Dialysis on children

Kidney failure is a condition that not only affects adults but children, teenagers and babies as well. Since they are so young to suffer the struggles dialysis have, they are in most of the cases candidates to get a kidney transplant. Nevertheless, the decision of a kidney transplant is made only when they kidneys fail completely. Until that moment, dialysis is the treatment option.

Fusco Foundation Donation_Dialysis on children_joe cosgrove

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The challenges of kidney failure for children include physical effects from the loss of kidney function and emotional effects due to their illness. Physical effects of kidney failure can include

  • extreme fatigue
  • weak bones
  • nerve damage
  • sleep problems
  • growth failure

There are two dialysis options for children:

Peritoneal Dialysis is usually the treatment of choice for children. It is gentle and can be done overnight, using the cycler machine (APD). This dialysis is done every day and while children are not doing the dialysis, they can play, go to school, spend time with their friends. There is only one restriction for them, swimming. But, food does not have any restrictions for them: It means, they can enjoy of regular activities children do.

This dialysis will eliminate the most common symptoms of kidney disease such as feeling struggle and tired to do lots of fun activities in the day. The machine cycler or APD (Automated Peritoneal Dialysis) is used while children sleep. The fluid go in and out around 5 or 6 times. Hence, the machine is sit next to their bed at night. Usually, doctors give them a medicine for them to sleep.

A catheter (tube) is required for the dialysis. The catheter is put into the tummy in a special space called peritoneum. Catheters always have a little dressing to keep them clean and stays in place every day. Once the dialysis starts, the catheter is attached to a special bag of dialysis and a drain bag. So, the old fluid come in the drain bag and the new fluid is put in. After new fluids are put in, all the bags are disconnected. It takes around half an hour to complete the whole process so children will not feel they cannot do what other children do.

The second dialysis option for children is Haemodialysis.

Dialysis Machine_Dialysis on children_joe cosgrove

Image courtesy of Amber Case at Flickr.com

Haemodialysis is used less often for children, but it is an effective treatment. Usually it is centre based rather than home. Contrary of the Peritoneal Dialysis that is done at home, Haemodialysis is done at the hospital although older kids can go on home haemodialysis. This dialysis must be done three times a week during the whole morning or the afternoon. Nevertheless, this dialysis does not affect children’s activities. They can play, run, got to school. And, when they are on dialysis, they can read, play with toys, watch TV or movies, do school work or listen to music. In this dialysis, the nurses put a special needle in the dialysis access, usually the arm, using a special cream eliminating any hurting sensation. Then, the needle come out after the dialysis finishes.

However, this dialysis does requires parents to be more attentive and careful with their children’s diet. For instance, protein is very important. It is also recommended to limit sugary foods, fizzy soft drinks, food that are high in bad fats. Also, increasing the fruit, vegetables food intake will make kidneys effort less. Talking about fluids, the right amount of it is prescribed by the kidney specialist since it depends on the kidneys failure.

However parents or guardians are the most important members of a child’s team, children need a more complete team of  skilled professionals who can make things easier during the process: Those professionals are the following:

  • pediatrician
  • nephrologist
  • dialysis nurse
  • transplant coordinator
  • transplant surgeon
  • social worker
  • mental health professional
  • dietitian

Pediatrician

A pediatrician is the doctor who treats children and is likely to be the first to recognize a kidney problem—either during a routine physical exam or during a sick visit.

Nephrologist

A neurologist or pediatric neurologist if possible, is a doctor who treats kidney diseases and kidney failure.

Dialysis Nurse

If the child needs dialysis, a nurse with special training will make sure all procedures are followed carefully.

Transplant Coordinator

When preparing for a transplant, children and their families work with a coordinator at a transplant center, who serves as their main contact.

Transplant Surgeon

The transplant surgeon performs the kidney transplant and monitors a child’s health before the surgery and after the surgery.

Social Worker

Every dialysis clinic and transplant center has a social worker who can help families locate services such as transportation and family counseling.

Mental Health Professional

A mental health professional, such as a psychologist, can help children with CKD find useful ways to deal with the emotional turmoil caused by having a chronic illness.

Dietitian

Proper nutrition is extremely important for children with CKD. Every dialysis clinic has a dietitian to help people understand how the food they eat affects their health.

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A brief history on the origins and evolution of hemodialysis

A bit of context

Hemodialysis is the most common treatment for kidney failure. It is done by circulating the blood through a semipermeable membrane to remove waste from the blood, thereby supplanting the function of the kidneys. Although in theory this is an easy process, in practice it is not so easy to create a hemodialysis machine. Proof of this is that the history of hemodialysis has only two hundred years. We’ll take a look at the most important milestones of its history in this post.

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On the origins and early history of hemodialysis

Thomas Graham, a Scottish chemist and Fellow of the Royal Society of England, is considered by many as the father of dialysis. Graham laid the foundations of colloid chemistry demonstrating, among other things, that the vegetable parchment acted as a semipermeable membrane. He tightened this parchment on a cylindrical wooden frame and placed it in a bowl of water. After pouring on the parchment a liquid that contained crystalloids and colloids, he found that, over time, only crystalloids passed through the parchment.

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In another experiment, he showed that the crystalloids in urine passed through a semipermeable membrane into the water, which left a residue of urea crystals once it evaporated. Graham gave this phenomenon the name of “dialysis” (from the Greek “dià”, meaning “through”; and “lỳsis”, meaning “splitting” or “loosening”). However the experiments conducted by Graham had no practical clinical application until half a century later.

In 1913, the American pharmacologist and biochemist John Abel and his colleagues performed the first dialysis in animals, and described a series of experiments with a primitive device which they called artificial kidney. But it was the German medical doctor Georg Haas who, based on the ideas of Abel, practiced in 1926 the first dialysis in a human being. The dialysis lasted 35 minutes, and, except for a febrile reaction, the patient managed to tolerate the procedure. Subsequently, Haas would perform another two dialysis sessions, with two uremic patients using the newly discovered heparin.

It is in the 1940s, with the advent of Willem Kolff’s rotating-drum kidney and the techniques developed by Gordon Murray when hemodialysis becomes an accepted procedure for clinical application. However, at first, it was not a widespread practice because of the many technical problems it had, mainly the lack of effective anticoagulation, the appearance of numerous infections and the fact of not having an efficient, stable vascular access that would allow the execution of hemodialysis as yet another substitute treatment.

The late twentieth century

In 1955, hemodialysis had already been implemented in a few hospitals, but only in exceptional cases, since many considered it a laborious, expensive and dangerous experimental procedure. However, the successful usage of this technique in many cases of acute renal failure prompted a new impetus for its development.

The application of hemodialysis in patients with chronic renal failure had to wait until 1960. That year, Belding Hibbard Scribner used the first external bypass, built with thin-walled Teflon. The Scribner bypass was a U-shaped cannula that connected the vessels at the wrist (radial artery and cephalic vein or ulnar artery and basilic vein) through an external, synthetic bridge (external arteriovenous fistula) permanently installed, so that the artificial kidney could be connected as often as necessary. The bypass was designed so that, when not in use, the cannula served as an extension of the circulatory system: the U-shaped section drove the artery blood back into the vein. When the dialysis was done, the U-shaped portion could be disconnected and the artery and vein connected to the artificial kidney. The bypass could be used immediately and did not require puncturing the vessels, since the disconnection from the bridge allowed the extraction of blood from the arterial branch, which after passing through the dialyzer, once purified, returned by the venous branch to the patient.

Manual of Medical Information - Dialysis_medical_joe cosgrove

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The appearance of Scribner’s bypass allowed repeated access to the bloodstream and the birth of the first regular hemodialysis program, which was created in Seattle in 1961, in the hospital of the University of Washington. A procedure to replace the kidney’s purifying function had finally been standardized, thus preventing the deaths of patients with chronic renal failure and, in a matter of years, many hemodialysis units were created.

However, the problem of finding a suitable vascular access was not completely solved, since the Scribner’s bypass limited the patient’s movements, required a meticulous cleaning and would often lead to infections and thrombosis. These problems were solved in 1966, when Cimino and Brescia describe the arteriovenous fistula (AVF), which allows for an adequate blood flow, has low incidence of infectious and thrombotic processes and is well tolerated by the patient.

How to understand and support dialysis patients

One of the scariest news a patient can receive is having a kidney disease or a kidney failure.  In spite of being surrounded by many people willing to help, these patients tend to feel lonely and overwhelmed when they have to face the news and the treatment proposed by doctors.  Even when some of them receive an optimistic diagnose for their condition and feel grateful about it, they cannot avoid worrying about how their lives will change from that moment on and the impact it would have on their core family members.  

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Image courtesy of Karol Franks at Flickr.com

As a companion you may feel in a similar way.  It is very difficult to know how to react when you do not know what to expect.  It is a good idea to try to understand what your loved one is experiencing by learning about kidney disease and its treatment.  You could either read about it or talk to an expert as this will help you honestly address fears and concerns you and your loved one may have.

What does the patient with kidney disease feel?

For many people, having a renal disease is like having the flu all the time, especially when it becomes worse.  Your loved one may:

  • Feel tired and weak to climb steps and walk around the block.  These activities can become very difficult for him or her.
    • feel cold all the time as if he or she had fever.
    • have trouble concentrating and can easily forget things.
    • sleep longer than considered normal.

You may think that these patients always feel this way, but these symptoms are usually due to anemia, low red blood cells, and that can be treated.  

  • Your loved one may also have some parts of his or her body swollen, like feet and ankles and / or hands and face.  Sometimes he or she cannot even put on their shoes.  This is due to the fact that when kidneys are failing, the body does not remove the excess of waste and fluid.  
  • The extra fluid in the lungs can make breathing difficult, which has been sometimes confused with asthma or pneumonia.  
  • Having plenty of fluids can strain the heart especially in people whose heart is already weakened by congestive kidney failure or other problems.

Undoubtedly, each patient is different; some people have some or most of the symptoms listed above while others insist that they feel good and their kidney disease has to be detected only through blood tests.  So, the best way to really know how your loved one feels is by asking him or her.

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Image courtesy of Karol Franks at Flickr.com

What are the emotional implications of kidney disease?

Most people who discover they have kidney failure and dialysis should be done are afraid of the whole situation at the beginning.  Besides feeling this way, it is also common to feel anger and / or guilt, as well as depression, which is also very common in any chronic disease.  This is part of grieving that they have lost their healthy nature and a “normal” life.  Of course, family, friends and close people around them may be affected, too. Searching for guidance with your doctor or health professionals can help you and your loved one see things more positively.  Remember to clarify with the doctor what your loved one can and cannot do now that the dialysis is being performed.  You may be surprised to know that your loved one will be able to continue to do most activities he or she did before undergoing this treatment.

It will be very helpful for your loved one and you speaking honestly about your feelings.  Doing it frequently has better cathartic effects as, in doing so, negative thoughts and feelings will remain under control and will give both of you more energy to focus on what really is important to your relationship.  Additionally, being able to communicate freely with each other will also help other family members, especially children, to share feelings and to ask questions.

How can you help your loved one to keep independent?

It is very common to see that when someone loved has a short-term disease, others “make charge” of the situation until there is improvement.  However, when people have a chronic illness, they need to learn how to live with it and do everything themselves, at least almost all they could do before.  It is understandable to have the desire to help, but it is important to be careful not to be preventing your loved one from doing things that he or she is still able to do.  It is better to encourage and expect your loved one to contribute to their treatment and daily activities in any way he or she can as it has a great impact on self-esteem.