Improving your Dialysis Efficiency

If you have been following this blog you will know that I have been feeling weak and lousy for a few months now, and I have blamed it on the non-functioning graft (transplanted kidney) currently sitting quietly in my lower abdomen.

Jon, my nephrologist has been resisting my calls for its removal, on what I saw as the flimsy excuse that there are no symptoms (pain in the graft (kidney), lack of appetite (I eat like a pony, hopefully soon like a horse), general malaise. My symptoms he said are more like inefficient dialysis (high potassium, high phosphate, energy up and down): “Maybe the culprit is my fistula, there may be some kind of blockage, not allowing enough blood flow.”

I have written about healthy fistulas before, and though it’s 14 years old, mine seems pretty good. Nevertheless, he arranged for a fistulagram. I’d never had one before, and I was interested to see how it worked.

I thought it was a simple ultrasound, but no, it’s a complex ultrasound. Basically, they introduce a large needle (larger than a BigD needle) into the fistula, and release some dye or contrast that the ultrasound can track, and measure how well it flows through the fistula. To do this they first put a blood pressure cuff on the fistula arm to block flow, introduce the dye, then release the cuff. They did this several times over about 40 minutes.

Long story short, they found a narrowing of the fistula near the anastomosis (where the vein and the artery are joined). This meant that during Dialysis the arterial needle couldn’t draw enough “new” (uncleaned) blood through the anastomosis, so it sucked it from further up my arm. Unfortunately, that blood had just been returned via the venous needle, nice and clean. So it was cleaned again (and again and again), while the toxins in the blood in the rest of my body were virtually untouched. Hence my low-efficiency dialysis.

Fortunately, they can fix or at least improve this situation. They introduce a balloon into the fistula and position it in the narrowing. They then expand the balloon several times, each time a little more, until the narrowing is pretty well gone. Again, it takes around 40 minutes. You can feel it happening, but there is minimal pain.

And it worked well. I went to BigD that evening, dialysed as normal and felt great. I have had eight sessions since. Yesterday I had blood tests (before dialysis) and both phosphate and potassium levels have dropped dramatically, to almost normal levels.

Hopefully, it will be another 14 years before I need another one (though the guy doing mine said that sometimes it needs to be re-done every 3 months or so, depending on the elasticity of the fistula). I’d like my fistula to be elastic, but not too elastic…

So, I’m sad to say, my self-diagnosis skills have taken another hit, and the specialist was right (again): the kidney stays. And that’s OK with me, at least until my next self-diagnosis.

6 thoughts on “Improving your Dialysis Efficiency

  1. Pingback: What does a Healthy Dialysis Fistula Look Like? « Big D and Me

  2. Just came across you blog and found it informative…I just started dialysis last week and already have to go see the vascular surgeon on monday because of flow problems and infiltration.


    • Hi badboyinri and welcome! It can take a while to get things working without a hassle. So many new things. Keep at it and all will be fine. Greg


  3. Pingback: Improving Dialysis – Fistula Efficiency: Plan B « Big D and Me

  4. Pingback: Dialysis: how much is enough? | Big D and Me

  5. Not sure anyone still looks at this post, but the info was really good. My husband just started the big D and he already has trouble with his fistula. No-one told us, he should not sleep on that side. Anyway, he goes back today and hopefully, it is working again. He was worried about that swooshing sound, but told him maybe it was supposed to sound that way. Gonna have him do the lifting arm test. Thanks again.


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