Dialysis a method of filtering wastes from the blood through a semipermeable membrane when the kidneys are not functioning properly. Over 700,000 Americans have kidney failure and need dialysis or a kidney transplant to survive. More than 500,000 of these patients received dialysis at least 3 times a week. 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. Both types use a semipermeable membrane and dialysis solution in the filtering process to remove unwanted substances from the blood.

Hemodialysis uses a machine containing the semipermeable membrane called a dialyzer to filter blood; the treatment is usually provided in a hospital or dialysis center. The machine is also called an artificial kidney. An access site used to remove unfiltered blood and return filtered blood. Types of access sites are an arteriovenous (AV) fistula or graft usually located in the forearm or a central venous catheter located in the neck or groin region. During the process, waste products from the blood diffuse across the filtration membrane into the dialysis solution. The filtered blood is returned to the body. 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 3 times a week..

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Peritoneal dialysis uses a filtering membrane located in the abdomen called the peritoneum to filter blood; the treatment is usually administered at home. Two types of peritoneal dialysis, continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). Compared with hemodialysis, peritoneal dialysis requires more time and is done daily. Peritoneal dialysis can be administered while the person is asleep or ambulatory, depending on the type of dialysis prescribed. A flexible catheter is implanted through the abdomen and into the peritoneal cavity and serves as the entry and exit site for the dialysis solution.

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During CAPD, the dialysis solution enters and exits the peritoneum by gravity, whereas with APD uses a machine to assist with the transfers. The process of filling and draining the peritoneum is called an exchange and takes approximately 30 to 40 minutes. The main difference between the two types of peritoneal dialysis is CAPD is done during the day with multiple exchanges, whereas APD, the majority of exchanges are done at night with the assistance of a machine. A typical CAPD schedule calls for 4 exchanges a day, each with a dwell time of 4 to 6 hours. With APD, there is an extended dwell time during the day, and multiple exchanges occur at night.

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Massage and Dialysis – Massage can be given, with massage modifications made according the type of dialysis the client is receiving. Consider incorporating aromatherapy, hot stone massage, foot massage, or foot reflexology into the session to improve treatment outcomes.

In cases of hemodialysis, avoid the arm with the fistula. In cases of peritoneal dialysis, avoid the site containing the dialysis catheter, which is usually located in the abdomen. Infection at the access site is a major concern; the massage practitioner is advised to observe the area, monitoring it for signs and symptoms of local infection (swelling, heat, redness pain) with referral made to the client’s healthcare provider when noted.

Clients with an abdominal catheter can receive a massage with a few positional modifications. To reduce pressure on the catheter while the client is prone, place a pillow across the abdomen above the catheter and another pillow below the catheter. A soft crescent-shaped face rest cushion can be used as catheter support. If these prone positional modifications are uncomfortable for the client, use a side-lying position.

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 between dialysis treatments, and other clients may feel tired before or immediately after a dialysis treatment.

Because of the likelihood of orthostatic hypotension, ask the client to arise from the massage table in three stages. (1) Sit up on the table for 1 minute. (2) Sit on the side of the table with legs dangling for 1 minute. (3) Stand with care, holding onto the edge of the table or other non-movable object for 1 minute. Because of increased thirst, offer drinking water before and after the session.

research iconResearch. A 10-minute aromatherapy massage applied to the face during hemodialysis significantly decreased headache severity among patients who suffered from headaches during hemodialysis (Biçer et al, 2015). Sesame oil (48 cc) blended with lavender and rosemary essential oils (1cc each) was used to administer the facial massage. A 20-minute massage to the lower extremities during hemodialysis administered 3 times weekly for 2 weeks decreased leg cramp frequency (Mastnardo et al, 2016). A 20-minute back massage using hot stone administered thrice weekly for 4 weeks enhanced sleep quality in patients on maintenance hemodialysis (Ghavami et al, 2019). Massaging the non-fistulated hand for 7 minutes using 3- to 5-mL of lavender, mint, and tea tree oils at 5% concentration relieved itching (pruritus) in hemodialysis patients who had pruritus scores above a 3. Six sessions were administered over 2 weeks (Shahgholian et al, 2010).

Hemodialysis patients who received a 30-minute foot reflexology session 3 times in 1 week experienced reduced fatigue, pain, and cramping (Ozdemir et al, 2013). A 10-minute foot massage given during dialysis 3 times a week for 4 weeks improved sleep quality and increased sleep duration in patients undergoing hemodialysis. Sleep status improved each week compared with the previous week (Malekshahi et al, 2018). Hemodialysis patients who received foot reflexology and back massage twice weekly for 4 weeks noted improved sleep quality and reduced fatigue, but foot reflexology was more effective compared with back massage (Unal & Balci Akpinar, 2016). Similar results were found in a later study regarding the outcome of fatigue—foot reflexology was found more effective compared with back massage; sessions were given twice a week for 3 weeks (Ahmadidarrehsima et al, 2018). Foot reflexology significantly lowered nausea in hemodialysis patients. The sessions began 1 hour after the onset of hemodialysis, lasted 30-minutes, and were administered daily for 12 days (Naseri-Salahshour et al, 2019).

Twelve minutes of acupressure administered 3 days a week for 4 weeks decreased fatigue and depression in hemodialysis patients (Cho & Tsay, 2004). Twenty minutes of acupressure applied during the first 2 hours of dialysis given 3 days a week for 4 weeks decreased fatigue in hemodialysis patients (Sabouhi et al, 2013).

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References:

Ahmadidarrehsima, S., Mohammadpourhodki, R., Ebrahimi, H., Keramati, M., Dianatinasab, M. (2018). Effect of foot reflexology and slow stroke back massage on the severity of fatigue in patients undergoing hemodialysis: a semi-experimental study. J Complement Integr Med, 15(4).

Biçer, S., Ünsal, A., Demir, G. (2015). The effect of aromatherapy massage applied to facial area upon headache severity among patients who suffered from headache during hemodialysis. International Journal of Caring Sciences, 8(3).

Cho, Y.C., Tsay, S.L. (2004). The effect of acupressure with massage on fatigue and depression in patients with end-stage renal disease. J Nurs Res, 12(1), 51-59.

Ghavami, H., Shamsi, S.A., Abdollahpoor, B., Radfar, M., Khalkhali, H.R. (2019). Impact of hot stone massage therapy on sleep quality in patients on maintenance hemodialysis: A randomized controlled trial. J Res Med Sci, 24, 71.

Malekshahi, F., Aryamanesh, F., Fallahi, S. (2018). The effects of massage therapy on sleep quality of patients with end-stage renal disease undergoing hemodialysis. Sleep and Hypnosis: A Journal of Clinical Neuroscience and Psychopathology, 20(2), 91-95.

Mastnardo, D., Lewis, J.M., Hall, K., Sullivan, C.M., Cain, K., Theurer, J., Huml, A., Sehgal, A.R. (2016). Intradialytic massage for leg cramps among hemodialysis patients: a pilot randomized controlled trial. Int J Ther Massage Bodywork, 9(2), 3-8.

Naseri-Salahshour, V., Sajadib, M., Abedic, A., Fournier, A., Saeidi, N. (2019). Reflexology as an adjunctive nursing intervention for management of nausea in hemodialysis patients: A randomized clinical trial. Complement Ther Clin Pract, 36, 29-33.

Ozdemir, G., Ovayolu, N., Ovayolu, O. (2013). The effect of reflexology applied on haemodialysis patients with fatigue, pain and cramps. Int J Nurs Pract, 19(3), 265-273.

Sabouhi, F., Kalani, L., Valiani, M., Mortazavi, M., Bemanian, M. (2013). Effect of acupressure on fatigue in patients on hemodialysis. Iran J Nurs Midwifery Res, 8(6), 429-434.

Shahgholian, N., Dehghan, M., Mortazavi, M., Gholami, F., Valiani, M. (2010). Effect of aromatherapy on pruritus relief in hemodialysis patients. Iran J Nurs Midwifery Res, 15(4), 240-244.

Unal, K.S., Balci Akpinar, R. (2016). The effect of foot reflexology and back massage on hemodialysis patients’ fatigue and sleep quality. Complement Ther Clin Pract, 24, 139-44.

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Dr. Susan Salvo is a massage practitioner, author, educator, researcher, explorer, and perpetual student. To learn more about Susan, check out the “About Susan” tab. You can contact Susan at susansalvo@hotmail.com.