Hemodialysis in South Africa

How Does Hemodialysis Work?
During hemodialysis a dialysis machine and a dialyzer, which is a special filter are used to clean the blood. Blood is obtained from a hemodialysis access, which is connected to the blood vessels.
The dialyzer consists of two parts: One part is for the blood, and the other part is for a fluid that is known as dialysate. The dialysate is a washing fluid. The two parts are separated by a thin membrane. Components of the blood like protein and blood cells do not pass through the membrane. However, waste products in the blood like urea, creatinine, potassium and excess fluid pass through the membrane and get washed away.

What are the Different Kinds of Hemodialysis?
Hemodialysis can be of different kinds. The type of hemodialysis that the patient needs is determined by the doctor.

• In-center hemodialysis
  This is conducted in a hospital or a dialysis center. It takes approximately three to five hours a day, and is usually done three days a week.
• Home hemodialysis
  This is conducted at home if the patient is trained or has trained helpers and family members. It is done three days a week or on every alternate day. These sessions may be of varied lengths depending on the doctor’s advice. Some sessions may be six hours long, which may help the patient to feel better.
• Daily home hemodialysis
  When the patient is adequately trained to conduct the hemodialysis treatments at home, it can be conducted on a daily basis for about three hours.
• Nocturnal home hemodialysis
  This can be done three to seven nights a week at home. The sessions are done overnight for six to eight hours.

What is a Hemodialysis Access?
A hemodialysis access is a site on the patient’s body that is created to enable the blood to flow in and out during the treatment. The type of hemodialysis access that is made on the patient’s body depends on how soon the hemodialysis needs to be started.

What are the Different types of Hemodialysis Access?
The access that is created for hemodialysis may be of the following types:

• Fistula
  A fistula is a hemodialysis access that is made by joining one artery to a vein in the lower arm. Repeated access can be made through a fistula for every dialysis session. The fistula may take many months to be formed. It will not clot easily like other dialysis access methods. It is a very effective and durable method of access for hemodialysis. Complications that may be involved are infection and thrombosis, which is formation of a clot.
• Graft
  A graft is an access in which a synthetic tube is implanted under the skin of the patient’s arm. It may be used if the patient’s veins are very small. The tube is used as an artificial vein where the needle is placed to access blood during hemodialysis. The graft which has been placed in the patient’s arm can be used after a week of its placement. Complications of clotting and infection are common, so a replacement graft may be required often. A common type of graft used for hemodialysis is a polytetrafluoroethylene graft.
• Venous Catheter
  If the patient requires immediate hemodialysis and if the patient does not have a permanent access, a temporary catheter tube may be placed in a vein located in the neck, chest or groin. It is not used as a permanent form of access for routine use because infection and clogging is a common problem in a venous catheter.