“Doctor,Can dialysis be temporary?” When patients first start dialysis, this is a common question they ask me. Dialysis can be temporary or permanent depending upon cause and circumstance of the patient. Since causes of dialysis can be different, the duration also varies. Some of the factors on which the duration of dialysis depends on are:
Cause of kidney failure:
The duration of dialysis depends on the cause of kidney failure. Kidney failure can be acute or chronic.
Acute Kidney Failure-
When kidney failure occurs suddenly, it is called acute kidney failure. Acute kidney failure can be caused due to:
- Damage to kidney structure- It includes any blockage, kidney stones, tumors, enlarged prostate in men etc.
- Damage to vascular supply- kidney is supplied by blood vessels. Vasculitis, low blood pressure, dehydration, hemorrhage etc can affect blood supply and causes acute kidney failure
- Infections like septicemia and pyelonephritis can harm the kidney. Leptospira infection or pneumonia can also be causes of infectious diseases of the kidney.
- Any physical injury or some medicines like Aspirin, chemotherapy drugs, toxic antibiotics
- Autoimmune diseases of kidney like Acute Nephritic Syndrome
- Acute tubular necrosis- It is a condition where tubules of kidney are damaged and thus cause acute kidney failure.
Chronic Kidney Failure-
Chronic refers to a long term condition. The major causes of chronic kidney failure are:
- Diabetes- In diabetes, blood sugar level is higher than the baseline always. This leads to a series of complications known as Diabetic Nephropathy. The smaller blood vessels of the kidney are injured in diabetes. This results in reduced effectiveness of the kidney to clear blood. Therefore, the body retains more salt than needed. Also, proteins and ketone bodies are present in urine.
Diabetes can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys.
Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.
- Hypertension- Hypertension or high blood pressure constricts blood vessels. When the blood vessels of the kidney are narrowed, it hampers blood flow. When this happens, kidneys no longer function properly.
Extra fluid in the blood vessels can raise your blood pressure even more, creating a dangerous cycle, and cause more damage leading to kidney failure.
Sometimes, the cause of chronic kidney failure is not diagnosed. The patient presents a smaller history because of recent symptoms. Dialysis may be started as a one time procedure but as the underlying cause is later revealed, the patient has to continue with dialysis for a longer time. In this case, the patient’s symptoms are resolved by dialysis.
So, a patient can start dialysis thinking that it will be temporary, but it can convert to a permanent solution over time as the diagnosis becomes clearer.
In another scenario, a patient who has a chronic condition may need dialysis suddenly because of a sudden acute kidney injury. For example, a patient of hypertension may suddenly develop diarrhoea or dehydration; which can force them to start dialysis. Once this issue is resolved, they may not require dialysis any longer.
So the cause to start dialysis varies depending on the circumstance of the patient. It is unique and it takes time to answer these questions.
So, now coming to the most important question :
Can dialysis be stopped once started?
The simple answer is that it can be stopped if dialysis was done for acute kidney failure and the kidneys have recovered. If, on the other hand, dialysis was started for chronic kidney failure, then it needs to be continued lifelong or till a kidney transplant is performed.
How long can you be on temporary dialysis?
Temporary dialysis helps mainly with acute kidney disorders. The duration of the dialysis will depend on the cause. So, for example,
- In case of infections, which may be bacterial or viral, dialysis continues until the resolution of the infectious cause. Once the culture report comes negative and normal kidney functions restore, dialysis can be stopped.
- In kidney obstruction, it can take longer.
- If the obstruction is morphological, like ureter obstruction or bladder obstruction, dialysis helps till surgery or till they are unblocked.
- In other cases like kidney stones or tumors causing obstruction, surgery which removes the cause of obstruction can be done. After the surgery and the recovery, one can stop dialysis.
- Enlarged prostate can be cured by finding the underlying cause. The patient can stop dialysis once the condition resolves.
- Acute dehydration is another common reason to start temporary dialysis. In the first few stages of dehydration, oral water consumption can resolve the issue. But if the dehydration is affecting the kidney, it means it has progressed. In such scenarios, along with giving iv fluids, the patient is put on a temporary dialysis.
- A resembling condition to the above can be severe diarrhoea. Diarrhoea, which is caused by a plethora of reasons, leads to loss of a large amount of water. This mimics the situation of acute dehydration. And as a result, temporary dialysis can be done here.
- Temporary dialysis can be started because of use of certain medicines. Medicines like NSAIDs, some antibiotics etc can impair kidney function in higher doses or over longer term use. Such patients can start dialysis for a short time and stop when they stop using drugs.
But sometimes, it can convert to chronic dialysis because the effects can be irreversible.
- Some patients start dialysis due to vasculitis. In vasculitis, blood vessels get inflamed and thus all organ systems, including renal, are affected. Vasculities can be resolved by taking certain medicines and until then, patients can be on temporary dialysis,
In conclusion, the duration of temporary dialysis depends on the condition of the patient. Some patients improve after a single session while others require multiple rounds of dialysis. As a rule of thumb, temporary dialysis is stopped once underlying conditions are addressed.
Sometimes the acute conditions (for which dialysis was started temporarily), convert to chronic health conditions. In such cases, dialysis has to be continued for a longer time duration. As the duration of dialysis increases, the chances of complete recovery reduce.
Furthermore, there are some chronic conditions which may require dialysis for months to years.
- Diabetes is one such case. Once a patient develops diabetic nephropathy, it is very difficult to reverse it. Certain risk factors like: smoking, sedentary lifestyle, long standing high blood sugar, obesity, family history of kidney failure etc. make a patient more susceptible.
The kidneys get damaged progressively and after some time,chronic dialysis remains the only viable solution.
- Hypertension is also a cause of chronic kidney disease.It reduces the efficiency of filtration by harming blood vessels of the kidney. This results in fluid retention, which further increases blood volume. Increased blood volume causes higher blood pressure.
To stop this vicious cycle, dialysis is often the last resort of the patient.
In the context of chronic diseases like hypertension and diabetes, please note that dialysis is not the treatment. To restore kidney function, the disease has to be controlled. For example, in diabetes controlling increased blood sugar level by medicines and change in lifestyle will eventually restore kidney health.
While in hypertension, reducing systolic blood pressure should be the aim of treatment.
Dialysis is just helping with the symptoms. The duration of dialysis in turn, will depend on the effectiveness of treatment therapy.
Regaining kidney function after dialysis
The goal of dialysis is to assist blood filtration until kidneys take over. If the reason to start dialysis is an acute kidney injury, then chances of recovery are high. The kidneys will gradually regain function. Sometimes, a single session is enough before recovery.
Once kidneys recover, patients should regularly monitor the kidney functions through KFT and RFT. Any abnormality should be discussed with your nephrologist diligently.
In conclusion, dialysis can be temporary or for a chronic time period. It depends on the unique circumstance of the patient. It is decided by factoring in the history of illness, severity of illness and patient’s overall health.
I hope this article helped in answering your doubts. All the best!