Diabetes and Dialysis: Understanding When Dialysis is Necessary

Diabetes, if left unmanaged, can lead to a cascade of complications, one of the most serious being kidney failure. When kidneys fail, they can no longer effectively filter waste products and excess fluids from the blood. This is where dialysis steps in, acting as an artificial kidney to perform these vital functions.

Dialysis Explained: What You Need to Know

Dialysis is a life-sustaining treatment that filters and purifies the blood when the kidneys can no longer do so adequately. It involves removing waste products, excess fluids, and electrolytes from the blood to maintain a healthy balance in the body.

There are two main types of dialysis:

Hemodialysis: This is the most common type of dialysis. It involves using a machine to filter the blood outside the body. Blood is drawn from a patient's access point (usually a fistula or graft) and passed through a dialyzer, where it is cleaned before being returned to the body.
Peritoneal Dialysis: This type of dialysis uses the lining of the abdomen (peritoneum) as a natural filter. A special fluid called dialysate is introduced into the peritoneal cavity through a catheter. Waste products and excess fluids pass from the blood into the dialysate, which is then drained and replaced with fresh fluid.

Dialysis for Diabetes: When is it Time?

For people with diabetes, the decision to start dialysis is typically based on a combination of factors, including:

Kidney function: The most important factor is the level of kidney function, usually measured by the glomerular filtration rate (GFR). A GFR below 15 mL/min/1.73 m² generally indicates the need for dialysis.
Symptoms: Symptoms of kidney failure, such as fatigue, nausea, vomiting, loss of appetite, swelling, and difficulty breathing, may also prompt the need for dialysis.
Overall health: Other factors, such as age, overall health, and the presence of other complications, are also considered when making the decision.

It's important to have open and honest discussions with your healthcare team to determine the best time to start dialysis for your individual situation.

Dialysis Procedure: A Step-by-Step Guide

The specific steps involved in dialysis depend on the type of dialysis being performed.

Hemodialysis: How it Works

Preparation: Before each hemodialysis session, the patient's vital signs are checked, and the access point is cleaned and prepared.
Connection: Two needles are inserted into the access point, one to draw blood out and the other to return it after cleaning.
Filtration: The blood flows through the dialyzer, where waste products and excess fluids are removed.
Return: The cleaned blood is returned to the body through the second needle.
Monitoring: The patient's vital signs and the dialysis machine are monitored throughout the session.
Disconnection: After the session, the needles are removed, and the access point is bandaged.

Hemodialysis typically takes 3-5 hours and is usually performed three times a week at a dialysis center.

Peritoneal Dialysis: Understanding the Process

Preparation: The patient cleans the area around the catheter and prepares the dialysate.
Fill: The dialysate is infused into the peritoneal cavity through the catheter.
Dwell: The dialysate remains in the peritoneal cavity for a set period, allowing waste products and excess fluids to be removed from the blood.
Drain: The used dialysate is drained from the peritoneal cavity.
Repeat: The fill, dwell, and drain cycle is repeated several times a day or overnight using a machine called a cycler.

Peritoneal dialysis can be performed at home, offering more flexibility and independence.

Dialysis Treatment: What to Expect

Starting dialysis can be a significant adjustment, both physically and emotionally. It's important to understand what to expect during treatment:

Time commitment: Dialysis requires a significant time commitment, typically several hours, multiple times a week.
Dietary restrictions: Patients on dialysis need to follow a special diet to manage fluid intake, potassium, phosphorus, and sodium levels.
Medications: Medications may be prescribed to manage blood pressure, anemia, and other complications.
Side effects: Dialysis can cause side effects such as low blood pressure, muscle cramps, fatigue, and itching.
Emotional impact: Dialysis can also have an emotional impact, leading to feelings of anxiety, depression, and frustration.

It's crucial to have a strong support system and to communicate openly with your healthcare team to manage any challenges that may arise.

While dialysis is a life-sustaining treatment, it's not a cure for kidney failure. For some patients, a kidney transplant may be an option. It's essential to discuss all treatment options with your healthcare team to make the best decision for your individual needs and circumstances.

Remember, living with diabetes and kidney failure can be challenging, but with proper management and support, you can continue to lead a fulfilling life.