Post-Dialysis Care

Hemodialysis Overview for Patient Education

• Dialysis is a treatment for severe kidney failure, also known as end-stage kidney disease or renal failure. Dialysis is typically required when 90 percent or more of the renal function has been lost.
• Renal function can be lost quickly (acute kidney damage) or gradually (chronic kidney disease) over months or years.
• When kidney function declines, fluid and waste products accumulate in the blood. Dialysis helps the kidneys, which are failing, get rid of waste and fluid.
• Your kidney function, as measured by blood and urine tests, health, nutritional status, symptoms, quality of life, individual preferences, and other factors influence when dialysis begins.
• Dialysis should be started as soon as the kidney disease has reached a stage where life-threatening consequences are possible.
• Dialysis can be performed in a hospital, hospital clinic, or stand-alone clinic.
• Doctors, nurses, and technicians are involved in your care.
• Hemodialysis at the center takes three to five hours (an average of three and a half to four hours) and is performed three times a week.
• During treatment, you can read or sleep and usually have access to a television.

Common post-dialysis risks:

After-care for hemodialysis patients:

• The key to feeling better after dialysis treatment depends on what you do before and between dialysis treatments.
• Adhering to your prescribed fluid restrictions is very important.
• If you gain more fluid than prescribed, you will need to remove more fluid during the prescribed dialysis time. This causes rapid fluid shifts in your body, leading to hypotension and fatigue.
• Your diet is also essential. You must follow the diet prescribed by the nutritionist/dietitian. Remember that your kidneys can no longer excrete food by-products, so the by-products will accumulate until your subsequent treatment. This can make you feel weak and tired.
• Take your medication as prescribed unless your healthcare provider tells you to alter the pre-dialysis dose.
• Treating the condition that caused kidney failure is essential to maintain your health and well-being.
• It would be best if you incorporated some activities based on your tolerance. This will help you feel better over time.

The most important points to remember in post-dialysis care are:

WHEN TO GO FOR FOLLOW-UP VISITS:

Dialysis patients need special care after dialysis:

Erythropoietin: Your kidneys don’t produce enough erythropoietin in chronic kidney disease. Erythropoietin is a hormone (natural chemical) produced by kidneys that helps your body make red blood cells. Your doctor can give you an artificial hormone called EPO, which is like erythropoietin and may help prevent anaemia (low red blood cell count). When you have anaemia, your body doesn’t get enough oxygen, and you may feel weak and exhausted most of the time.

Vitamins: You may need to take medications containing iron and folate to help your body produce enough red blood cells, which should give you more energy. You may also need to take calcium to prevent or treat bone disease, which can sometimes occur with kidney failure.  Your bones may soften and break more easily.

Arteriovenous fistula or graft care: 

• Daily cleaning of the skin overlying the fistula or graft with soap and water is the first step in caring for an arteriovenous fistula or graft.
• Remove the dressing from the fistula or graft 4 to 6 hours after dialysis.
• Check your fistula or graft daily for good blood flow by touching it with the fingertips. The hum means it is working.
• Check for bleeding, pain, redness, or swelling. These can be signs of infection or a blocked fistula or graft.
• To avoid damaging the fistula or graft,  one should not draw blood or measure blood pressure from the arm with the fistula or graft.
• Don’t wear tight clothing or jewellery. Wear loose clothing and do not sleep on this arm.
• Check for signs of blood, discomfort, redness, or swelling. These symptoms may indicate infection or a blocked fistula.

Dialysis diet:

You may require a special diet.

A dietitian will help plan what you can and cannot eat.

• Potassium is abundant in some fruits and vegetables. Ask your nutritionist what fruits and vegetables you can consume and how much you can eat.
• Adjusting to a new diet can take time. Special cookbooks can help find new recipes.

• Write down how much fluid you drink every day. Try to only drink when you are thirsty. Limit the amount of caffeine you drink, like coffee, tea and soda.
• Ask your nutritionist what liquids you can and cannot drink. Sucking on candy or gum can help keep your mouth moist without having to drink any liquids. Lemon wedges can also help keep your mouth moist.
• Don’t drink alcohol. Almost every part of your body can be damaged by alcohol; drinking alcohol can also worsen kidney failure.

Contact your doctor if:

Seek help immediately if:

DIALYSIS IS A TREATMENT, NOT A CURE.

You must continue to manage the disease that caused renal failure. Always remember to talk about your worries with your doctor and other healthcare team members! Before starting any medical regimen, talk to your doctor, nurse, or pharmacist to see if it is safe and effective. They can make your treatment experience and overall health better!