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.

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.