What is dialysis?

Dialysis is a process by which artificial filtering of the blood takes place, replacing some of the functions of the kidney. In this way we get rid of toxic substances accumulated in the blood and excess fluid when the kidneys can no longer do so.

There are two types of dialysis: haemodialysis and peritoneal dialysis.

Peritoneal dialysis

For this type of dialysis, the membrane that we use as a filter is natural and called peritoneum. This membrane is covering all the viscera and walls of the abdomen and forms the peritoneal cavity. To perform peritoneal dialysis, we need to implant a small soft flexible tube called a catheter into the abdomen. It is placed below the navel through a minor surgery intervention with local anaesthesia, and it is maintained while the technique lasts.

The dialysis fluid is introduced into the peritoneal cavity through this catheter. This fluid stays in the abdomen for several hours (permanence). Once this time has passed, the dialysis fluid is drained (drained) and replaced with a new dialysis solution (infusion). This process, which lasts about 20 minutes, is called an exchange and is done three or four times a day. With this technique is achieved the elimination of toxic substances and excess liquid retained in the body that pass to the dialysis fluid through the peritoneal membrane during the time of permanence.

Peritoneal dialysis is performed at the patient’s home, and medical check-ups by nephrologist in Delhi are performed periodically. It can also be done only at night, while the patient sleeps with the help of an automatic machine or cycler.

Haemodialysis

This technique is performed by an extracorporeal circuit through which the patient’s blood passes through a filter that has a membrane.

Special artificial to be able to eliminate the toxins together with the excess of liquid. The blood, once clean of said toxins is returned to the patient. This process is performed by the haemodialysis machine.

In order to perform haemodialysis, we need to have access to blood (vascular access) so that it can pass in the amount needed by the filter of the dialysis machine. Normal veins are not enough. The ideal vascular access is the arteriovenous fistula, which consists of the connection of an artery and a vein through a small operation that is performed on the wrist, elbow or arm, with local anaesthesia and that will allow the veins of the arm to develop. to be able to puncture them without difficulty.

Sometimes own veins are not enough and it is necessary to place a graft (artificial vein). When it is not possible to use an arteriovenous fistula, it is necessary to use a catheter located in a central vein in the upper part of the thorax.

Haemodialysis is usually performed in health centres and is carried out by a kidney specialist in Delhi that attends the patient at all times.

It can also be done at the patient’s home. In this case the patient or a family member must go through a period of training to be able to perform the technique safely.

The haemodialysis sessions have a variable frequency and duration depending on the needs of each patient. In the health centre it is usually four hours per session and three sessions a week, and at home they usually use 2-2.5 hours 5 or 6 days a week.

Both dialysis techniques are applicable to the patient with diabetes. A detailed information on both, including the visit to the facilities, will allow the patient to choose the option that best suits their living conditions, in the same way as a patient who does not have diabetes.

Other patient care in dialysis.

Dialysis is not enough for the proper treatment of patients. To replace other functions of the kidneys are also needed drugs to lower blood pressure, correct anaemia, protect bones and circulation, among others. The peculiarities of the dialysis patient with diabetes have to do mainly with the diet, and the life and medication regimen for the optimal glucidic control suggested by the best nephrologist in Delhi.

In chronic kidney disease and diabetes, we must consider food as one of the fundamental pillars in the treatment. An adequate diet plan can greatly improve the style and quality of life of patients, as well as prevent the complications of the disease.

The dietary goals for patients with diabetes on dialysis are:

• Prevent nutritional deficits and ensure a good nutritional status, providing enough protein.
• Maintain blood glucose levels within normal parameters.
• Provide enough energy through complex fats and carbohydrates. These last ones must suppose the base of their feeding.
• Coordinate the schedule of meals with physical exercise, medication for Diabetes and the dialysis session.

A few years ago, the patient with dialysis on dialysis was prescribed very restrictive diets completely eliminating carbohydrates from their diet, both simple and complex; they could not eat rice, pasta, potatoes … besides having to reduce vegetables, legumes and fruits to control potassium. With this type of diet, the incidence of malnutrition in these patients was very high, causing them a detriment in their style and quality of life. Currently it is shown that giving a more varied diet, including complex carbohydrates, mainly rice and pasta, substantially improve the patient’s nutritional status, which results in an improvement in their lifestyle.

During the stay in dialysis it is important to maintain the greatest possible physical and intellectual activity, which allows an optimal social insertion according to the expectations of each person. In the meantime, they will be included in the waiting list for kidney transplant in Delhi, as long as it can be done according to the characteristics of each individual. In people with type 1 diabetes, the combined kidney-pancreas transplant, either in two stages or simultaneously, is the best therapeutic option that can be offered by the best kidney specialist in Delhi.