Dialysis surgery plays a central role in the preparation and maintenance of blood washing (dialysis), a vital treatment for patients with advanced renal insufficiency. These patients suffer from impaired or absent kidney function, which means that the kidneys can no longer fulfil their task of filtering the blood and excreting excess fluids and waste products. The most common conditions that require dialysis include
Chronic kidney failure (CKD):
A gradual deterioration in kidney function that often progresses over years. It can be caused by diabetes, high blood pressure or other rare chronic diseases.
Acute renal failure:
A sudden loss of kidney function that can be caused by severe infection, medication, dehydration or shock. This can be reversible in some cases, but often requires temporary dialysis.
End-stage renal disease (ESRD):
The final stage of renal failure in which kidney function is so severely impaired that dialysis or kidney transplantation becomes necessary to preserve the patient’s life.
Dialysis surgery comprises various procedures that are necessary to create access to the bloodstream so that dialysis can be carried out effectively. The most important surgical procedures include
Arteriovenous fistula (AV fistula):
The AV fistula is the preferred dialysis access and is created by connecting an artery to a vein, usually in the forearm. This fistula must mature for several weeks or months before it can be used for dialysis. It provides the best blood flow and has a long lifespan.
Arteriovenous graft (AV graft):
If the patient’s veins are too small or weak for a fistula, a synthetic tube (graft) can be used to create a connection between the artery and vein. The AV graft is quicker to use than a fistula, but is also more susceptible to complications such as infection or thrombosis.
Central venous catheter:
In acute or emergency situations where immediate dialysis access is required, a catheter is inserted into a large vein (often in the neck or groin). This access can be used immediately but is less ideal for long-term use as it carries a higher risk of infection.
The main causes of chronic kidney disease requiring dialysis are:
Diabetes mellitus:
Long-term high blood sugar levels can damage the blood vessels in the kidneys and often lead to kidney damage.
Hypertension (high blood pressure):
Persistently high blood pressure can damage the sensitive structures in the kidneys and lead to kidney failure.
Glomerulonephritis:
An inflammation of the filtering units of the kidneys caused by infections, autoimmune diseases or other factors, leading to a deterioration in kidney function.
Polycystic kidney disease:
A genetic disease in which cysts form in the kidneys and displace healthy kidney tissue, ultimately leading to kidney failure.
The symptoms of chronic kidney disease (CKD) usually develop gradually and often go unnoticed in the early stages. Only in the advanced stages do clear symptoms appear, when kidney function is already significantly impaired.
Early symptoms (stage 1-3):
In the early stages there are often hardly any symptoms. Occasionally non-specific complaints occur, such as
Tiredness and exhaustion:
due to the accumulation of metabolic toxins.
Concentration disorders and reduced performance
Loss of appetite or slight weight loss
Increased urination (polyuria), especially at night (nocturia)
High blood pressure:
A common early sign of impaired kidney function.
Prevention of kidney disease and the associated need for dialysis surgery focuses on controlling the underlying causes:
Blood glucose control:
Good blood glucose control in diabetes is crucial to reduce the risk of kidney damage.
Blood pressure management:
Regular monitoring and control of blood pressure can help prevent kidney complications.
Healthy lifestyle:
A balanced diet, regular physical activity, avoiding obesity and refraining from smoking make a significant contribution to maintaining kidney health.
Early detection and treatment of kidney disease:
Regular check-ups, especially for people with risk factors such as diabetes or high blood pressure, can help to recognise kidney disease early and treat it before it progresses.
Avoidance of nephrotoxic substances:
Long-term use of certain medications (such as non-steroidal anti-inflammatory drugs) or exposure to toxic substances can damage the kidneys. These substances should therefore only be used under medical supervision.
New creation of AV fistulas and shunts
Implantation and replacement of tunnelled dialysis catheters
Surgical, endovascular and combined (hybrid) treatment of occluded or suboptimally functioning AV fistulas and shunts
Modern vein therapies: Varicose veins, thrombosis, pelvic congestion and pelvic vein occlusion, leg illustration with varicose vein
