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

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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.

 

A Brief History of Dialysis

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Dialysis is a procedure commonly used to help filter the waste present in the blood when the kidneys simply can’t do it. As a medical procedure, it has been around for more than 70 years, helping patients have normal lives or at least livable ones.

Like most medical procedures, dialysis also has a story to be told, one that dates back to the 1940’s when the first dialysis machine was invented by a Dutch physician called Willem Kolff. Since the day this first machine was invented, to nowadays, dialysis has evolved incredibly, reaching the point where many patients are able to live with it for many years and still have regular lives.

In this article, Joe Cosgrove will share a bit of history related to dialysis and the great impact is has had in medical history and the lives of millions of people in time.

The 1940s: The beginning

At the beginning of the 1940’s a physician named Dr. Willem Kolff invented a device that worked as an artificial kidney. Thanks to his invention, Kolff is considered to be the pioneer of dialysis. As a physician, Kolff spent about 10 years of his career developing an artificial kidney in the Netherlands while working at the University of Groningen Hospital. He was first inspired to create this type of artifact when visiting the University Hospital and watching how a young man would irremediably die because his kidneys couldn’t filter waste anymore.

Once motivated to create something that could help those experiencing kidney failure, Kolff decided to go to research about ways to remove waste from the blood once the kidneys stopped working. Then he found an article written by the pharmacologist John Abel in 1913 about hemodialysis in animals. Thanks to this article, Kolff dedicated himself to the cause of developing an artificial kidney for humans.

Kolff had a hard time developing this device since he was sent to a remote hospital to serve at during war. Despite the poor conditions he kept on moving forward and improvised many times with many different materials (including sausage skins) to create something that could remove waste away from the blood.

By the year 1943 and after overcoming a great share of difficulties, Kolff’s invention was finished and was tested without any success on numerous patients, until in 1945, it helped an old woman overcome a uremic coma.

The machine Kolff invented is considered to be the first dialyzer of our times and its structure remained almost untouched for ten years as the best alternative for physicians to treat patients who were suffering from kidney failure. Probably Kolff didn’t know it back then, but his machine turned out to be one of the most important medical inventions in history and helped to save the lives of thousands.

The 1950s: Evolution of the dialyzer

At the beginning of the 1950’s, Kolff’s dialyzer had already been improved and used to treat injured soldiers fighting during the war. It had also been used to treat end-stage renal disease and acute renal failure patients. However, during the middle of the 20th century, not many doctors were optimistic about the usage of Kolff’s dialyzer because they believed a human made machine couldn’t resemble the kidneys’ function and they also found it difficult for the human veins to stand such treatment in the long term.

It was in Boston where a professor named Dr. Belding Scribner came up the idea of plugging the patient to the dialyzer by using flexible tubes made of a new plastic called Teflon. This way the tubes could be introduced inside the arteries and veins, keeping the circulatory access opened thanks to the usage of a tiny device with the shape of a “U”. This u-shaped device was called The Scribner Shunt.

By using this device patient no longer needed to get a new incision when going under the dialysis treatment. Even though this method isn’t used today, it helped other doctors develop new techniques to access the circulatory system that were useful to treat those who had acute kidney failure.

The 1960s: A decade of changes

Scribner was the first person on earth to open a dialysis facility in 1962. Problems started to appear when the number of patients who wanted and needed to be treated exceeded the capacity of the clinic – with only six available machines. Scribner needed to find a way to decide which patients were getting the dialysis done since many of them actually were close to death.

By this moment, Scribner decided to create an anonymous committee of people who could make that decision for him. This committee was composed of local people and doctors who worked in the kidney fields. Although this Solomonic choice created controversy, in time this committee was seen as the first bioethics committee of all time and changed the relationship common people had with the offer of health services.

The Past 60 Years

During the past 60 years, the history of dialysis has gone under several changes, new machines have been developed, new materials have been invented and many people in the world depend on this treatment to survive. We still know medical pioneers like Kolff or Scribner that are concerned about the way medicine evolves and is being practiced.

It is always expected in the future to come for specialists to be able to create new solutions that may help patients live longer, happier and have regular lives despite the fact they need to undergo dialysis treatment several times per week. History is still being written and hopefully, the years to come will be full of great surprises in this important medical field.

Everything You Need to Know About A Dialysis Machine

As Joe Cosgrove has pointed out before in this blog, kidney plays a vital role in the functioning of the human body. Without them, the waste present in the blood couldn’t be removed, and most individuals would die within a few days. Sadly, these bean-shaped organs can fail and when that happens, the best option for patients is to go under dialysis.

Dialysis is a medical procedure that works as an artificial kidney. It takes place when a person’s blood is filtered with the help of a dialysis machine. This machine aims to mimic the regular functions of human kidneys. This way, it is able to remove toxic waste from the blood as well as the extra water that may be present in it.

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Each dialysis machine is built up in a similar way and healthcare providers and technicians know how to operate them in order to help patients filtering their blood. There is a list of parts and components that need to be well known by technicians in order to properly handle the dialysis machine. Below, you will find a list of these components with a brief description of each one of them.

Pumps

The most common type of pump used during dialysis is known as Peristaltic pumps. These are tubes meant to drive different fluids, such as blood, water, saline, and dialysate. This type of tubes is ideal for dialysis since they let a higher volume of fluids flow without letting them be touched by human hands. Also, dialysis pumps are a flexible system that helps to push fluids forward with the help of motors (AC or DC motors) which speed can be regulated by the technician.

Some pumps are connected to a sensory system that allows them to automatically regulate the flowing pressure of fluids depending on the patient’s needs. Nevertheless, in order to properly function, pumps need to be configured in advance based on the type of fluid that is going to pass through them

Valves

Dialysis machines need to have a few electronic valves to operate properly. This happens since dialysis machines need to use variable mixing ratios that are only possible when different valves open and close at different times. This type of valves are solenoids which can be controlled with precision thanks to the action of stepper motors or another mechanism.

Sensors

Most dialysis machines use different types of sensors. This happens because they need to monitor and regulate different parameters that take place during the dialysis procedure. Some of these parameters include motor speed, temperature, oxygen saturation, dialysate pressure, dialysate membrane pressure, and airflow.

Nowadays, dialysis machines usually have digital outputs that allow the technicians to know what is going on during the dialysis procedure. When they don’t have these digital outputs the signal sent by the sensors needs to be amplified and digitized before reaching the controller. In order to be more accurate, a series of ADC resolutions are used and the sampling speed varies.

Cleaning system

A dialysis machine can be used to treat many different patients. This is why it needs to be cleaned before each session and components that are going to be reused must be properly sterilized too. Each machine can be cleaned in a different way, but most of them have the same system.

Technicians need to heat water to high temperatures so it can sterilize the tubes and each part of the dialysis machine when it runs through them. The inner and outer circuit of the machine needs to be cleaned with that water by activating the cleaning mode of the machine. However, there are different types of machines that require this process to be monitored and controlled.

Syringe

The syringe is an external element used to pump substances into the dialysis machine. This procedure is needed since the blood tends to clog the machine’s pumps and a drug called heparin needs to be injected into the tubes to keep them unclogged. The syringe is attached to the pumps in most machines.

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Dialyzer

The dialyzer is probably the most important piece of the dialysis machine because it is where the blood is filtered. Here a filtering membrane and a cleaning solution called dialysate can be found. The dialyzer is, in general terms a blood compartment.

Dialysate Solution

The dialysate is a solution made of purified water, an acid and bicarbonate that can be found inside the dialyzer. It is meant to remove waste from the blood thanks to the action of the minerals and electrolytes present in the solution. Dialysate never mixes with the blood; it simply takes waste away with the help of a filtering membrane.

Once the blood is cleaned and filtered thanks to the combined action of both the dialyzer and dialysate, it is pumped back into the patient’s body. This process takes place in the form of a moving current since only one pint of blood can be treated at the time.