An introduction to Dialysis

Dialysis is a procedure considered when a patient has advanced chronic kidney disease, which is a
condition where the kidneys have suffered considerable damage and are not able to filter blood
normally. This results in water retention and waste products such as urea which start building up in the
body causing other serious health complications such as cardiovascular disease and even stroke if the
condition is not treated. Dialysis may also be used in cases where kidney failure is a temporary problem
and may be stopped once the kidneys recover. Dialysis is most often used when a kidney transplant is
not immediately possible, such as if a patient is not well enough to undertake the operation or if it will
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take time to locate a suitable doner.

Dialysis comes in two main types: Haemodialysis (HD) and Peritoneal dialysis (PD). In Haemodialysis,
blood is pumped out of the body through a tube attached to a needle which is inserted into the patient’s
arm. Blood is passed through this tube and filtered through a dialyser, which is the part in the
haemodialysis machine where blood is filtered. An anticoagulant is administered to stop the blood from
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clotting during this process.

The dialyser is made up of a semi-permeable membrane and the dialysate which is composed of water
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salts and electrolytes. The blood passes next to the dialysate which has a larger concentration gradient
causing the waste products such as urea to pass through the semi permeable membrane into the
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dialysate which is then discarded. The filtered blood is then returned to the patient’s body afterwards.
HD is usually carried out in 4-hour sessions and the patient is usually brought into a hospital for these
sessions 3 days a week. However, home dialysis sessions are also available for the patient, where they
are trained on how to use the machine and have more flexible options including having the dialysis be
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done overnight while they are sleeping.

Peritoneal dialysis is rather different from HD. Instead of using external machinery to filter the blood and
return it to the body, PD utilises the lining of the patient’s abdomen which is called the peritoneum as
the filter through which to pass the patient’s blood though. This works due to the peritoneum
containing thousands of blood vessels much like the kidneys which make it suitable for filtering blood
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through it. An incision is made near the belly button and a catheter is inserted through it into the
peritoneal cavity where it is then left permanently, which does pose some risk as it increases the chance
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of infection.

Dialysate which is warmed to body temperature is then inserted through the catheter into the
peritoneal cavity. Blood passes through the blood vessels lining the peritoneal cavity and excess fluids
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and waste products are extracted from the blood into the dialysate which is replaced once it is used.
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The process takes around 30 to 40 minutes and needs to be repeated around 4 times a day. Dialysis
overall helps patients lead a good life.

References:

1. NHS Choices. Overview - Dialysis [Internet]. NHS. 2019. Available from:

https://www.nhs.uk/conditions/dialysis/

2. Ashby D, Borman N, Burton J, Corbett R, Davenport A, Farrington K, et al.

Renal Association Clinical Practice Guideline on Haemodialysis. BMC
Nephrology [Internet]. 2019 Oct 17;20(1). Available from:
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-019-1527-3

3. Vadakedath S, Kandi V. Dialysis: A review of the mechanisms underlying

complications in the management of chronic renal failure. Cureus. 2017 Aug
23;9(8).

4. ‌Peritoneal dialysis [Internet]. Mayo Clinic. Available from:

https://www.mayoclinic.org/diseases-conditions/end-stage-renal-
disease/multimedia/peritoneal-dialysis/vid-20231465

5. Obinwa, O. , McLoughlin, J. , Kavanagh, D. , Wall, C. . Peritoneal Dialysis

Catheters. In: Ekart, R. , editor. Some Special Problems in Peritoneal Dialysis
[Internet]. London: IntechOpen; 2016 [cited 2022 Nov 04]. Available from:
https://www.intechopen.com/chapters/51296 doi: 10.5772/64024