Hemodialysis
What a different experience hemodialysis is compared to peritoneal dialysis! Dylan was switched from peritoneal dialysis (PD) to hemodialysis (HD) when he had his nephrectomy earlier in July. Dylan’s HD lines were placed a week before nephrectomy so that we could test HD a few times first to make sure the lines were working and that HD would work post-nephrectomy. For Dylan, the line insertion went exceptionally well! He was admitted for the first night for pain control, but was running up and down the hall in the evening as though he never had a procedure that morning.
Dylan’s first test of hemodialysis was the next morning after his lines were placed. Doing HD when Dylan still had his kidney and was producing lots of urine was a breeze! His urea and creatinine were the best they had ever been, plus we weren’t taking any fluid off so he felt great. He would come off hemodialysis and run circles around the unit. The start of HD was kind of intimidating as it seems like a significant amount of blood that is being taken out to go to the machine. The visual aspect of dialysis took a bit to get comfortable with.
After nephrectomy, things were quite different. It’s been a very challenging time trying to figure out Dylan’s “dry weight” to pull off the right amount of fluid. For the first few weeks, Dylan wasn’t able to make it to the end of his treatments before his blood pressure would drop and they would need to stop. If it wasn’t his blood pressure, it was clots forming in the dialyzer. This caused many issues with his hemoglobin dropping. We trialed a few different doses of heparin as well as increasing the size of the dialyzer tubing. It took a number of weeks but it was finally figured out! A medication, called midodrine, is also given before treatments to help prevent Dylan’s blood pressure from dropping.
HD has been a very different experience from PD. A very frustrating experience. Trying to entertain an almost 3 year old for close to 4 hours four times a week while they are unable to move much is incredibly difficult. Especially when too much fluid is pulled off which made him feel quite unwell. Other challenges we have faced, are that Dylan LOVES to play with his lines. Between pulling them out and needing them to be replaced, and removing his bandage on them every other day, I cannot wait for these lines to be gone! Thankfully we only need to do hemodialysis for 3 months, but I do have a very new respect for people who do this for years while waiting for their new kidney.
