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The kidneys' function is to clean the blood by removing waste and regulating homeostasis by regulating electrolytes, hormones, and body fluids. The renal systems includes the kidneys which is between the T11 and L3, the Ureters, the Bladder, the abdominal descending aorta, the renal artery and vein, and the inferior vena cava. The renal system eliminates waste, filterate the blood,  homeostasis which includes blood pH and volume, Hormone production, and vitamin D synthesis. While the kidney functions in this manner, there can be dysfunction within the kidneys leading to a decrease in the functionality of the kidney's ability to clean the blood. This dysfunction causes a build-up of waste and an imbalance in homeostasis, thereby leading to inability to function properly. In order to confirm the kidney's state, a process known as Hemodialysis is done

<center>https://upload.wikimedia.org/wikipedia/commons/7/7d/Blausen_0313_Dialysis.png</div>
[wikimedia.org](https://commons.wikimedia.org/wiki/File:Blausen_0313_Dialysis.png)</center>

With a dialyzer, the blood is taken out of the body, cleaned, and returned back to the patient. With a dialyzer, the patient would perform 3 sessions in a week for about 3 to 5 hours in a session. Before a dialysis, a vascular access such as a radiocephalic fistula, a forearm loop graft, or a cathetar is used to take blood out of the body so it can be cleaned and returned. The fistula allows blood to leave towards the hand but it shouldn't lead to a ischemia. Parastesia (tingling), pallor (pale), change of pulse, pain, should not occur in patients who have vascular access. Patients can also experience AV fisture still syndrome where there is no perfusion in the hand where the fistula is placed. Between the first Vacular access and the dialysis usually take 6 months before it heals properly for dialysis.

Before the procedure there are preparations for the dialysis. The vital signs are checked, the thrill in the vascular access is felt, the pulse is checked and other vitals are checked including the blood pressure, and temperature to accertain if the patient is ready for dialysis. Labs are also done to  check the electrolyte levels, the creatinine levels, the anti-coagulant level and so on before the dialysis is done. Before a dialysis, patient shouldn't take diuretics, vasodilator medication, nitroglycerin, digoxin, antibiotics, vitamin B , folic acid (vitamin B9) and vitamin C, as these drugs can be easily removed from the patient during the dialysis, while diuretic drugs can affect blood pressiure leading to hypotension.

<center>https://upload.wikimedia.org/wikipedia/commons/6/6e/Plugged_into_dialysis.jpg
[wikimedia.org](https://commons.wikimedia.org/wiki/File:Plugged_into_dialysis.jpg)</center>

When the patient is ready for dialysis, the vascular access point it checked and needle inserted. The kidney is checked, heparin or other anticoagulant is given to the patient, to prevent clotting at the vascular access needle. The rate, and flow of blood is checked, also the patient is questioned for signs of nausea, vomiting, or cramping. When the procedure is done, bleeding is stopped from the access, and the patients vital signs are checked for comparism, post procedure and pre-procedure. While performing this procedure, there can be complications and these complications can involve loss of vascular access which can occur as a result of stenosis, clots, pressure on the access as a result of a constrictive clothing, or blood pressure check on the hand. Infections can also be another complication that could occur in the area of the vascular access leading to the inability for the dialysis to be done. If the patients are older, underlying diseases and infection can also cause issues with dialysis as the body will be stressed. After the dialysis, patients can bleed, there can be hemorrhage or ulcers leading to hypotension. Patients can have muscle cramps as a result off changes in electrolytes, patients can also begin to experience nausea and vomiting, also patients can suffer from disequilibrium syndrome but this is a rare case. 


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##### <center>Reference</center>
* https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis
* https://www.ncbi.nlm.nih.gov/books/NBK563296/
* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654453/
* https://www.statpearls.com/ArticleLibrary/viewarticle/22725
* https://www.kidney.org/atoz/content/hemodialysis

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