Overview

Basic Information About Your Kidneys
Kidney Disease and Failure
What is Haemodialysis?
Taking Care of Your Haemodialysis Access
Dietary Advice for Patients on Haemodialysis
Side Effects of Haemodialysis and Symptoms

Basic Information About Your Kidneys

The kidneys are bean-shaped organs that are about the size of our fist. They are found just below the rib cage, near the middle of the back.

The kidneys perform several important functions such as:

• Remove waste products of metabolism such as urea and creatinine from the blood.
• Balance body fluids.
• Remove drugs and other toxins from the body.
• Regulate water and electrolyte levels within the body needed for good health.
• Produces hormones that help in regulation of blood pressure, production of red blood cells and maintenance of calcium required for bones and normal chemical balance in the body.

Kidney Disease and Failure

Kidney disease occurs when the kidneys are damaged and start to lose some of their functions permanently. As the damaged kidneys slowly stop doing their job, there will be a build-up of waste products in the bloodstream that are harmful to the body and build-up of fluids. Kidney disease that is untreated will lead to kidney failure which is also known as End Stage Renal Disease (ESRD) where the kidneys stop doing their job. Once the kidneys fail, a patient must begin dialysis or get a kidney transplant.

Some signs and symptoms of kidney failure:

• Extreme tiredness, loss of concentration
• Loss of appetite, nausea and vomiting
• Swelling in hands, face and feet
• Itchiness
• High blood pressure

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What is Haemodialysis?

Haemodialysis is the most common therapy for patients with ESRD. Haemodialysis is a therapy that filters waste, removes extra fluid and balances electrolytes in the body. It also helps to control blood pressure.

How it Works

Blood is removed from the body and filtered through a semi-permeable artificial kidney that is also known as a dialyser and the filtered blood is returned to the body. Dialysis fluid which is also known as dialysate helps to pull the toxins away from the blood in a process called diffusion. There is a high concentration of waste in the blood of the haemodialysis patient as compared to the low concentration in the dialysate. Therefore, the waste will move through the semi-permeable membrane to create an equal concentration on both sides.

Haemodialysis requires an access to be created for blood to be drawn to the dialyser and returned to the body. The dialysis machine keeps track of blood flow, blood pressure, amount of fluid removed and other vital information.

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3 Types of Access Available

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Caring for Your Access

• Do keep the skin over the graft or fistula clean to help prevent infections.
• Do avoid using your access arm for drawing of blood.
• Do avoid activities that could block or slow the blood flow within the access. Such activities include blood pressure monitoring on access limb, carrying or resting heavy objects on access limb, sleeping on the access or access arm and wearing tight fitting clothes.

It is important to seek medical attention when the following symptoms are present:

• Changes in appearance of the skin on top of your access, such as redness, localised swelling or pimples.
• Localised bulging over areas of your access.
• Swelling of the access extremity (arm or leg), face or neck and/or the presence of multiple small, enlarged veins on the upper arm or chest.
• Numbness, weakness or pain in the lower part of your access extremity (hand or foot).

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Dietary Advice for Patients on Haemodialysis

Nutrition is an important part of your dialysis treatment plan. Food consumed is broken down in the stomach and intestines where nutrients are absorbed and waste products are put back into the bloodstream. Healthy kidneys remove wastes from the body through urination. Haemodialysis takes over the function of removing wastes in the body of patients with ESRD. However, wastes can accumulate in the blood between dialysis sessions. Therefore, taking control of your diet can help to reduce the amount of wastes and improve both your dialysis and health.

• Fluid intake

  Fluids will accumulate in the body as a result of the kidneys’ inability to remove excess fluids through urine formation. Some effects of fluid accumulation include the following:

  1. Swelling of face, feet and/or hands
  2. Fluid build-up around the lungs
  3. High blood pressure
  4. Congestive heart failure
  
  

  You can control fluid accumulation by avoiding excessive fluid intake and by regulating your intake of food high in sodium. Drinking from smaller cups or glasses may help in controlling your fluid intake.

• Protein

  Protein is required for building muscles, tissue repair and boosting resistance to infection. High quality protein such as those found in meat, fish and poultry produce less waste than others. The body breaks down protein to form a waste product known as urea. Too much protein may lead to the following:

  1. High blood urea levels
  2. Nausea and vomiting
  3. Bone problems

• Phosphate

  Phosphate plays an important role in the health of our bones and teeth as well as our body’s metabolism. Excessive phosphate can cause bone disease and may make your skin itch. Foods high in phosphate are milk, milk products and animal proteins.

• Potassium

  Potassium is needed in the body to keep nerves and muscles working well. High blood potassium levels can cause irregular heartbeat and heart failure. Potassium is found in most food, especially fruits and vegetables. Foods like avocados, bananas and kiwis should be avoided, as they are very high in potassium.

• Sodium

  Sodium is used to hold water in the body. Too much sodium will make you thirsty and drink more water, leading to fluid retention. Increased sodium and water will lead to the heart working harder to pump the fluid around the body and lead to an increase in blood pressure. Sodium is found in salt and other foods. Foods that are high in sodium include processed and preserved food.

  ESRD affects many areas of your life and this includes necessary dietary changes. Therefore it is important for you to discuss with your dietitian as he or she will be able to offer information about the best food choices for you. This meal plan will be catered individually to you based on your kidney function, nutritional status, lifestyle, body size, gender and preferences.

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Common Side Effects

You may experience the following common symptoms while on haemodialysis:

• Fatigue
• Itching
• Headache
• Sleep disturbances
• Nausea, vomitting
• Muscle weakness
• Cramps, joint, chest and back pains
• Shortness of breath

Contact your Doctor promptly when you experience the following:

• Changes in skin colour or bruising around your fistula or graft access
• Lack of buzzing or rushing sensation (thrill) at your fistula or graft access
• Skin around your fistula or graft access that is hot or cold to the touch
• Pain, swelling and redness at your catheter access
• Nausea, vomiting, giddiness or headache
• Feeling lethargic or unwell
• Blurred vision
• Poor appetite
• Diarrhoea
• Fever