What Is Dialysis?

The kidneys are a pair of organs, each about the size of a fist,
located on either side of your spine. Theyre responsible for
purifying your blood by removing waste and excess fluid from
your body. When the kidneys dont work properly, dialysis is
used to perform the function of the kidneys.
Dialysis is a treatment that filters and purifies the blood using
a machine. This helps keep your body in balance when the
kidneys cant do their job. Dialysis has been used since the
1940s to treat people with kidney problems.
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Part 2 of 6: Purpose

Why Is Dialysis Used?

Properly functioning kidneys prevent extra water, waste, and
other impurities from accumulating in your body. They also
help control blood pressure and regulate the levels of
chemicals in the blood, such as sodium, or salt, and
potassium. They even activate a form of vitamin D that
improves the absorption of calcium.
When your kidneys can't perform these functions due to
disease or injury, dialysis can help keep the body running as
normally as possible. Without dialysis, salts and other waste
products will accumulate in the blood and poison the body.
However, dialysis isnt a cure for kidney disease or other

problems affecting the kidneys. Different treatments may be

needed to address those concerns.
Learn more about the kidneys using Healthlines Body Maps.
Part 3 of 6: How It Works

How Does Dialysis Work?

Dialysis is an artificial way of cleaning your blood. There are
two different types of dialysis:

Hemodialysis
Hemodialysis is the most common type of dialysis. It uses an
artificial kidney, known as a hemodialyzer, to remove waste
and chemicals from your blood. To get the blood to flow to the
artificial kidney, your doctor will surgically create a vascular
access, or an entrance point, into your blood vessels. This
vascular access will allow a larger amount of blood to flow
through your body during hemodialysis treatment. This
means more blood can be filtered and purified.
The two type of vascular access designed for long-term
dialysis treatments are an arteriovenous (AV) fistula, which
connects an artery and a vein and an AV graft, which is a
looped tube. For short-term use, a catheter may be inserted
into the large vein in your neck.
Hemodialysis treatments usually last three to five hours. The
treatment is typically needed three times per week. However,

hemodialysis treatment can also be done in shorter, more

frequent sessions.
Most hemodialysis treatments are done at a hospital, doctor's
office, or dialysis center. The length of treatment depends on
your body size and the amount of waste in your body.
After youve been on hemodialysis for an extended amount of
time, your doctor may feel that you're ready to give yourself
dialysis treatments at home. This option is more common for
people who will need long-term treatment.

Peritoneal Dialysis
Peritoneal dialysis involves surgery to implant a catheter into
your belly area. During treatment, a special fluid
called dialysate flows into your abdomen. Once the dialysate
draws waste out of the bloodstream, its drained from your
abdomen.
There are numerous different types of peritoneal dialysis, but
the main ones are continuous ambulatory peritoneal dialysis
and continuous cycler-assisted peritoneal dialysis. In
continuous ambulatory peritoneal dialysis, your abdomen is
filled and drained multiple times each day. Continuous cyclerassisted peritoneal dialysis, however, uses a machine to cycle
the fluid in and out of your abdomen. Its usually done at
night while you sleep.
Peritoneal dialysis can be done at home. Youll receive
training on how to perform the steps of the treatment.

Risks

Preparation
Outlook
Read This Next

Part 1 of 6: Overview

What Is Dialysis?
The kidneys are a pair of organs, each about the size of a fist,
located on either side of your spine. Theyre responsible for
purifying your blood by removing waste and excess fluid from
your body. When the kidneys dont work properly, dialysis is
used to perform the function of the kidneys.
Dialysis is a treatment that filters and purifies the blood using
a machine. This helps keep your body in balance when the
kidneys cant do their job. Dialysis has been used since the
1940s to treat people with kidney problems.
Advertisement

Part 2 of 6: Purpose

Why Is Dialysis Used?

Properly functioning kidneys prevent extra water, waste, and

other impurities from accumulating in your body. They also
help control blood pressure and regulate the levels of
chemicals in the blood, such as sodium, or salt, and
potassium. They even activate a form of vitamin D that
improves the absorption of calcium.
When your kidneys can't perform these functions due to
disease or injury, dialysis can help keep the body running as
normally as possible. Without dialysis, salts and other waste
products will accumulate in the blood and poison the body.
However, dialysis isnt a cure for kidney disease or other
problems affecting the kidneys. Different treatments may be
needed to address those concerns.
Learn more about the kidneys using Healthlines Body Maps.
Part 3 of 6: How It Works

How Does Dialysis Work?

Dialysis is an artificial way of cleaning your blood. There are

two different types of dialysis:

Hemodialysis
Hemodialysis is the most common type of dialysis. It uses an
artificial kidney, known as a hemodialyzer, to remove waste
and chemicals from your blood. To get the blood to flow to the
artificial kidney, your doctor will surgically create a vascular
access, or an entrance point, into your blood vessels. This
vascular access will allow a larger amount of blood to flow
through your body during hemodialysis treatment. This
means more blood can be filtered and purified.
The two type of vascular access designed for long-term
dialysis treatments are an arteriovenous (AV) fistula, which
connects an artery and a vein and an AV graft, which is a
looped tube. For short-term use, a catheter may be inserted
into the large vein in your neck.
Hemodialysis treatments usually last three to five hours. The
treatment is typically needed three times per week. However,
hemodialysis treatment can also be done in shorter, more
frequent sessions.

Most hemodialysis treatments are done at a hospital, doctor's

office, or dialysis center. The length of treatment depends on
your body size and the amount of waste in your body.
After youve been on hemodialysis for an extended amount of
time, your doctor may feel that you're ready to give yourself
dialysis treatments at home. This option is more common for
people who will need long-term treatment.

Peritoneal Dialysis
Peritoneal dialysis involves surgery to implant a catheter into
your belly area. During treatment, a special fluid
called dialysate flows into your abdomen. Once the dialysate
draws waste out of the bloodstream, its drained from your
abdomen.
There are numerous different types of peritoneal dialysis, but
the main ones are continuous ambulatory peritoneal dialysis
and continuous cycler-assisted peritoneal dialysis. In
continuous ambulatory peritoneal dialysis, your abdomen is
filled and drained multiple times each day. Continuous cyclerassisted peritoneal dialysis, however, uses a machine to cycle
the fluid in and out of your abdomen. Its usually done at
night while you sleep.
Peritoneal dialysis can be done at home. Youll receive
training on how to perform the steps of the treatment.
Part 4 of 6: Risks

Are There Any Risks Associated

with Dialysis?

While both peritoneal dialysis and hemodialysis are

treatments that can save your life, they can have certain
risks.
Peritoneal dialysis is associated with an increased risk for
infections in or around the catheter site in the abdominal
cavity. For example, a person can experience peritonitis, an
infection of the membrane lining the abdominal wall, after
catheter implantation. Other risks include:

abdominal muscle weakening

high blood sugar due to the dextrose in the dialysate
weight gain
Hemodialysis also has unique risks, including:

low blood pressure

anemia, or not having enough red blood cells
muscle cramping
difficulty sleeping

itching
high blood potassium levels
depression
pericarditis, which is an inflammation of the membrane
around the heart
If you continue to have these symptoms while on peritoneal
dialysis or hemodialysis, tell the healthcare provider
performing the treatment.
Those who undergo long-term dialysis treatments are also at
risk of developing other medical conditions, including
amyloidosis. This disease can occur when amyloid proteins
produced in bone marrow build up in the kidneys, liver, heart,
and other organs. This usually causes joint pain, stiffness,
and swelling. Some people may also develop depression after
being diagnosed with long-term kidney failure. Call 911
immediately if youre having thoughts associated with
depression, such as thoughts of harming yourself or
committing suicide. TheNational Alliance on Mental
Illness can also provide you with resources if you struggle
with depression.

What is a dialysis machine? During dialysis, your blood is cleaned using a fluid
called dialysate, or bath. Wastes and fluid from your blood go into the bath and
are drained away. The dialysis machine controls the flow of the blood and the bath.
The dialysis machine has two systems the e x t r a c o r p o re a l (outside the
body) circuit and the dialysate delivery system. T h e extracorporeal circuit is the
tubing, blood pump, h e p a r i n (blood thinner) pump, k i d n e y, and monitors for
blood flow, blood pressure, and air bubbles. The dialysate delivery system of the
machine mixes the bath with purified water and checks to be sure it is safe.

Dialysis machine: A machine used in dialysis that filters a patient's blood to remove excess water
and waste products when the kidneys are damaged,
dysfunctional, or missing. The dialysis machine itself can be thought of as an artificial kidney. Inside,
it consists of more plastic tubing that carries the removed blood to the dialyser, a bundle of hollow
fibers that forms a semipermeable membrane for filtering out impurities. In the dialyser, blood is
diffused with a saline solution called dialysate, and the dialysate is in turn diffused with blood. When
the filtration process is complete, the cleansed blood is returned to the patient. Most patients who
undergo dialysis because of kidney impairment or failure use a dialysis machine at a dialysis clinic.
Also, a machine called a peritoneal dialysis machine can be used chronically at home for dialysis,
which eliminates the need for regularhemodialysis clinic treatments. Using this machine during the
day and frequently during sleep, the patient can control his/her own dialysis.

Hemofiltration[edit]
Main article: Hemofiltration
Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle. The
blood is pumped through a dialyzer or "hemofilter" as in dialysis, but no dialysate is used. A pressure
gradient is applied; as a result, water moves across the very permeable membrane rapidly,
"dragging" along with it many dissolved substances, including ones with large molecular weights,
which are not cleared as well by hemodialysis. Salts and water lost from the blood during this
process are replaced with a "substitution fluid" that is infused into the extracorporeal circuit during
the treatment.

Hemodiafiltration[edit]
Hemodiafiltration is a combination of hemodialysis and hemofiltration.

Intestinal dialysis[edit]
In intestinal dialysis, the diet is supplemented with soluble fibres such as acacia fibre, which is
digested by bacteria in the colon. This bacterial growth increases the amount of nitrogen that is
eliminated in fecal waste.[14][15][16] An alternative approach utilizes the ingestion of 1 to 1.5 liters of nonabsorbable solutions of polyethylene glycol or mannitolevery fourth hour.[17]

HISTORY

A Dutch physician, Willem Johan Kolff, constructed the first working dialyzer in 1943 during the Nazi
occupation of the Netherlands.[5] Due to the scarcity of available resources, Kolff had to improvise
and build the initial machine using sausage casings, beverage cans, a washing machine, and
various other items that were available at the time. Over the following two years, [1943-1945] Kolff
used his machine to treat 16 patients suffering from acute kidney failure, but the results were
unsuccessful. Then, in 1945, a 67-year-old comatose woman regained consciousness following 11
hours of hemodialysis with the dialyzer, and lived for another seven years before dying from an
unrelated condition. She was the first-ever patient successfully treated with dialysis. [5] Dr. Nils
Alwall modified a similar construction to the Kolff kidney by enclosing it inside a stainless steel
canister. This allowed the removal of fluids, by applying a negative pressure to the outside canister,
thus making it the first truly practical device for hemodialysis. Alwall treated his first patient in acute
kidney failure on September 3, 1946.

Deciding on a dialysis plan

If dialysis is recommended for you, you will have to decide whether you want to have haemodialysis or
peritoneal dialysis.
Both methods have the same levels of clinical effectiveness, so the choice is usually a case of personal
preference. However, there may be some circumstances where peritoneal dialysis is not recommended for example, where a person is visually impaired or has dementia.
It should be stressed that any decision that you make about which treatment method to have will not be
final, and you can choose to move from one treatment option to another.
Haemodialysis
Disadvantages
Haemodialysis usually involves using the dialysis machine three times a week, with each dialysis session
usually lasting for about four hours.
Therefore, the obvious disadvantage of haemodialysis is that, to a large extent, you will have plan your
life around your dialysis sessions. For example, if you were to travel to another country you would have to
pre-arrange access to dialysis facilities.
Another disadvantage of haemodialysis is that your diet, and the amounts of fluid that you drink, will need
to be restricted. For example, many people receiving haemodialysis have to avoid foods that are high in
potassium, such as bananas, chocolate, and crisps, and are usually advised not to drink more than a
couple of cups of fluid a day .
Advantages
The main advantage of haemodialysis is that, unlike peritoneal dialysis, you will be able to have four
dialysis-free days a week.
Haemodialysis - home or hospital?

If you decide to choose haemodialysis, you have the option of having a haemodialysis machine installed
in your home. This means that you will not have to make regular visits to a dialysis unit.
There are a number of criteria that usually have to be met for home haemodialysis to be considered as a
suitable treatment option. These include:

you are physically and mentally capable of operating the dialysis equipment,

previous sessions of dialysis have stabilised your symptoms,

you are free of complications and do not have any other significant health conditions,

there are no problems associated with using a catheter to gain access to your blood,

you have a carer who has made an informed decision to assist you with the dialysis, and

there is enough space in your home for a haemodialysis machine and the associated equipment.
If you fulfil these criteria, you still may not necessarily want to have home haemodialysis, and you will
certainly not be pressured into having it.
Many people who are suitable for home dialysis still prefer to visit a dialysis unit because they find the
attention and supervision of the staff both comforting and reassuring.
Also, many people find that having the haemodialysis machine in their house can be an unwelcome
reminder that they have a serious health condition.
Before making a decision, you may wish to discuss the option of home haemodialysis further with your
family, partner and/or other household members.
Peritoneal dialysis
Advantages
The obvious advantage of peritoneal dialysis is that, unlike haemodialysis, it does not require regular
visits to a dialysis unit or, in the case of home haemodialysis, having a bulky machine installed in your
house.
Also, the equipment that is used in peritoneal dialysis is portable, allowing you to travel with more
freedom compared with if you were using haemodialysis. There are two main types of peritoneal dialysis
equipment - one type is roughly the size of a hat stand on wheels, and the other type is the size and
weight of a small suitcase.
Another advantage of peritoneal dialysis is that there is less restriction to diet and fluid intake compared
with haemodialysis. People having haemodialysis are given a strict limit on the amount of fluids that they
can drink (see below for more information).
Disadvantages
One of the main disadvantages of peritoneal dialysis is that you will need to perform it every day, whereas
haemodialysis is usually only performed three days a week.
Another major disadvantage of peritoneal dialysis is that it increases the risk of your peritoneum
becoming infected with bacteria (peritonitis). Peritonitis causes symptoms that include:

abdominal pain,

vomiting, and

chills (episodes of shivering and cold).

Repeated episodes of peritonitis can damage the peritoneum and surgery may be required to repair it.

Another drawback of peritoneal dialysis is that the dialysis fluid that is used in peritoneal dialysis can
cause a reduction in protein levels, which can lead to a lack of energy and, in some cases, malnutrition.
Some people using peritoneal dialysis also experience a raise in their blood cholesterol levels, which can
put them at a greater risk of developing a cardiovascular disease, such as heart attack, or stroke.
Weight gain is another side effect of peritoneal dialysis that affects some people.
Peritoneal dialysis - continuous or automated?
There are two types of peritoneal dialysis:

continuous ambulatory peritoneal dialysis (CAPD), and

automated peritoneal dialysis (APD).

CAPD does not involve using a machine; it uses a portable set of equipment that includes a dialysis bag
which contains fluid and a number of tubes.
With CAPD you will carry out regular dialysis sessions during the day; these sessions are known as
exchanges because clean fluid is exchanged with fluid that contains waste products. Most people using
CAPD will have four exchanges a day, with each exchange lasting between 30-40 minutes.
With APD you will use a dialyser machine, although the machine is much smaller than the one used in
haemodialysis. Dialysis is performed during the night as you sleep, with a session lasting between 8-10
hours.
The main advantage of using CAPD is that the equipment is portable which allows you to have more
freedom to travel away from your house. For example, there should be no reason why you cannot take
your CAPD equipment to your workplace. However, you will need to spend at least two hours a day
performing dialysis.
The main advantage of using APD is that your days will be dialysis free. However, you will need to keep
and maintain a dialyser machine (and the associated equipment) in your house, which is a prospect that
some people find off-putting.

ECG
The etymology of the word is derived from the Greek electro, because it is related to electrical
activity, kardio, Greek for heart, and graph, a Greek root meaning "to write".
Alexander Muirhead is reported to have attached wires to a feverish patient's wrist to obtain a record
of the patient's heartbeat in 1872 atSt Bartholomew's Hospital.[4] Another early pioneer was Augustus
Waller, of St Mary's Hospital in London.[5] His electrocardiograph machine consisted of a Lippmann
capillary electrometer fixed to a projector. The trace from the heartbeat was projected onto a
photographic plate that was itself fixed to a toy train. This allowed a heartbeat to be recorded in real
time.

An initial breakthrough came when Willem Einthoven, working in Leiden, the Netherlands, used
the string galvanometer he invented in 1901.[6] This device was much more sensitive than both the
capillary electrometer Waller used and the string galvanometer that had been invented separately in
1897 by the French engineer Clment Ader.[7] Einthoven assigned the letters P, Q, R, S, and T to the
various deflections,[8] and described the electrocardiographic features of a number of cardiovascular
disorders. In 1924, he was awarded theNobel Prize in Medicine for his discovery.[9]
Though the basic principles of that era are still in use today, many advances in electrocardiography
have been made over the years. Instrumentation has evolved from a cumbersome laboratory
apparatus to compact electronic systems that often include computerized interpretation of the
electrocardiogram.[10]

What Is an Electrocardiogram (ECG, EKG)?

Patient CommentsShare Your Story

The electrocardiogram (ECG or EKG) is a diagnostic tool that is routinely used to

assess the electrical and muscular functions of the heart. While it is a relatively simple
test to perform, the interpretation of the ECG tracing requires significant amounts of
training. Numerous textbooks are devoted to the subject.
The heart is a two stage electrical pump and the heart's electrical activity can be
measured by electrodes placed on the skin. The electrocardiogram can measure the
rate and rhythm of the heartbeat, as well as provide indirect evidence of blood flow to
the heart muscle.
A standardized system has been developed for the electrode placement for a routine
ECG. Ten electrodes are needed to produce 12 electrical views of the heart. An
electrode lead, or patch, is placed on each arm and leg and six are placed across the
chest wall. The signals received from each electrode are recorded. The printed view of
these recordings is the electrocardiogram.
By comparison, a heart monitor requires only three electrode leads one each on the
right arm, left arm, and left chest. It only measures the rate and rhythm of the heartbeat.
This kind of monitoring does not constitute a complete ECG.

How the Test is Performed

You will be asked to lie down. The health care provider will clean several
areas on your arms, legs, and chest, and then will attach small patches

called electrodes to those areas. It may be necessary to shave or clip some

hair so the patches stick to the skin. The number of patches used may vary.
The patches are connected by wires to a machine that turns the heart's
electrical signals into wavy lines, which are often printed on paper. The
doctor reviews the test results.
You will need to remain still during the procedure. The health care provider
may also ask you to hold your breath for a few seconds as the test is being
done.
It is important to be relaxed and warm during an ECG recording because any
movement, including shivering, can alter the results.
Sometimes this test is done while you are exercising or under light stress to
look for changes in the heart. This type of ECG is often called a stress test.

How to Prepare for the Test

Make sure your health care provider knows about all the medicines you are
taking. Some drugs can interfere with test results.
Do not exercise or drink cold water immediately before an ECG because
these actions may cause false results.

How the Test will Feel

An ECG is painless. No electricity is sent through the body. The electrodes
may feel cold when first applied. In rare cases, some people may develop a
rash or irritation where the patches were placed.

Why the Test is Performed

An ECG is used to measure:

Any damage to the heart

How fast your heart is beating and whether it is beating normally

The effects of drugs or devices used to control the heart (such as a

pacemaker)
The size and position of your heart chambers

An ECG is often the first test done to determine whether a person has heart
disease. Your doctor may order this test if:

You have chest pain or palpitations

You are scheduled for surgery

You have had heart problems in the past

You have a strong history of heart disease in the family

There is no reason for healthy people to have yearly ECG tests.

Normal Results
Normal test results include:

Heart rate: 60 to 100 beats per minute

Heart rhythm: consistent and even

What Abnormal Results Mean

Abnormal ECG results may be a sign of:

Damage or changes to the heart muscle

Changes in the amount of the electrolytes (such as potassium and
calcium) in the blood

Congenital heart defect

Enlargement of the heart

Fluid or swelling in the sac around the heart

Inflammation of the heart (myocarditis)

Past or current heart attack
Poor blood supply to the heart arteries

Abnormal heart rhythms (arrhythmias)

Some heart problems that can lead to changes on an ECG test include:
Atrial fibrillation/flutter
Heart failure
Multifocal atrial tachycardia
Paroxysmal supraventricular tachycardia

Sick sinus syndrome

Wolff-Parkinson-White syndrome

LIMITATIONS OF ECG /EKG MACHINES

ECG or EKG machine is a very powerful and common screening tool for heart diseases. It is
relatively inexpensive, non-invasive and easy to use. It does have some limitations.
Understanding those limitations is important to put things in proper perspectives.

The ECG monitor displays the electric activities generated by the heart and gives a snapshot of
the heart rate and rhythm during the test; however it does not reflect many underlying
problems. Cardiac abnormalities may occur only intermittently and ECG needs to be performed
at the "right" moment to capture the episodes. At other times, a patient may have entirely
normal ECG.
To compensate for this, many ECG are performed when the patient is exercising, which increases
heart rate and put the heart under stress. The exercise stress ECG test, in many situations, can
reveal many hidden conditions which otherwise would not be detected.
When the ECG machine displays an unusual pattern, there can be multiple unrelated reasons,
including a normal variant. A doctor needs to do more detailed investigation, including other
tests (e.g. echocardiogram), to sort things out.
False negative is probably the biggest concern with ECG. For some heart patients, the EKG may
be entirely normal and yet their conditions should be reflected in the ECG. The reasoning behind
this is not well understood. A good ECG reading does not preclude having the underlying heart
disease and other symptoms, such as chest pain, must be taken into account and further
evaluation may be required.

Not all heart problems will show up on an ECG. A prime example is vulnerable plaque (a form of
atheroma). Vulnerable plaque is a fast growing deposit or degenerative accumulation of lipidcontaining plaques on the innermost layer of the wall of an artery. Because artery walls typically
enlarge in response to enlarging plaques, they do not affect blood flow and cannot be detected
even in a cardiac stress ECG test. Yet vulnerable plaque is a major cause of heart attacks.
A stress ECG test requires high-grade stenosis to show positive reading. High-grade stenosis is a
good indicator of advanced heart disease; however it is not the major cause of heart attack.
False positives and false negatives are common among clinical tests. A doctor has to weight all
the evidence prior to making a diagnosis.