5th July 2024

Haemodialysis

Overview

Haemodialysis involves filtering waste by passing blood through an artificial kidney machine. Haemodialysis is the most common form of kidney replacement therapy for patients with end stage kidney disease in the world. In the UK 35.4% have hospital based or in-centre haemodialysis. Home haemodialysis forms 2%, as per the latest figures. (UK Renal Registry 2020).

Image Source: Wikimedia Commons (2008). Hemodialysis-en, Licensed under a creative commons licence. Available for free at: https://en.m.wikipedia.org/wiki/File:Hemodialysis-en.svg (Accessed: 5 February 2024).

Practical Points

Acute Indications for Dialysis

• Refractory Hyperkalaemia
• Refractory metabolic acidosis
• Refractory pulmonary oedema
• Uremic end organ damage (i.e. encephalopathy, pericarditis)

In this instance, treatment is usually initiated in an intensive care unit using a temporary internal jugular or femoral vein dialysis line or vascath.

Maintenance Treatment

Vascular Access for Dialysis

• Tunnelled dialysis catheter. The tip of the line should sit just above the right atrium. Access can be gained via the right internal jugular vein (most common), left IJV, or Subclavian vein.
• Arterio-venous fistula or graft. This can be done by connecting a superficial vein to an artery (arteriovenous fistula) or using a synthetic graft which connects a vein to an artery.

Hospital or in-centre dialysis (ICHD) tends to take place 3 times a week in 3.5-4 hour sessions.

Home Haemodialysis (HHD) patients have more frequent dialysis sessions, up to 5 times a week.

Missed Treatment

Recording the last session of dialysis with verbal confirmation with the patient is essential.

Practical tip: Inform your renal unit promptly if a dialysis patient is admitted to hospital. They may require to be transferred in order to continue dialysis.

Complications

• Infections: Dialysis access related infection should be considered. Tissue invasive infections like endocarditis, visceral abscesses are not uncommon.
• Inadequate dialysis: Patients may have been unable to complete dialysis sessions. Non-compliance may also be a factor.
• Acute deterioration precipitated by illness or intervention: Dialysis prior to and following an intervention requiring general or regional anaesthesia is vital. When unwell, they may need shorter and more frequent sessions. This is best managed in a tertiary care unit.

References

• Kidney Care UK 2020. https://www.kidneycareuk.org/about-kidney-health/treatments/dialysis/