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.

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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.

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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.

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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.

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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.

Learning The Basics About Dialysis Membranes

As Joe Cosgrove has already said in this blog, dialysis is a method used on patients who have End Stage Renal Disease (ESRD) and whose kidneys are not able to filter blood properly in order to remove waste from it.

Renal Dialysis Technician

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As the dialysis process needs to filter blood waste, it should use a membrane in order to do so. Nowadays, most of these membranes are artificial ones, made out of polymer compound and blends. The most common polymer used to manufacture dialysis membranes is regenerated cellulose. However, many companies have developed modified cellulose membranes and even synthetic polymer membranes that are useful to filter blood.

Dialysis membranes are used clinically to remove waste from the patient’s’ blood. Most of this waste is made of uremic toxins that would otherwise cause blood intoxication. Besides removing waste, these membranes are responsible for providing the lacking dialysate ions the body needs to properly function.

As the number of patients who need dialysis increases so does a number of dialysis membranes that are required to treat them. Every year, at least 70 million square meters of dialysis membranes are used in the world. The most common type of dialysis membranes that is used to remove accumulated toxins is made of hollow fibers. A hollow fiber membrane included numerous materials, such as cellulose and other synthetic polymers.

Related: Which dialyser membrane to choose?

A Bit Of History

At first, dialysis membranes were made of cotton or cotton derived fibers. These membranes were thought to be natural ones and their structure would activate blood leukocytes and their immunity response. Due to this, the body started to develop inflammatory responses and finally, it was concluded that those membranes were not biocompatible with the body.

In time, scientists started to develop polymers made of both natural and synthetic compounds in order to mitigate the body’s response and further development of inflammatory reactions. This is how it was concluded that cellulose was more biocompatible to the body and didn’t cause as many reactions as cotton would do. Research institutions started to develop cellulosic membranes that were highly more compatible to the body and modified cellulosic membranes were born.

Many membranes have been developed over the years. Currently, we can find synthetic membranes with higher filtration capacity due to the larger size of their pores. This way, synthetic membranes can remove more particles than “natural” ones would do. This is how, besides the low flux cellulose membranes, five types of high-flux synthetic membranes can be found in the market today.

Characteristics

Biocompatibility: This characteristic describes how a membrane can cause a biological or biochemical effect on the body. In other words, is there is an inflammatory reaction in the body, the membrane is not biocompatible because it activated the leukocytes and made them react. This usually happens when natural fibers are not modified.

The main cause of death in dialysis patients is caused by these inflammatory responses. When healthcare providers use synthetic materials, patients have a better response to the dialysis treatment. This happens because high-flux synthetic polymers don’t activate leukocytes as unmodified cellulose membranes do, therefore they are considered to be more biocompatible to the body and their mortality rate associated with them is lower.

Impermeability: This characteristic is related to the membrane’s impermeability to dialysate impurities such as bacteria. Dialysate can be easily contaminated by other substances, allowing dangerous substances enter the body through the membrane directly to the blood stream.

Those membranes with larger pores, paradoxically, have fewer chances of filtering bacteria directly to the blood stream. This happens because membranes with larger pores are more absorbent that those with smaller pores. This way, synthetic membranes or cellulose modified membranes can absorb more bacterial products of dangerous substances for the body. These membranes are considered to be more impermeable to impurities.

However, it is recommended to use pure dialysate on patients, simply to avoid taking any potential risk that may affect the patient’s health. Using a synthetic membrane can be understood as taking an additional precaution.

Adsorption: As it was said before, membranes used during the dialysis process need to be absorbent. This way, they can remove any potential threat present in the dialysate fluid. There are some peptides, necrosis factors, and other substances that should be absorbed by the membrane in order to keep the body healthy.

In order to increase the membrane’s capacity to absorb impurities, most dialysis machines also include other inner systems such as beads with special properties meant to absorb harmful substances. This way, the absorption capacities won’t rely exclusively on the membrane, but also on the dialysis machine.

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Pore size: This characteristic varies from one material to another. Natural membranes have smaller pores and synthetic membranes have larger pores. Nowadays, scientists and researchers have created new synthetic materials and compounds that allow membranes to have larger pores, increase the flux and properly remove harmful substances.