What is it like to live with dialysis?

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In the United States at least 217,000 patients need to live with dialysis. This represents national costs for over $11 billion dollars every year. This procedure needs to take place when the kidneys are unable to filter fluids and their full capacity is lost. Sometimes, patients who need to live with dialysis have to do so because they were born with a kidney condition and they cannot afford a kidney transplant.

Statistically speaking, this is a dramatic situation for thousands of people in the United States. However, most patients seem to believe that dialysis is not such a terrible thing and they have adapted to a “new normal life”. But, what does it means to live with dialysis? In this article, Joe Cosgrove will share some details related to the way patients learn to have regular lives while they depend on dialysis to survive.

The Experience

First of all, when a patient decides that it is time to go under dialysis treatment it is because its kidneys are not able to do their job. This means that dialysis becomes the only alternative to survive. Keeping this in mind makes it easier and more motivating to people who need to go under treatment.

During a regular dialysis routine, the patient needs to come to the dialysis clinic and meet the nurse at the counter. Papers and forms will be filled out and a short checkup will take place. Since most patients have done this a thousand times, the process usually doesn’t take long.

After the checkup, the patient settles into one of the comfortable recliners inside the room where the process usually takes place. The patient may be the only one in the room or not, depending on the day and time it decides to go and get the treatment.

After settling, the patient will need to prop its left arm, allowing the technician to slip a couple needles into its blood vessels (close to the wrist). One of the needles is in charge of removing the blood and the other one is in charge of taking it back to the body. These needles are attached to plastic tubes that at the same time are connected to the dialysis machine.

For the next three hours, the needles will do their job and the patient’s blood will be filtered. All this is possible thanks to the dialysis machine that stands still next to the patient’s recliner. Most patients bring a book or spend this time watching a movie or a TV show on Netflix. Sometimes, this is even the perfect moment to take a nap.

Besides from the initial moment of the procedure, when the needles need to be stuck on your veins, the dialysis process doesn’t hurt. Sometimes patients may feel dazed and their blood pressure can drop. But, other than that, the process takes place in a comfortable way.

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Living with dialysis is supposed to make things easier for patients with End Stage Renal Disease (ESRD). However, the mortality rates in the United States remain to be considerably high compared to those in Japan or Europe since many patients choose to skip the procedure or don’t accept it to last for too many hours.

Related: How To Make The Most Out Of Your Time On Dialysis

How Dialysis Works

The best way to describe the dialysis process is as an artificial kidney. This means that dialysis should be able to do what your kidneys cannot do anymore. There are two different forms of dialysis: hemodialysis and peritoneal dialysis. At least 90% of the patients in the United States who live with dialysis choose to go under the hemodialysis treatment. This is the procedure that was described in the experience above.

When patients live with hemodialysis, their blood needs to be circulated outside of the body with the help of a hemodialysis device. This device cleanses the blood and then returns it back to the body of the patient.

Not everyone is a right candidate to get hemodialysis. This is why every patient needs to have the doctor’s approval before having an entrance or access (a minor surgery on the leg, arm or neck to access the blood vessels). This access is called fistula and the patient will need to keep it clean and usable for as long as it needs to go under dialysis treatment.

The fistula is something dialysis patients need to learn how to live with since it is the only way doctors have to access the blood in a fast and effective way. Fistulas are joints between arteries and veins located under the skin that form a larger vessel where needles are inserted.

When patients don’t need to live with dialysis and only go under a temporary treatment, they can get a catheter on their neck and there is no need for them to go under this minor surgery. In the case of the fistula, the wound needs to heal before the dialysis treatment takes place. However, in case patients use a catheter, they can go under the dialysis treatment right away and the procedure is slightly different.

Everything You Need to Know About Pediatric Dialysis

As Joe Cosgrove has already pointed out in previous articles, having kidney disease means that your kidneys are not properly working and are not able to filter blood anymore like they should. When this condition gets worst it is known as end-stage renal disease or ESRD and needs to be treated with dialysis.

Pediatric Emergency Department

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Most people think that ESRD only affects adults since their bodies are more deteriorated. However, ESRD also affects children. At least 1,462 children in the United States need to start dialysis treatment every year. Most of these children have congenital disorders (33%), have damaged kidneys due to glomerular disease (24,6%), or need to go on dialysis because they have glomerulonephritis (12,9%).

When we talk about adults, the most common causes of kidney failure are related to high blood pressure or diabetes. Nevertheless, when we talk about children, kidney disease is rarely related to those two conditions and it is often caused as a side effect of other treatments or because they have a hereditary condition that may affect their urinary tract.

Treating Children with ESRD in the United States

Every year over 10,000 children is treated for ESRD in the United States. Most of these children use hemodialysis as it is less invasive and easier to adapt to their bodies. This is how, every year 56 percent of these children are treated with hemodialysis and the rest just go under peritoneal dialysis, have kidney transplants or take alternative treatments.

At least 1,300 children are listed for kidney transplant every year. Over the past 20 years, this number seems to have grown dramatically since kidney diseases have become more popular among the U.S. population.

This is how treatments and medical procedures for children have also evolved. Technology has done major improvements and filtering membranes and catheters are now meant to be used in children, so their size is smaller, sometimes they are more resistant and flexible.

At first, there were many side effects related to hemodialysis in children. However, this seems to have been controlled over the past two decades. Now the morbidity rates during dialysis have considerably decreased and it is less common to experience seizures as a side effect during the treatment. The already mentioned medical advances have made it easier for children to deal with such an invasive procedure, so hypotensive episodes are quite uncommon nowadays.

A sensitive treatment

Saddest Pediatric Patient

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Two decades ago it was common for a dialysis patient to say that it was feeling pain or discomfort during the treatment. Keeping in mind that children’s bodies are more sensitive and fragile, dialysis procedures are less painful and discomforting today. The catheters used during the entire dialysis process are internal, making it impossible for children to remove it without helps. Besides, anesthetic creams are used to puncture the patient.

More sensitive and less invasive technologies have also been developed in order to reduce dramatic effects such as morbidity. These technologies can also reduce healthcare costs, making it simpler for the health care providers too.

Synthetic materials used in children are biocompatible and have a smaller size. This way, tubing and other processes related to pediatric dialysis are easier on the infant’s body. Diameter and length of tubes have been reduced so they can fit the patient’s veins. This way, the volume of filtered blood is going to be adequate both for having a successful a treatment and taking care of the child’s needs.

Machines used in pediatric dialysis are also special ones, so blood pumping is normal compared to the one that happens during the treatment adults get. Most dialysis machines used with children are designed to meet their needs and be used with pediatric patients.

The speed used when the blood is pumped in children is slower than in adults and needs to be kept that way since the capacity of patients to output blood is different and veins could be cloaked. For this reason, children need to be monitored during the entire dialysis session. Machines are always designed in a way that it is easier for healthcare providers to be in control of the dialysis process during the entire time.

Related: Is dialysis always recommendable?

Hemodialysis

Since children with ESRD will need to be exposed to dialysis for a long period, hemodialysis needs to be seen as a whole and not as a mere step of kidney disease therapy. Dialysis in children should be seen as a temporary thing. This happens because if the patient is feeling better then it will stop the treatment and if things complicate and the kidneys completely fail, then the pediatric patient will need to get a kidney transplant.

When patients have the chance to heal, then hemodialysis enables the chances for patients to improve their condition, while they can keep having a normal life. This treatment can often affect children’s physiologically when it is done in the long term, so it is recommended to give some kind of support to children while they are going through dialysis treatment.

Some significant concepts about the Renal Compensation

As we have seen in different posts, the renal function is vital for human’s living. Through this process, the human body can filter the toxins and different substances from the blood, which cleans it and gives to people what they need to have a good quality living. If the renal system does not work adequately, a renal failure may occur. This problem could be defined in a few words like the impossibility for the body to process the different substances from the blood. A renal failure could be acute or chronic. Let’s see some of the most imperative concepts about this topic and some of its elements.

Acute renal failure

This renal failure is when the human body loses an important blood amount, or if for some reason a particular person ingests a toxic substance, causing the kidneys to fail and eventually to generate renal failures. In other words, an acute renal affectation could be generated by different external situations that change the normal functioning of the human body.

Chronic renal failure

This affectation is generated for some diseases or healthy hereditary problems, causing failures in the renal system. In some occasions, these issues are incurable and may require constant medical intervention, like dialysis or surgeries.

These two concepts are vital to understanding what the Renal Compensation is because they explain in a few words how the renal system works and which are its affectations. Having this clear, we can talk about other important concepts like the respiratory compensation, the respiratory acidosis, the respiratory alkalosis or the Glomerular Filtration Rate. However, it is important to understand firstly what the Renal Compensation is.

Renal Dialysis Technician

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The Renal Compensation concept

It could be defined as the process where the kidneys can regulate the acidity in the plasma, that is to say, that through the Renal Compensation, the human body can establish and control the pH in the blood.

When the plasma pH differs from 7.4, the body could suffer acidemia or alkalemia. Acidemia is when the blood acidity is lesser than 7.4, which means lack of acids which must be in the blood. Alkalemia occurs when the plasma pH is higher than 7.4 and means an excess of acid substances in the blood. When some of these problems occur, the human body can suffer respiratory or metabolic problems, and they could happen if there is a lack of Renal Compensation.

The Glomerular Filtration Rate

This concept refers to the filtered fluid volume in time by the human body, from the renal system to the Bowman capsule, which is part of the renal functioning where all the body substances to be excreted are filtered. Through this rate, the correct working of the renal system is measured, in other words, the Glomerular Filtration Rate is used for knowing if the kidneys and other elements from the renal circuit are operating in an adequate way.

Usually, the Glomerular Filtration Rate is measured through different techniques. Some of the most important are the measurement using inulin, the measurement with radioactive tracers, the estimation using the Cockcroft-Gault formula, the MDRD formula or the Starling Leonardo technique. Each one of these methods is developed to know and understand how the level of filtered fluids in the blood by the renal system, is working.

The Glomerular Filtration Rate is measured millimeters per minutes. In men, the adequate rate is 90 ± 14 millimeters per minute, in women is 60 ± 10 millimeters per minute.

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Respiratory compensation

It is a medical method to change the blood acidity varying the respiratory rate. Put differently, the Respiratory compensation is a mechanism to alter the breathing way in the human body so the plasma pH can vary, depending on what the person needs.

The normal breathing rates in humans are measured in breaths per minute and are distributed like this:

In children, the normal rates are: from birth to six weeks of living, between 30 to 40 breaths per minute, from 6 months to three years, between 25 to 40 breaths per minute, from three to six years, 20 to 30 breaths per minute, and from six years to ten years, between 17 to 23 breaths per minute.

In adults, the rates are 12 to 18 breaths per minute, older than 65 years, between 12 to 28 breaths per minute, and older than 80 years, 10 to 30 breaths per minute.

We have seen some of the most used and recognized concepts in the Renal compensation process, but there are much more that must be understood to have a fuller picture of this term and its functioning. For example, other important notions about it are the Creatinine clearance, the Kt/V and its standardization, the Renal blood flow, the Ultrafiltration, the Filtration fraction, the PaH clearance, among other elements that are fundamental for the renal system understanding and its renal compensation.

Related: Dispelling The Most Common Myths About Kidney Disease by Joe Cosgrove