The cornerstone of therapy is regular, intensive, efficient dialysis. This translates into 4-5 hours of dialysis three times per week. This would be particularly important in your case, if you still had some residual kidney function until one of your kidneys was removed.

There are many treatment options and you should seek the advice from your Nephrologist what measure would suit you best. And as hope springs eternal: In up to 20% of symptomatic patients itching disappears spontaneously and it would be definitely gone after a successful renal transplantation

Fistula or Graft

• Wash with an antibacterial soap each day, and always before dialysis.
• Do not scratch your skin or pick scab.
• Check for redness, a feeling of excess warmth or the beginning of a pimple on any area of your access.
• Ask your dialysis care team to rotate the needles when you have your dialysis treatment.

Catheter

• Keep catheter dressing clean and dry.
• Make sure the area of the access is cleaned and the dressing is changed by your care team at each dialysis session.
• Keep an emergency dressing kit at home in case you need to change your dressing between treatments.
• Never open your catheter to the air.

Keeping Your Access Working

Your dialysis care team will check your access often to make sure it is working well. An access that is not working well can decrease the amount of dialysis you receive. Your dialysis care team will teach you how to check your fistula or graft at home each day. Here are some tips you should follow to help keep a fistula or graft working longer:

1. Check the blood flow several times each day by feeling for a vibration, also called a pulse or thrill. If you do not feel this, or if there is a change, call your doctor or your dialysis center.
2. Do not wear tight clothes or jewelry on your access arm.
3. Do not carry anything heavy or do anything that would put pressure on the access.
4. Do not sleep with your head on the arm that has your access.
5. Do not let anyone use a blood pressure cuff on your access arm.
6. Do not let anyone draw blood from your access arm.
7. Do not be afraid to ask your dialysis care team to rotate needle sites.
8. Apply only gentle pressure to the access site after the needle is removed. Too much pressure will stop the flow of blood through the access.
9. If you have breakthrough bleeding after you have dialysis, apply gentle pressure to the needle site with a clean towel or gauze pad. If the bleeding does not stop in 30 minutes, call your doctor or your dialysis center.

If Access Problems Occur

Sometimes, even when you are very careful, your access may clot or become infected. If an infection occurs, your doctor will order antibiotics for you. If your access develops a clot, you may need to go to the hospital for treatment. Removing the clot can usually be done on an outpatient basis, and you will not need to stay overnight.

The amount of urea in these two blood samples is compared to see how much was removed during dialysis. Although urea is just one of the body’s waste products, how effectively it is removed indicates how well other waste products have been removed. So, if you have a URR of 65%, it means your blood is 65% cleaner than when you started this dialysis treatment.

The minimum target for Kt/V is 1.2. This applies to patient who receive dialysis three times each week. A slightly lower value may be OK if you still have some function from your own kidneys.

Causes of low Kt/V include:

• Dialysis treatment too short (less than four hours)
• Problems with blood flow or recirculation at vascular access
• Artificial kidney (dialyzer) too small

How to improve Kt/V and/or dialysis dose – possibilities include

• Longer dialysis
• Better access (fistula or line)
• A larger artificial kidney may help if blood flow is good
• More frequent dialysis (e.g. 4 times per week instead of 3)

• your Kt/V should be at least 1.2
• your URR should be at least 65 percent

Blood cells, protein and other important things remain in your blood because they are too big to pass through the membrane. Smaller waste products in the blood, such as urea, creatinine, potassium and extra fluid pass through the membrane and are washed away.

*Ultra filtration: All excess fluid must be removed from the bloodstream as the patient’s blood flows through the dialyzer. The process of water removal from the bloodstream is called ultra filtration, and the amount of fluid removed is the ultra filtrate.

• how well your kidneys work
• how much fluid weight you gain between treatments
• how much waste you have in your body
• how big you are
• the type of artificial kidney used

In hemodialysis, your blood is allowed to flow, a few ounces at a time, through a special filter (dialyzer) that removes wastes and extra fluids. The clean blood is then returned to your body. Removing the harmful wastes and extra salt and fluids helps control your blood pressure and keep the proper balance of chemicals like potassium and sodium in your body. One of the biggest adjustments you must make when you start hemodialysis treatments is following a strict schedule.

Most patients go to a dialysis center— three times a week for four hours each visit. For example, you may be on a Saturday – Monday – Wednesday schedule or a Sunday – Tuesday – Thursday schedule. You may be asked to choose a morning, afternoon, or evening shift, depending on availability and capacity at the dialysis unit. Your dialysis center will explain your options for scheduling regular treatments.

Catheters are not ideal for permanent access. They can clog, become infected, and cause narrowing of the veins in which they are placed. But if you need to start hemodialysis immediately, a catheter will work for several weeks or months while your permanent access develops.

However, AV grafts are at high risk to develop narrowing, especially in the vein just downstream from where the graft has been sewn to the vein. Narrowing often leads to clotting or thrombosis. As foreign material, they are at greater risk for becoming infected. More options for sites to place a graft are available, because the graft can be made quite long. Thus a graft can be placed in the thigh or even the neck (the ‘necklace graft’).