Dialysis removes waste products from blood when kidneys are not functioning properly. Types of dialysis are hemodialysis and peritoneal dialysis. Approximately 300,000 people in the U.S. receive dialysis each year. Massage, foot reflexology, and acupressure were found to benefit individuals undergoing hemodialysis. Read on to learn more.
Dialysis is required for people who have acute renal failure until the condition has resolved or during end-stage renal disease until a transplant becomes available. Dialysis also can be used to remove drugs or poisons during medical emergencies. Antibiotics are administered as a protective measure owing to the high incidence of bacterial infections associated with renal dialysis. The two methods of dialysis are hemodialysis and peritoneal dialysis.
Hemodialysis uses an external machine to filter blood and is usually provided in a hospital setting or dialysis center. An arteriovenous fistula, usually located in the forearm, assist with blood transport. The person’s blood circulates through a machine that contains a semipermeable filtration membrane. Dialysis solution is located on the other side of the filtration membrane. During the process, waste products from the blood diffuse across the filtration membrane into the dialysis solution. After filtering, the cleansed blood flows back into the body through a tube. Anticoagulants such as heparin are administered to prevent the blood from clotting during the procedure. The entire process takes approximately 3 to 4 hours and is usually performed three times per week.
Peritoneal Dialysis is usually administered at home. There are two types of peritoneal dialysis, continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). Compared with hemodialysis, both peritoneal dialysis methods require more time and are performed every day. Peritoneal dialysis can be administered while the person is asleep or ambulatory, depending on the type of dialysis prescribed. During peritoneal dialysis, the peritoneal membrane itself serves as a filtration membrane. A flexible catheter is implanted into the peritoneal cavity and serves as the entry and exit site for the dialysis solution.
During CAPD, the dialysis solution, or dialysate, enters and exits the peritoneal cavity by way of gravity, whereas with APD, a machine is needed to assist with the transfers. The process of draining and filling the peritoneal cavity with the dialysis solution is called an exchange and takes approximately 30 to 40 minutes. The main difference between the two types of peritoneal dialysis is that CAPD is done during the day with multiple exchanges, whereas with APD the majority of the exchanges are done at night with the assistance of a machine. After filtering, waste products leave the body when the dialysis solution is drained.
Some side effects of dialysis include hypotension, local or systemic infection, muscle cramps, and bleeding from the access site.
Massage Therapy and Dialysis – It is important to screen your client carefully and modify your massage according to presenting signs, symptoms, disease complications, and the type of dialysis your client is receiving.
In cases of hemodialysis, avoid the arm with the fistula. Another reason to avoid the arm is that in hemodialysis the involved blood vessels tend to be sclerotic or damaged. Massaging the hand without the fistula using 3- to 5-mL of lavender, mint, and tea tree oils at 5% concentration relieved itching or pruritus in hemodialysis patients (1). Foot massage or reflexology decreased fatigue, pain, and cramps in hemodialysis patients (2). Acupressure massage reduced fatigue (3, 4) and depression (3) in hemodialysis patients.
In cases of peritoneal dialysis, avoid the abdomen.
It is important to discuss the timing of massage sessions. Each client will experience dialysis differently. Depending on client preference, you may provide massage on the same day or at the same time of dialysis. Or you may wait a few days or even a week or more. Some clients may feel progressively worse as waste products build up in the blood between dialysis treatments, and other clients may feel very tired before or immediately after dialysis treatment. Even with the best scheduled appointment time, the client may feel overly fatigued. In these cases, use light pressure. An example of light pressure is approximately a 3 on a 10-point pressure scale. Light pressure will also reduce the risk of bruising as anticoagulants administered during the dialysis procedure increase the risk of bruising from deep pressure massage.
Articles and Journals Referenced:
- Shahgholian N, et al: Effect of aromatherapy on pruritus relief in hemodialysis patients. Iran J Nurs Midwifery Res 15(4):240–244, 2010.
- Ozdemir G, Ovayolu N, Ovayolu O: The effect of reflexology applied on haemodialysis patients with fatigue, pain and cramps, Int J Nurs Pract 19(3):265–273, 2013.
- Cho YC, Tsay SL: The effect of acupressure with massage on fatigue and depression in patients with end-stage renal disease, J Nurs Res 12(1):51–59, 2004.
- Sabouhi F, et al: Effect of acupressure on fatigue in patients on hemodialysis. Iran J Nurs Midwifery Res 8(6):429–434, 2013.
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at firstname.lastname@example.org.