Is automated peritoneal dialysis recommended?

Many patients who need a dialysis treatment to control kidney failure must decide between two options. The first one, best-known as ‘hemodialysis,’ is the first image that pops into the minds of people when it comes to dialysis. This procedure consists of connecting the patient to a machine that fulfills the same functions as the kidneys: filtering the blood and eliminating the excess of fluids from the body. For this reason, it is necessary that patients go a couple of times a week to a hospital or to a specialized center, and lay down while the machine does its work. This is not the only option, though. There is also peritoneal dialysis. Despite this treatment does not differ essentially from hemodialysis, offers certain conveniences to patients that hemodialysis cannot allow. One of them is that patients do not have to plug into a machine or move to a hospital for doctors to monitor their health status.

Automated peritoneal dialysis is fundamentally not different from traditional peritoneal dialysis. This system uses the same type of catheters, and the kidney function is carried out in the same way. The difference is related the way in which the process is carried out. In automated peritoneal dialysis, a machine controls the development of the renal function. This means how much liquid gets into the bag and is ejected when the filtration process is over. In this way, patients do not have to worry about how much liquid they have added to the bag, and the machine is responsible for reminding patients when they should start a cycle in advance.

The filtering process takes about eight hours, but it may extend to ten, especially when patients are sleeping. One of the functions of the machine, in addition to calculating the amount of liquid that gets into the bag, is measuring the time of infusion, permanence, and drainage, and in a very safe way, which gives a lot of peace to both patients and doctors.

Read also: Dialysis most common complications, by Joe Cosgrove

The machines used for this procedure are not large. The biomedical engineering that has worked been behind the studies of automated peritoneal dialysis has made these machines fit in a small suitcase, which, although it may be heavy, has wheels and can be carried anywhere. The machine can be used almost anywhere (an airplane, for example.) One of the great advantages of this system is that the machine keeps a record of the activity from the beginning of the treatment, which can be observed by the doctor even without the patient moving to the hospital. This system is connected to the Internet. This means, in a few words, that the machine is permanently gathering information from the patient and transmitting it through the cloud. The doctor only has to use a device with an Internet connection to check the patient’s condition (it may be an app in his or her smartphone.)

The latter is a great advantage for doctors because the patient does not have to make any report. The system is responsible for producing the necessary information for the doctor to evaluate the patient’s conditions. Even some software systems are designed so that the machine tells the doctor if the patient is presenting problems that must be resolved urgently (the first symptoms of peritonitis, for example) and that patients may not detect in time, meaning this a great danger to their health.

the-merck-home-manual-of-medical-information-dialysis.jpg

Image courtesy of Amber Case at Flickr.com

Automated peritoneal dialysis, in addition to being very useful for the health of patients, is also useful for medical research in this field. Because the number of patients suffering from kidney failure increases every year, doctors are very concerned about finding new ways to solve this problem. For this, it is tremendously important to have a large amount of information available.

Some doctors wonder if this system is recommended. The truth is that it is. There are studies showing that automated peritoneal dialysis is related to a much higher survival rate than the traditional peritoneal dialysis system. The reason for this is that the machines can calculate much more accurately the amounts of liquid that the patients need, as well as the filtering and expulsion times. The medical community knows that the more customized the treatments, the results will be much better since every organism is different and may react differently to the general conditions of any treatment. This is the case. On the other hand, one of the main problems that occur in peritoneal dialysis are infections, which has been resolved in a large percentage thanks to automation and its monitoring. The behavior of blood pressure is also another problem, and the study mentioned above shows that medical science is ready to reduce this issue to almost the minimum. There is still much to be discovered in terms of peritoneal dialysis, but the truth is that it is progressing so fast thanks to the data provided by patients. Let’s hope for the best.

Recommended: Do Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis Have the Same Clinical Outcomes?

* Featured Image courtesy of Franck Genten at Flickr.com

Advertisements

Dialysis most common complications

The procedure known as dialysis has been created so that the elimination of toxins and the excess of liquids in the body is possible; a function that, in healthy patients, carries out the renal system (kidneys, in particular.) Even though dialysis is so far the best-known option to treat kidney disease, and despite the fact that the biomedical technology makes all its efforts in considerably improving this system, it is still not possible to execute processes of error-proof dialysis. Unfortunately, complications can occur during the process, which can even negatively affect the health condition of patients. In this post, we will talk about the most frequent complications that can occur during dialysis.

In extracorporeal dialysis, the processes in which blood is removed from the body, complications are not as common. However, it is possible that an arteriovenous fistula infection may occur. Since the fistula is punctured three to four times a week to purify the blood, the risk of infection by bacteria in the puncture site is high. In addition, there is the possibility that thrombi form that obstructs the blood vessel and renders it unusable for dialysis. However, as a general rule, a surgical intervention allows the thrombus to be removed and the fistula to be unblocked.

In peritoneal dialysis, in which the blood is purified inside the body, there is a risk of inflammation of the peritoneum. Bacteria enter the peritoneal cavity through the catheter and cause a painful infection that, under certain circumstances, may endanger the life of patients. Normally, this inflammation responds well to treatment with antibiotics, but sometimes it is not that simple.

People with severe kidney disorders and kidney failure must pay great attention to their diet since many of the complications suffered by dialysis patients are related to food. Since the kidneys are not able to carry out their function of purification and excretion, in many cases those affected can only drink a limited amount of liquid. In addition, they must be careful with the contribution of protein and potassium, since an excess of these substances may lead to serious metabolic disorders in dialysis patients.

Read also: Baxter ShareSource System: A New Dialysis Option for You, by Joe Cosgrove

People with impaired renal function often have a high concentration of phosphate in the blood which may cause damage to blood vessels, such as arteriosclerosis. When the concentration of this is too high, despite having a low phosphate diet, so-called phosphate binders are helpful, they bind to the phosphate ingested with food in the gastrointestinal tract and are subsequently excreted. There are various types of phosphate binders, for example, containing aluminum or calcium, or free of both, which effectively improve the altered balance of minerals in dialysis patients. According to recent scientific findings, it seems that calcium-free phosphate binders are the ones that cause fewer side effects. Nowadays, the use of phosphate binders with aluminum content is no longer recommended due to the adverse effects that they may cause. A treatment with this type of medicine – for many years – may produce an accumulation of aluminum in the brain and bones which leads to worsening brain function and movement limitations.

In order to prevent possible infections of hepatitis B and C, and even HIV, through dialysis, the medical centers in which this treatment is carried out meet the strictest hygienic standards for the cleaning of dialysis machines. People suffering from these type of infections are treated in their own dialysis machines which are not used with any other patients. In addition, active vaccination against hepatitis B is recommended to all dialysis patients.

lab_blood_tube

Image courtesy of Pixabay at Pexels.com

There are other complications related to hemodialysis. Intradialytic arterial hypertension is less frequent than arterial hypotension, but it has relevant prognostic implications. Fever and chills in patients on hemodialysis should be attributed to endovascular infections, especially in those who have vascular access through a high-flow venous catheter. Likewise, fever at the end of the hemodialysis treatment is suggestive of endovascular infection.

On the other hand, hypervolemia is a complication that occurs regularly. This happens when the patient consumes more fluid than the one he manages to eliminate thanks to dialysis. Hypervolemia can also develop in response to sodium retention in the body due to impaired electrolyte excretion. In nephrological practice, hypervolemia due to sodium retention is observed in acute ophthalmic syndrome, in the oliguric phase of acute renal failure, due to the consumption of large amounts of fluid and obstruction of the urinary tract with volume-dependent hypertension. This problem usually leads to weight gain, and, when not treated in time, can be deadly because heart failure may occur.

Taking into account that during the last decades there has been an increase in cases of renal replacement therapy for different diseases, and, additionally, considering the increase in infections that are difficult to treat, mainly due to the widespread abuse of analgesics by professionals and patients who self-medicate (and who do not know how to differentiate a virus from a bacterial infection,) it is vital to know the different treatment modalities in these patients as well as the complications that can occur in practice.

Recommended: Infections in Patients Undergoing Chronic Dialysis

* Featured Image courtesy of Pixabay at Pexels.com

Kidney Disease in Children

As per discussed in previous articles by Joe Cosgrove, kidney disease can affect individuals in various ways. Children, nonetheless, are not the exception. Just like with adults, kidney disease can affect children in different ways, ranging from treatable, to some extent, conditions or disorders without the already mentioned lasting consequences to really life-endangering complications. Kidney disease, especially acute kidney disease, comes out of nowhere, may even last a short amount of time, may also be serious enough for it to leave children with long-lasting consequence, or may go away after treatment. Chronic kidney disease, however, does not fade away so easily, and it tends to worsen as time passes by. Chronic kidney disease (CKD) eventually evolves into kidney failure, end-stage kidney disease or even end-stage renal failure when dialysis is involved.

Children with chronic kidney disease actually are forced to face many tough and dreary challenges. Some of them include a really negative self-image, some relationship problems, behavioral issues, learning disorders, trouble focusing on what is important, delayed language and motor skills development, amongst others. Children suffering from CKD have shown a much slower growth rate in comparison to their peers; urinary incontinence is also very common.

Are there causes for kidney disease in children?

Kidney disease, regardless of its nature, in children can be caused by several causes: birth defects, hereditary conditions, infections, systemic diseases, trauma, nephrotic syndrome, reflux or urine blockage. From birth to age 5, hereditary conditions alongside birth defects are the most leading causes of kidney diseases and kidney failure. Between ages 6 and 15, kidney failure has been associated mostly with hereditary diseases, the aforementioned nephrotic syndrome and other systemic diseases. After that, between ages 16 and 20, several diseases that affect the glomeruli are the leading cause of acute kidney disease and chronic kidney disease. Hereditary diseases seem to be less common in comparison to early stages of life.

The most common causes explained:

Birth defects and conditions

The term birth defects suggests that a problem has happened while the baby is developing in the womb. Birth defects can range from renal agenesis, to renal dysplasia, and even to ectopic kidneys, just to mention several. These are mainly abnormalities of size, position, and structure of the organs. Generally speaking, children with these diseases can get to live full and healthy lives; nevertheless, some children end up facing much higher odds of developing a much worse kidney disease.

Kidney Disease in Children_renal compensation_learning_education

Image courtesy of Pixabay at Pexels.com

Hereditary conditions

Hereditary conditions or hereditary kidney diseases are those that are passed from parent to children through genes. One example is the commonly referred to as polycystic kidney diseases or PKD, which is often characterized by the presence of many grapelike groups of cysts (fluid-filled cysts, in this case) that make both organs much larger over time. The cysts often destroy the individual or the children’s working healthy and kidney tissue as time passes by. Alongside PKD, Alport Syndrome, which is often caused by a mutation in a gene, is also common in children. The disease leads to scarring of the organ. This syndrome generally appears in early childhood, and it seems to affect boys more than women. Besides, it evolves into, or causes, hearing and vision issues in addition to the original affection.

Infection

Aside from the aforementioned syndrome, infections also may end up causing other syndromes as well. Acute post-streptococcal glomerulonephritis and hemolytic uremic syndrome are kidney conditions that can develop in children after the presence of a tough infection. The latter is rather a rare condition that is often generated by the E. coli bacteria—mostly found in contaminated foods—. Hemolytic uremic syndrome starts to form when E. coli gets to the digestive tract and the toxins are allowed into the host’s bloodstream. The toxins start to attack the individual’s red blood cells and damage blood vessels while at it. Most children who have E. coli infection often suffer from ongoing episodes of vomiting, stomach cramps and bloody diarrhea for up to three days. They also become pale and show tiredness and irritability. The former, acute post-streptococcal glomerulonephritis, often occurs after episodes of both skin infection or strep throat. The streptococcus bacteria does not go straight for the kidneys; it starts by confusing the immune system, prompting it to produce antibodies in excess. Antibodies are proteins created by the immune system. The immune system is responsible for protecting individuals from different infections by assessing and subsequently identifying and destroying bacteria, viruses and other foreign threats. When the body over produces antibodies and these get to the blood and finally end up being allocated in the glomeruli, the kidneys are at open to suffering heavy damage. Most cases develop within 3 weeks after having suffered an untreated infection. It is nonetheless treatable; however, kidney damage may last forever.

* Featured Image courtesy of Pixabay at Pexels.com