will allow the dialysis fluid (dialysate) to be pumped into the space inside your abdomen (the peritoneal cavity). An incision is usually made just below your belly button. A thin tube called a catheter is inserted into the incision and the opening will normally be left to heal for a few weeks before treatment starts. The catheter is permanently attached to your abdomen, which some people find difficult. If you're unable to get used to the catheter, you can have it removed and switch to haemodialysis instead.

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