How dialysis works in developing countries

Currently, we are facing a situation where many people in the world are suffering from kidney-related diseases. In fact, according to the National Kidney Foundation, at least 10% of the global population suffers from chronic kidney disease, and at least two million people receive dialysis treatment nowadays. Sadly, most of the patients who actually have access to dialysis treatment are those who live in developed countries. Those who live in developing countries not always have access to the treatment, and when they do it is often unsatisfying.

It is not a secret that for those patients who have end stage renal disease or ESRD, dialysis becomes the only alternative to survive before actually thinking about getting a kidney transplant. However, if you are living in a developing country and don’t have the resources to pay for private treatment, your chances of being properly treated can run really low.

intensive-care area of the El Fasher Hospital_developing countries

Image courtesy of UNAMID at Flickr.com

Poverty, ignorance and the lack of medical resources are some of the most common elements that affect the possibilities patients have to access dialysis. Even sometimes, when patients have the chance to pay for a better treatment, this is not available in their region and there is little or nothing they can do about it once they are sick.

So, why all this happens? In this article, we will explore the main factors related to the way dialysis treatment takes place in developing countries. All this keeping in mind that many of the patients who need dialysis in these countries actually don’t know about it. This happens either because they cannot afford to go to the doctor, their healthcare systems are also poor, their records are not properly kept, or simply because they lack the will or intention to go to the doctor under these unpleasant circumstances.

Let’s take a look to some of the most important issues that affect the way patients who need dialysis treatment are actually treated in developing countries.

High costs

This is the most obvious and common factor related to many things that don’t operate properly in developing countries. When it comes to treating ESRD patients, healthcare providers face a critical situation because their ethics tells them they should treat the patients properly. However, the financial capacity keeps them away from actually doing so.

Setting and running a dialysis unit is rather expensive. Even though every country in the world has patients with kidney disease among its population, not many institutions have the needed resources to start a dialysis unit. Besides, when these dialysis units are actually set, they will need to keep on growing and being properly maintained. This also implies expenses related to the unit’s operation that many institutions can’t afford.

Machine problems

Let’s say that the dialysis unit was created. All the machines in it will need to be properly taken care of in order for it to be sustainable. Most times, the machines that are kept in good shape remain in the cities, where technicians and medical equipment companies are located at. This leaves the poorest areas of developing countries aside. Therefore, people who live in the areas (which also happen to be the poorest) has little or no chances to access the dialysis services.

Another problem related to dialysis machines is that they are not always enough to treat all the patients. In addition, the available machines are not often functioning and present multiple problems like breakdowns, missing parts, or obsolete systems. All this is being considered also keeping in mind that in some low-income areas power can also be off.

Staff problems

Problems related to machines are not the only ones to come. We also need to keep in mind that in order to use one of these dialysis machines, we need to count on the help of a prepared staff member, who knows how to use the machine.

Military Hospital_health_medicine

Image courtesy of US Army Africa at Flickr.com

Here we face bigger problems because sometimes there are not properly educated individuals who know how to operate the dialysis machines and when there are, wages are usually not enough for them to make a living out of it.

All this crisis happens because many of the dialysis units depend on the state. Public hospitals and public health care facilities are often poorly financed in developing countries, which makes it hard for the ideal staff to work at these places and operate dialysis units. As a consequence of this, many units need to close because they don’t have the required staff to work at them, and once they are restructured, they can be opened again.

It is important to keep in mind, that matter how poor a country is, the motivation of people to work is usually directly related to the amount of money that is being paid to them. If there are no resources to cover up for the staff expenses, then there won’t be enough or well-prepared people to work at dialysis units.

Related: The Most Common Questions Patients Have About Dialysis by Joe Cosgrove

* Featured Image courtesy of Albert González Farran, UNAMID at Flickr.com

The Most Common Questions Patients Have About Dialysis

The kidneys are vital organs in the human body. Their functions are those of secreting hormones, cleaning your blood, absorbing minerals and producing urine among others. They are absolutely necessary to maintain the body’s toxin levels at normal levels, they help regulate blood pressure and even stimulate the production of red blood cells.

renal-dialysis-technician

Image courtesy of wistechcolleges at Flickr.com

As you can probably guess, the kidneys have a lot of responsibility and are organs that work under constant stress. It is expected that when organs such as these stop working like they are supposed to, the consequences are dire, as the body loses its ability to regulate the toxins that are normally cleansed by the kidneys and you begin to feel sick.

Kidney disease is the term utilized to refer to the condition by which the functions of kidneys are reduced in their efficiency or in some cases completely impaired. In cases like this, there are but a few options available for a patient to stay alive. One would be a kidney transplant, and the other would be to receive dialysis treatment. Dialysis is a treatment by which advanced machinery is used to help cover the slack left by kidneys unable to perform their functions and thus remove excess toxins from the patient’s body.

Today in Joe Cosgrove’s blog, we want to talk about some of the most common questions and concerns raised by new patients to dialysis treatment, and by the family members who want to support them during their process.

What are the different types of dialysis?

There are three primary types of dialysis. Hemodialysis and hemofiltration work similarly because they are both concerned with the cleansing of the blood directly. Blood is removed and cleaned in a machine before being pumped back into the body. The difference between both of these methods is that one uses a dialyzer solution while the other uses pressure to separate substances through a permeable membrane.

The third type of dialysis is called peritoneal dialysis and is less efficient than the former methods. In peritoneal dialysis, the blood is not directly but indirectly cleansed by pumping dialyzer into the patient’s abdomen and then removing it after the waste material has transferred to the fluid. The process is repeated several times per session.

How does dialysis work?

Dialysis is a treatment that simulates the process done by the kidneys when they are healthy by removing excess toxins from the blood and keeps the body in balance. A machine is used to extract the blood of the patient (in the case of hemodialysis) and clean it before injecting it back in. Minor surgery is necessary to create a vascular access. Vascular access is a place where the needles and tubes can be easily connected every time the patient needs to undergo the procedure. An access can be created by joining an artery and a vein together into a blood vessel called a fistula or by placing a narrow plastic tube in a large vein near the chest or neck.

In peritoneal dialysis, the blood is actually cleaned inside the body. The doctor places a catheter in the patient’s abdomen so the peritoneal cavity can be filled with fluid and thus excess toxins from the blood can be extracted from blood vessels in the abdomen that come in contact with the dialyzer that is later removed.

hands-walking-stick-elderly-old-person

Image courtesy of Pixabay at Pexels.com

Is it possible to travel?

Traveling is absolutely possible, but it requires a bit more planning that you may be used to. Dialysis can be done by the patient him or herself while traveling with no real risk. There are also many centers around the country and even worldwide that can accommodate your needs while traveling and give you all the care you need. It is imperative to plan properly and to have everything planned well in advance so you can receive the treatment you need.

Does my diet have to change?

The food you eat will depend on many factors like your current health, the stage of your particular kidney disease and the recommendations of your doctor depending on their evaluation of your specific situation. Salt, in general, is to be avoided in large quantities; the same goes for foods that contain too much phosphorus. Anything that can affect your blood pressure has to be eaten in moderation, and it is recommended to eat fewer proteins than usual, especially if you eat lots of meats and animal products.

How often do I have to undergo the treatment?

The frequency of dialysis sessions you require depends mainly on the current state of your kidneys. Some patients with a more advanced condition may require more sessions than someone whose kidneys are still performing partially. Normally, hemodialysis takes places about 3 times a week while visiting the clinic and peritoneal dialysis is usually done at home, several times during the day. As we have mentioned before, one method is more effective than the other, and that is why it requires fewer sessions.

 

Risks you need to face when starting dialysis treatment

Sometimes, when the kidneys stop working properly, patients need to go under dialysis treatment. Even though this treatment is supposed to improve their life quality, there are some risks related to it that they need to acknowledged by patients before actually starting it.

It is important to notice that not all risks are associated with all patients. These risks tend to increase when patients are older or have suffered other diseases (like cardiovascular diseases) before starting dialysis treatment. In this sense, knowing the associated risks becomes literally vital for patients to decide if they want to take the dialysis treatment or not.

medic-hospital-laboratory-medical-dialysis treatment

Image courtesy of Pixabay at Pexels.com

In this article, Joe Cosgrove will share some of the most remarkable risks that can take place when starting dialysis treatment. It doesn’t matter if you are going to dialysis treatment for a long time or for a short period of time, patients need to know what may happen and how to deal with it.

Starting dialysis

Initiating dialysis may be challenging for some patients. Studies show that the first 6 to 12 months of dialysis treatment can be decisive since the highest mortality rates take place during this period of time. This means that patients who are going under dialysis treatment and manage it to survive after the first year, have more chances of improving their life quality without actually suffering many side effects and after all surviving.

The dialysis preparation period in itself brings numerous risks with it. Infections can affect the dialysis incision, patients may present a drop in its blood pressure, and if patients are not properly taken care of by health specialist, they have a low rate of mortality even during the preparation period.

Dialysis Access and Infections

When starting dialysis one of the things that usually affects patients is the possibility of getting an infection related to the dialysis access. Patients who have a uremic immune- incompetence tend and patients who are getting a vascular access due to hemodialysis, are prone to develop infections.

Most of the times, these infections are related to the access that needs to take place in order to position a catheter. These infections occur when skin organisms migrate along the catheter and place themselves into the bloodstream. The migration of skin cells is one of the main causes of infection because tend to contaminate the catheter.

Another risk that patients need to deal with is the formation of a biofilm, made of a combination of bacterial and host molecules that place themselves on the surface of the catheter. When this happens, it is really hard for the body and antibiotics to fight bacteria.

Patients who start dialysis treatment are more prone to develop resistance to some bacteria than those who are not going under treatment. Another factor that makes it riskier for them is to have to go under treatment at a hospital because many bacteria and living organisms can be found in the hospital facilities.

hospital_kidney_pain

Image courtesy of Eric Lewis at Flickr.com

Other Related Risks

During the first 6 months of dialysis treatment, patients need to endure other risks, some of them are related to physiological issues, and others are related to the change in appetite or blood pressure changes.

Some of the most common emotional side effects that patients need to deal with during the first 6 months are anxiety, depression, and reduction in appetite. When the last side effect takes place, patients can suffer a lot, because their dietary habits change dramatically to an extent they tend to lose weight and suffer from malnutrition.

On the other hand, in some cases, patients who are not prepared to start dialysis may suffer from exhaustion, due to the new routine they need to face. Most of the times patients start by going to at least three dialysis sessions in a week, which means they need to travel to the healthcare facility and endure several hours of treatment. This can be harmful to the body and physically exhausting.

Another important thing that patients need to keep in mind when starting dialysis is that their diet will need to change. This conditions, mixed with the change in schedules and the treatment in itself can cause other side effects and risk conditions, such as dizziness, blood pressure drops, itching, body pain, and constant exhaustion.

In this circumstances, feeling depressed is quite common, as well as developing other psychological problems that may get worse if the dialysis treatment also gets worse. The reason to this is that dialysis treatment can also affect the social life of patients since it is rather a time consuming and can create psychological stress because of that.

Last, but not least, another related risk to starting dialysis treatment is to develop cardiovascular diseases related to changes in the blood pressure due to the removal of blood and fluids from the body. Some important cardiac diseases can take place, and that is why many patients need to be closely monitored by healthcare specialists all the time.