Dialysis

Dialysis is a treatment that does part of what the kidneys normally do — filtering waste and excess fluid from the blood. It is life-sustaining but not a cure; the kidneys themselves don't usually recover unless the injury is acute. In India, PM-NDP (Pradhan Mantri National Dialysis Programme) provides free haemodialysis to eligible patients at empanelled centres.

Two main types

• Haemodialysis (HD) — blood is filtered by a machine via an access (AV fistula, AV graft, or central venous catheter). Typically 4 hours, 3 times a week, at a dialysis centre. Home HD is rare in India.
• Peritoneal dialysis (PD) — fluid is exchanged in the abdominal cavity via a permanent catheter. Done at home; CAPD (4 manual exchanges a day) or APD (machine-driven overnight). Suits people who prefer home therapy and have reliable hygiene.

Choosing between them

• HD — better if you live near a dialysis centre, can't manage at-home sterility, or need intensive removal of fluid/potassium.
• PD — better for home-based care, flexibility, less cardiovascular stress, no needles; may suit younger patients, rural areas with travel issues, or those on the transplant waiting list.
• Neither is "better" overall — patient-matched.
• Some people switch between them; both are available in most Indian metros and many tier-2 cities.

Preparing for dialysis

• AV fistula creation should happen 3–6 months before dialysis starts for HD — central-line catheter dialysis carries much higher infection and clotting risk and should be avoided for long-term use.
• Hep B vaccine well before dialysis.
• Nutrition counselling — protein, salt, potassium, phosphate targets.
• Transplant evaluation before starting dialysis if eligible — pre-emptive transplant gives the best outcome.

Living well on dialysis

• Don't skip sessions — each missed HD session raises the risk of fluid overload, high potassium, and death.
• Fluid limit — usually 500 ml plus your urine output/day for HD patients.
• Salt, potassium, phosphate restrictions — a renal dietitian makes it manageable.
• Protein intake — adequate, because dialysis removes protein; your dietitian will set a target.
• Access care — check fistula thrill daily; no BP measurement, no blood draw, no tight watches/bangles on the fistula arm.
• Mental health — depression is common; support groups and counselling are underused.

When to call / go urgently

• Bleeding from the access that won't stop — press with a clean cloth, go to hospital.
• Redness, warmth, pain at access — infection.
• Sudden breathlessness, chest pain, severe leg swelling between sessions.
• Altered consciousness, new palpitations (high potassium sign).