Christine Ngoke is talking to Parveen about her husband Thomas, whose kidney function means he needs to start dialysis in the next few months...

“This dialysis sounds awful,” says Christine. “He has to have something done to his arm so he can have it, but then we have to wait a few weeks before he can start, and there are all kinds of restrictions about food and fluid intake and heaps of medicines he’s going to need. They say he is likely to be tired and washed out, and as he will need it two or three times a week. That’s more time than not he will be feeling that way.”

What can Parveen say to reassure Christine?

Answer

The decision to put Thomas on dialysis for his failing kidneys is not one that will have been made lightly, but equally he and Christine will have a little time to prepare.

It sounds like haemodialysis is the decided course of action, with the “something done to his arm” likely to be the formation of a fistula, the connection of an artery to a vein in order to provide a site from which the blood can be removed and returned to his body when he is hooked up to the artificial kidney.

Hopefully the nearest dialysis unit is not too far away, so at least the travel time will be kept to a minimum. The process itself runs to hours rather than minutes, but patients often find they get into the routine of it all quite quickly as the appointments are regular, so they get to see the same people – both staff and fellow patients – on each occasion. In time, Thomas may be able to move to home dialysis, which will make things even easier in some ways.

There are several things Thomas should do when – and even before – he starts dialysis, from making sure he is in decent physical shape by doing some regular exercise, quitting smoking if relevant, and clearing space in his diary to attend each and every session.

He may be advised to have a hepatitis B vaccination and needs to know that he will require heparin to thin his blood when he is dialysed, and have restrictions around his diet and fluid intake, as well as potentially requiring erythropoietin for anaemia.

It can also have a considerable psychological impact, so Christine needs to be alert for signs of depression when his sessions start.

The bigger picture

Dialysis is a form of renal replacement therapy that uses a machine to filter harmful substances and excess fluid from the blood when the kidneys are not able to perform this function.

While this is undoubtedly invasive and tiring, it brings with it undeniable benefits such as protecting the bones and reducing fluid accumulation, which in turn can cause oedema and shortness of breath, as well as malaise, fatigue and weakness.