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How does hemodialysis work? Hemodialysis

Many people experience kidney problems. The most common disease in the world is considered to be renal failure.

Today thanks modern technologies a unique opportunity has arisen to perform hemodialysis to treat this problem.

What is this technique, how is it carried out, and what results can be obtained?

basic information

According to anatomical structure present in the human body paired organ- kidneys.

They perform very important function throughout the body: responsible for the processes of urine excretion.

If any disturbances occur in the functioning of one of the kidneys, the person’s general state, metabolic products begin to accumulate in the body, and general intoxication occurs.

If the process is at an advanced stage, it can even lead to death.

The kidneys are directly involved in such body processes as:

circulation;
excretion from the body excess liquid in the form of urine;
regulation of the amount of salt ions in the human body;
participation in endocrine and metabolic reactions.

It is important to note that many people with some form of kidney disease have increased arterial pressure. However, today, thanks to the discoveries of scientists, hemodialysis helps in the fight against kidney failure.

Hemodialysis concept

Using the device " artificial kidney» allows you to completely cleanse the patient’s blood outside his body. This is the essence of the hemodialysis process. In this case, blood circulation occurs through a special filter that is attached to the dialysis machine.

In fact, it completely replaces the work of incompetent kidneys. The goals of this method are:

getting rid of accumulated breakdown products of protein compounds (for example, urea);
cleaning of excess creatinine;
removal of toxic substances;
removal of accumulated substances from medicines;
cleaning from alcohols and electrolytes;
removal of excess fluid.

Thanks to hemodialysis, the body's functioning is improved, toxins are eliminated, the balance of electrolytes is equalized, and blood pressure is normalized.

Today, it is performed mainly in hospital settings.

Operating principle of the device

For hemodialysis, a machine called an “artificial kidney” is used. It includes the following elements:

a special device that helps blood flow during cleaning;
dialyzer, in which blood purification occurs;
containers for solutions that purify blood;
device screen on which the entire process is visualized and controlled.

The principle of its operation is as follows:

through special tubes, blood from the patient’s vein enters the device;
the device is equipped with a special double-sided filter, which during the cleaning process allows the patient’s blood to flow on one side and a special cleaning solution on the other;
During the cleansing process, this solution rids the blood of all toxins and excess fluid.

It is important to note that cleaning solutions are selected for each patient separately. The feed speed is also individually set. On average, this process takes about 5-6 hours.

Indications for use

The main indications for hemodialysis are:

chronic and acute renal failure;
poisoning with toxic substances;
excess of drugs in the body;
alcohol poisoning;
burns, cystic fibrosis, intestinal obstruction or other diseases that cause electrolyte imbalance in the body;
drug overdose.

Contraindications

Among the contraindications to hemodialysis are the following:

the presence of an infection in the body, which, under the influence of this procedure, spreads faster through the blood;
patients after stroke;
mental disorders (neuroses, psychoses, schizophrenia);
tuberculosis or other diseases of the respiratory system;
the presence of malignant tumors;
disorders of the cardiovascular system;
age category of patients after 75 years;
various diseases of the circulatory system.

If there is a need for emergency hemodialysis, then contraindications are not taken into account.

Conducting a session

Before blood purification begins, the patient is vaccinated against hepatitis B, as well as a preventive conversation.

Be sure to measure the patient's temperature, blood pressure and pulse.

It is also very important for the correct calculation to know exact weight patient, he is measured before each session.
Next, the person takes a position that is comfortable for him: half-sitting or lying on the couch. Two catheters are connected to his arm: one of them passes through an artery, the other through a vein.

The process is quite painful.

After this, the desired flow rate of the cleaning solution and the duration of the procedure are set on the device monitor.

Thus, blood moves through one of the tubes, and the dialysate solution moves through the second. During hemodialysis, a person may feel sick due to large fluid loss.

After the cleaning process is completed, a tight bandage is applied to the hand and the patient is allowed to lie down for a while.

How often should the procedure be done?

The frequency depends on the patient’s disease:

in case of renal failure, carry out 2-3 times a week for 4-5 hours each;
in case of poisoning with toxins or alcohol, hemodialysis is carried out once for 12-14 hours;
if there is an excess of medications in the body, 1 hemodialysis is enough;
if there is an electrolyte imbalance or accumulation narcotic substances It is enough to carry out the procedure 2-3 times a week for 3-5 hours.

The number of sessions and their duration are selected by the doctor individually for each patient.

Types of places of use

Today there are several options for the procedure. It all depends on the equipment used and the degree of complexity of the disease. At severe forms Kidney diseases are prescribed treatment with hemodialysis only in inpatient settings.

At home

The procedure is carried out using portable devices, which can be very easily controlled independently.

Hemodialysis is done every day for several hours. The advantage of this method is convenience, safety, no need to visit the hospital and no risk of hepatitis B infection.

But it should be noted that this technique is quite expensive.

Outpatient use

In this case, a person can undergo hemodialysis according to the order of priority. As a rule, it is carried out 2-3 times a week for 4 hours. The disadvantage is the need to wait for your turn and the possibility of infection with hepatitis B and C.

One of the advantages is the constant monitoring of specialists over the process and the level of required indicators.

Stationary conditions

In this case, it is necessary to stay in the hospital constantly. The duration and number of sessions are determined individually. There is also a chance of contracting hepatitis B and C.

Meals during sessions

Proper nutrition plays a very important role important role. It is necessary to avoid taking salt, foods with potassium and phosphorus. It is important to remember that during treatment it is not recommended to drink a lot of liquid. There is no need to rely heavily on fish or dairy products.

Avoid eating spicy and fried foods. If, nevertheless, the patient could not resist and ate something from the prohibited foods, then it is necessary to warn the doctor about this. He will take this fact into account in future sessions.

Service cost

The hemodialysis procedure is very expensive. This is due to the high price of equipment and solutions for blood purification. On average, one session costs from 3 to 7 thousand rubles per session.

On average, 3 sessions per week are required. As a result, the price of hemodialysis varies from 9 to 21 thousand rubles.

When carried out at home, the price is slightly lower. The main amount is made up of an “artificial kidney” device and a specialist who monitors the patient’s condition.

In emergency cases, the patient can undergo the procedure free of charge.

Complications during treatment

Unfortunately, kidney diseases also affect other human organs. Therefore, after treatment, the patient may experience complications such as:

anemia, as there is a strong decrease in the level of red blood cells in the blood;
violations nervous system;
blood pressure surges;
disorders in the musculoskeletal system;
inflammatory processes in the cardiac lining.

The patient may also experience nausea or vomiting, loss of consciousness, visual and hearing impairment, convulsions and pain in the chest and back, and disturbances in the functioning of the cardiovascular system.

In some cases, you may experience an allergy to the cleaning solution. For any of these symptoms, it is best to contact the center where the patient underwent hemodialysis.

Results of using the device

Today, the process of purifying blood outside the patient’s body is very relevant.

Nowadays you can find small devices that the patient can even carry in his pocket. For patients with renal failure, hemodialysis remains the only option effective method treatment.

It must be remembered that during the procedure it is necessary to eat properly, take medications, and healthy image life and strictly adhere to the schedule of hemodialysis sessions.

Only in this case can you get the desired result. It is important to remember that when carrying out the procedure at home, control experienced specialist still necessary.

In some hospitals and centers, hemodialysis can be performed free of charge by getting a place in the queue. Today, hemodialysis helps patients with kidney failure to prolong their lives and get rid of discomfort.

The first kidney hemodialysis was carried out back in 1960, and since then it has been the only medical invention that completely replaces kidney function. internal organ person.

Many people have probably heard about the procedure and know that the device that cleanses the blood of accumulated toxins is called an “artificial kidney.” The name is correct, because during hemodialysis, blood purification occurs in the same way as the kidneys would do if they had not failed.

What is a kidney hemodialysis machine?

Yes, you understood correctly. If a person has , he will not die, but will be able to live. Some people think that this is an incomplete life, because a sick person has to be tied to a device. On the contrary, patients who have received indications for hemodialysis thank both God and technical progress for the opportunity to continue living in the hope of waiting for a transplant.

It is important to know! The kidneys are entrusted by nature with the responsibility to cleanse the blood and hemodialysis is a method in which cleansing human body occurs without the participation of the kidneys. During the procedure, toxins and waste are removed, water and electrolyte balance is normalized.

It is based on metabolism through a special membrane, in which blood flows through one side and dialysate through the other. The artificial kidney apparatus consists of:

dialyzer;
devices through which blood is supplied;
a device in which the dialysate solution is prepared and through which it is supplied.

The device contains a roller pump that supplies blood through tubes to the dialyzer. The system is configured with instruments to measure the pressure and speed of incoming blood. The optimal speed is about 300-450 ml per minute. The prepared hemodialysis solution flows near the membrane in the opposite direction from the blood flow at a rate of approximately 500 ml per minute.

Attention! The composition of a special solution for dialysis is similar to the composition of blood plasma. It can be adjusted depending on the level of electrolytes in the patient's blood. The content of calcium, chlorine, bicarbonate almost never changes; potassium has to be adjusted more often. To ensure that the amount of fluid removed from the blood is normal, the sodium supply into the solution is increased or decreased.

How is the procedure performed?

Attention! Before starting hemodialysis, each patient is examined by a doctor, his blood pressure, temperature and pulse are recorded. During the process and for some time after completion, the patient also remains under observation so as not to miss a possible deterioration in his health.

How does kidney hemodialysis occur?

A week before the start, a fistula is installed in the patient the right vessel(dialysis access is obtained), and hepatitis vaccination is given for preventive purposes. The procedure itself goes as follows:

The patient is placed in a reclining position in a special chair.
There is a device near the chair, which is connected via the veno-venous or arterial-venous route.
Using a pump, the blood is removed into the dialyzer, where it comes into contact with the solution.
Through another vein, the purified blood is returned back to the body.

How often should I visit the hemodialysis room? It all depends on the severity of the disease. In some cases, one procedure is enough for qualitative changes to occur in the kidneys; in others, this is a prescription for life. The frequency depends not only on the diagnosis, but also on the patient’s age, his weight and height, and some other circumstances.

There are different membranes that differ in the size of the useful surface. Because of this, kidney hemodialysis can be carried out according to different programs - from a daily procedure of 2 hours to 2 times a week. The regimen is determined individually, but most often there are three visits a week to the hemodialysis room with a duration of 4-5 hours.

Is hemodialysis possible outside the hospital?

This is an outpatient procedure, but there are also portable machines that allow hemodialysis to be performed at home. There are numerous cases where patients purchased “artificial kidney” devices with their own money so as not to be dependent on the medical center.

The advantage of a home device is that the patient’s routine is not particularly disrupted, and you don’t have to think too much about following a diet. The portable device can be installed anywhere – not only at home, but also at work or on the road. There is no need to prove that it will be much more comfortable for a sick person to undergo treatment at home.

There is only one disadvantage of home kidney hemodialysis and this is the cost of installation and Supplies. For this reason, it is not particularly widespread in our country, but portable “artificial kidneys” are widely used abroad. People continue to live full life, travel, go on business trips, their usual routine is not disrupted due to visits to the clinic.

Who is the procedure indicated for?

If your doctor prescribes kidney hemodialysis, should you start the procedure immediately or is there time to think about it? Delay can be disastrous, so treatment should not be delayed.

Attention! The psychological component is important. If the patient understands the seriousness of the situation and is psychologically prepared, one can hope for a greater effect from hemodialysis.

The main ones for hemodialysis are, in addition, the procedure is indicated for:

drug overdose;
severe poisoning with poisons, drugs, alcohols;
hyperhydration, life threatening person;
significant changes in the composition of the blood in terms of electrolyte content;
shock due to injuries.

Need to know! Most often, we do hemodialysis, where the indication is chronic renal failure at the final stage, when the kidneys completely lose the ability to filter blood and poisons begin to poison the body.

It would be ideal if all patients in need could undergo hemodialysis, but contraindications exclude this possibility. The procedure has absolute and relative contraindications.
Absolute contraindications for:

malignant neoplasms;
severe damage to the nervous system;
schizophrenia, epilepsy;
aged 80 years and older;
age from 70 years with diabetes mellitus;
the presence of several concomitant pathologies;
serious diseases of the circulatory system.

Relative contraindications are for active forms of pulmonary tuberculosis and for diseases where massive bleeding may occur - uterine fibroids, gastric ulcers, Melory-Weiss syndrome.

Attention! Alcoholism and drug addiction are contraindications, if the doctor notices a lack of interest in the patient to start new life, if the patient is not looking for ways to socially rehabilitate.
The procedure has numerous complications due to sharp decline osmotic pressure plasma and blood levels of calcium, sodium and potassium:
heart rhythm disturbances;
allergic reactions;
epileptic seizures;
nausea, vomiting;
loss of consciousness;
convulsions, stunning;
arterial hypertension and hypotension.

Minor complications can be resolved by changing the program so that the rate of blood flow decreases in the process. But during treatment there may also be local complications associated with infection. Rarely, septic embolism, bacterial endocarditis, and similar problems do occur.
How to eat during hemodialysis procedures?
Not only the procedure itself is important, but also a strict diet before and after it, since proper nutrition during hemodialysis makes it possible to maintain the results of treatment. You should ask your doctor for exact recommendations.
The basis of the special diet:
limiting foods that contain calcium, potassium, phosphorus;
exclusion of drugs containing aluminum;
strict control of the amount of water drunk during the day;
almost complete refusal of salt;
consumption of a lot of protein foods, but according to certain schedules.

Attention! There are a lot of restrictions in the diet, so the patient must keep a food diary, where he will indicate all the foods consumed during the day and the amount of water drunk. We must not forget that first courses also refer to liquids.

What to do if eating disorders occur? The most important thing is not to hide anything from the doctor. If he knows about more water or other errors in food, he will be able to adjust the hemodialysis program so that the disturbed homeostasis in the body is restored without consequences.

Thank you

General information

In the normal state, the kidneys of every person tend to function in normal mode. However, sometimes these organs fail to filter a sufficient amount of both waste and liquid. As a result, the amount of these components reaches dangerous levels high level, which leads to their accumulation in the human body. This phenomenon is called by specialists renal failure, i.e. a condition in which the ability of these organs to process and/or excrete urine is partially or completely lost, which in turn provokes the development of disorders of both acid-base and water-salt, as well as osmotic homeostasis. Leave this state without proper attention, it is extremely dangerous, since prolonged absence of treatment can cause the death of the patient.
Hemodialysis- one of the methods of therapy that is widely used in both acute and chronic renal failure. It is this treatment method that we will talk to you about right now.

Hemodialysis - what is it?

The term hemodialysis comes from two words “ haemo" And " dialisis", which is translated from Greek language means " blood" And " decomposition, separation" This term refers to the efferent method of blood purification in acute and chronic renal failure. This cleansing is carried out using a special “artificial kidney” apparatus. During its implementation, it is possible to remove all toxic components resulting from metabolism from the body. In addition, this method allows you to restore various disorders both water and electrolyte balance. Let us immediately note that specialists often use such a method of therapy as peritoneal dialysis, which has its own important features. So, for example, during hemodialysis, the blood is purified using an “artificial kidney” device, but during peritoneal dialysis, the blood is purified by changing special solutions in the abdominal cavity. There is also such a thing as intestinal dialysis, which involves washing the intestinal mucosa with special hypertonic solutions.

Information from history

For the first time, people began to talk about problems related to blood purification back in ancient times. At that time, experts were of the opinion that almost all diseases are the result of mixing various bodily fluids. In the fight against them, they used a variety of decoctions and infusions prepared from medicinal plants and minerals. This approach did not give the desired result. In some cases, patients became even worse. The problem of blood purification reached a completely new level only at the beginning of the 19th century. This is not surprising, since it was during this period that scientists managed to understand numerous quite complex processes that occur in the human body. The first foundations of dialysis were laid by a Scottish scientist Thomas Graham. This happened in 1854. Just 50 years later, the first apparatus was created with which it was possible to extract dissolved substances from the blood. The first efferent method of human blood purification was carried out by a doctor Georg Haas. This happened in 1924 in Germany. The procedure took about half an hour.

Artificial kidney device

As we have already said, this method of blood purification involves the use of an “artificial kidney” apparatus. His work is based on dialysis methods, which make it possible to extract components with low molecular weight from the patient’s blood plasma. The list of these components can include both products of nitrogen metabolism in the form of uric acid and urea, as well as electrolytes in the form of calcium, sodium, potassium, etc. Some principles of ultrafiltration also play an important role, which in turn help remove water and toxic components with a higher molecular weight. Today there are a huge number of different designs of this device. Despite this, they all have the same design and similar components. They consist mainly of a dialyzer, a perfusion device, which tends to ensure the movement of blood through the dialyzer, a monitor, as well as a device for preparing and supplying a special dialysate solution to the dialyzer. As for the dialyzer, it is considered to be the basis of the entire apparatus, the most important element which is a semi-permeable dialysis membrane. It is this membrane that allows you to divide the internal space of the dialyzer into 2 parts, one of which is intended for blood, and the other for solution. If we talk about the dialysate solution, its composition resembles blood plasma ultrafiltrate. It is used exclusively to restore uremic disorders of the acid-base and salt composition of the blood.

The procedure - how is it carried out?

During the procedure, the specialist uses access to conduct blood through the device itself. A small surgical intervention allows you to create such access. There are 2 types of access. In the first case we're talking about about a fistula, namely the connection of an artery with a vein. In the second case, a stent is inserted, i.e. an artificial tube designed to connect an artery to a vein. Already 7 days after surgical intervention a kind of maturation of the fistula is noted. Its size increases, as a result of which it appearance begins to resemble a cord under the skin. The duration of the process varies from 3 to 6 months. As soon as the fistula matures, dialysis needles are immediately inserted into it. If we talk about a stent, it can be used 2 to 6 weeks after its engraftment. As for the blood supply, it is carried out through tubes using a roller pump. Devices are also connected to the system, with the help of which it is possible to monitor the speed of blood flow, as well as pressure. The optimal speed is considered to be from 300 to 450 ml/min. It is also important to note the fact that the use of both a stent and a fistula can significantly increase the amount of blood flow through the vein. As a result, the vein becomes elastic and stretches easily, which significantly increases the effectiveness of this procedure.

Who does it?

This procedure is best carried out in medical institution under the supervision of medical staff, but it can also be performed at home with the help of a partner who has previously undergone special training. The most important thing is to thoroughly rinse and sterilize the device before performing hemodialysis. The procedure lasts from 5 to 6 hours. All this time, it is necessary to carefully monitor the patient’s pulse, blood pressure, and the condition of the vascular access. Immediately after the procedure, a sterile dressing must be applied to the area.

How does it work?

To carry out the procedure, a dialyzer is used, as well as a special filter designed to purify the blood. First, the blood enters the dialyzer, where it is cleansed of existing toxins, after which the already purified blood is returned back to the body. By the way, it returns through other tubes.

How often is this procedure allowed?

This procedure is in most cases carried out 3 times a week. During its implementation, the patient can sleep, talk, read, watch TV or write.

Materials and equipment

Here is a list of materials needed to carry out one such procedure:

pumping station;
reverse osmosis, necessary for water purification;
hemodialyzer ( the device itself);
Consumables;
a sterile set of tampons, napkins, and auxiliary instruments;
disposable syringes;
medical scales;
emergency medications and supplies;
chair for positioning the patient;
dialyzer ( functional unit dialysis, which includes a semi-permeable membrane);
saline;
antiseptic and aseptic preparations;
a line for carrying the patient’s blood from the bloodstream to the dialyzer and back;
heparin or low molecular weight heparins;
2 luminal needles for puncture of arteriovenous vascular prosthesis;
temporary central venous catheters;
bicarbonate and acetate concentrate in special containers.

Indications

The list of main indications for this procedure includes:

acute renal failure;
chronic renal failure;
alcohol intoxication;
serious violations electrolyte composition of blood;
drug overdose;
poisoning with poisons that tend to penetrate the hemodialysis membrane;
overhydration, which threatens the patient’s life and is not treated conservative methods.

It is worth noting that renal failure is considered to be the main indication for dialysis, since in this case this procedure allows to prolong the patient’s life. Moreover, hemodialysis in this case is considered to be a method of maintenance therapy.

Contraindications

Modern experts identify absolute and relative contraindications to this procedure.

Absolute contraindications include:

various cerebral vascular lesions;
damage to the blood system in the form of leukemia or anemia;
serious damage to the central nervous system;
age over 80 years;
age over 70 years with diabetes mellitus;
malignant neoplasms;
pathologies of the lungs in the obstructive stage;
chronic hepatitis;
pathology peripheral vessels in the stage of decompensation;
mental illnesses such as epilepsy, psychosis or schizophrenia;
the presence of tendencies towards drug addiction, vagrancy or alcoholism;
ischemic disease hearts with a previous myocardial infarction;

List relative contraindications presented by:

diseases in which there is increased degree risk of developing massive bleeding when anticoagulants are administered ( stomach or duodenal ulcer, uterine fibroids);
active forms of tuberculosis of the lungs and other vital organs.

Possible complications

The kidneys play an integral part in the functioning of numerous systems of the human body. Given this fact, disruption of their work causes a malfunction of the functions of many other systems and organs.
As for directly possible complications dialysis, then this is:

arterial hypertension;
anemia;
damage to the nervous system;
bone diseases;
pericarditis;
an increase in the total amount of potassium in the blood.

And now, more about each of these complications:

1. Arterial hypertension: characterized by a persistent increase in blood pressure. If this condition is noted along with one of the kidney pathologies, then experts recommend reducing to a minimum the intake of both fluids and table salt. Long absence treatment of this condition may cause the development of both heart attack, and stroke;

2. Anemia: accompanied by a significant decrease general level red blood cells ( red blood cells ) in blood. But it is precisely these cells that, with the help of hemoglobin, tend to transport oxygen to tissues. The main reason that provokes the development of anemia during hemodialysis is considered to be a lack of erythropoietin, namely the hormone that is synthesized healthy kidneys in order to stimulate the formation of red blood cells in bone marrow. Anemia during this period can develop against the background large blood loss or due to the patient's insufficient intake of iron and vitamins;

3. Damage to the nervous system: in medicine this phenomenon is called peripheral neuropathy, which is accompanied by impaired sensitivity in the area of both the feet and legs, as well as the hands. There are plenty of reasons for this, namely diabetes, the accumulation of large amounts of waste products in the body, and lack of vitamin AT 12 etc.;

4. Bone diseases: in patients with advanced stage of renal failure, there are serious disturbances in the absorption of both phosphorus and calcium, as well as various vitamins, which causes the development of renal osteodystrophy. This condition means increased fragility bones. Ultimately, all these changes lead to destruction. bone tissue and all because the kidneys can no longer transform the vitamin D into a form that facilitates the absorption of calcium. A clear imbalance of both phosphorus and calcium causes their deposition in joints, lungs, blood vessels, heart and skin. Deposition of these substances in skin provokes development inflammatory reactions and painful ulcers;

5. Pericarditis: characterized by inflammation of the pericardium, i.e. membrane that covers the heart. This phenomenon occurs due to the accumulation of a large amount of fluid around the heart, which provokes a significant decrease in blood output and heart contractions;

6. Increased total potassium in the blood: this condition is called hyperkalemia. Patients on dialysis should follow a diet that includes minimal amounts of potassium. Regular increases in the level of this component can cause cardiac arrest.

Side effects

Most often they make themselves known: side effects How:

heart rhythm disturbances;
muscle cramps;
bronchospasm;
pain in the back;
allergic reactions;
confusion;
hearing impairment.

Measures to prevent the development of complications

In order to prevent the development of certain complications, experts recommend:

strictly follow the prescribed diet;
observe all hygiene rules;
use permissible quantity liquids;
take prescribed pharmaceuticals regularly;
Immediately inform your doctor if any symptoms of complications develop;
pass preventive examinations see a doctor and take all the necessary tests.

Diet during dialysis therapy

In the fight against acute and chronic renal failure, both hemodialysis and special dietary nutrition are important, which are prescribed to all patients without exception. A properly selected diet can significantly reduce waste accumulated in the blood due to the body's vital functions.
Nutritionists advise such patients, first of all, to carefully monitor the level of potassium in the body. It's no secret that potassium is a mineral found in milk, nuts, some vegetables and fruits, and chocolate. Too much or too little of it can have a detrimental effect on the heart. During hemodialysis treatment it is necessary to consume a large number of squirrel. You should opt for chicken, lean beef, turkey and rabbit meat, since animal proteins are much better than vegetable proteins. Both creamy and vegetable oil can be added to food in an amount of no more than 20 g per day. The amount of liquid consumed should also be reduced to a minimum, since any liquid tends to accumulate in the body in large quantities, and especially if there are any problems with the kidneys. Excessive amounts of fluid can cause development various problems with heart, edema and high blood pressure. It would also be a good idea to limit yourself to foods such as nuts, milk, dried beans and cheese. All these products contain phosphorus, a large amount of which provokes the removal of calcium from the bones. Without enough calcium, bones will never be strong and healthy. IN minimum quantities You should also consume salt, which makes you very thirsty. Calorie content daily diet should not exceed 35 kcal per 1 kg of body weight.

Medications

Patients undergoing hemodialysis therapy require both special dietary nutrition, and in medicines. So, for example, they are often prescribed multivitamins and iron supplements, which help replenish the components that were lost during this procedure. In order to enhance the synthesis of red blood cells, they are often prescribed special hormones such as testosterone or erythropoietin. To remove excessive amounts of phosphates from the body, medications such as calcium acetate And carbonate. Low level Calcium in the blood can be increased with the help of special forms of the vitamin IN , as well as calcium supplements. Medicines are often used to lower blood pressure, which is observed in 90% of 100 cases.

Emerging problems

Regular dialysis procedures can save patients' lives, but long sessions often cause the development of stress conditions in any life situations. Such patients are especially worried about the threat of loss of independence. The thing is that all these patients are almost completely dependent on medical personnel or their household members. Often they have to give up work or school just because they have to devote time to this procedure at least 3 times a week. As a result, their rhythm of life changes completely. Now they need to follow a certain schedule, which they cannot evade under any circumstances. It is also important to note the fact that regular procedures very often they change the patient’s appearance, which also does not go unnoticed. Children undergoing such treatment are often developmentally delayed, which sets them apart from their peers. In adolescents, self-esteem is significantly reduced due to such treatment. Elderly people generally cannot remain alone and move to live with their relatives. In general, psychological difficulties arise all the time. Considering all this information, it is very important that both the patient and his relatives regularly consult a psychologist. This is especially necessary in case of obvious behavioral disorders, prolonged depression, as well as the occurrence of problems directly related to physical limitations or adaptation to such a rhythm of life.

Dialysis chairs

Chairs designed for this procedure are being improved more and more every year. This is not surprising, since they must provide patients with convenience and comfort. Note that all segments of such chairs are movable relative to each other, so take comfortable position before the procedure there will be no difficulty.
The latest models are generally equipped with a control panel, so the position of the chair can be easily changed during the procedure. The chairs are characterized by both stability and ease of movement. The height of the footrest is also adjustable. Almost all models are equipped with a hanging table on which you can put a book or your favorite magazine. The attached light bulb allows you to significantly improve reading conditions, as it illuminates the entire manipulation field. There is also a special foot pedal used in emergency situations to move the chair to horizontal position. To turn off the power supply to the chair, you do not need to reach for the outlet. Just press the existing switch, which is located under the seat.

Home hemodialysis could replace kidney transplantation

Canadian scientists conducted studies in which they came to the conclusion that home dialysis, carried out for various kidney pathologies, can replace a transplant of this body, which was obtained from a deceased donor. The main feature of this treatment is considered to be that the patient undergoes the procedure from 6 to 8 hours, which significantly exceeds the duration of the same procedure in a hospital setting. Moreover, such procedures can be performed at home almost every night. For 12 years, specialists observed their patients. All of them suffered from various kidney pathologies. Some of them were treated at home, but the other part underwent surgery for a kidney transplant. After this, scientists compared mortality in the two groups. Their surprise knew no bounds, as it turned out that home dialysis was more effective compared to the standard transplant procedure. Scientists are confident that this particular procedure can become an excellent alternative to transplantation for all those patients for whom a kidney transplant for one reason or another is categorically contraindicated.

How to prevent the development of kidney pathologies?

In order to prevent the development of this kind diseases, experts recommend:

do not sit on rocks and cold ground;
do not abuse alcoholic beverages, especially beer;
after swimming in a cold pond, dry yourself well with a dry towel and take off your wet underwear;
With special attention treat accepted medicines, many of which tend to have a detrimental effect on the kidneys;
Do not under any circumstances suffer colds and flu on your feet;
dress exclusively for the weather and cover your lower back at all times;
avoid hypothermia, which can cause vasospasm in the kidneys.

Before use, you should consult a specialist.

Dialysis machine and special solution
Indications and contraindications for hemodialysis
- Contraindications
The course of the procedure and hemodialysis regimen
Possible complications

If there is a need to detoxify the entire body, hemodialysis of the kidneys and blood is usually prescribed. This procedure is carried out with the participation of a special apparatus, the so-called one, which helps cleanse the blood of harmful toxins and electrolytes, provided that a person’s own kidneys cannot help the body in solving this vital issue.

The basis of this procedure is the removal of metabolic products: a semi-permeable membrane separates the patient’s blood from the dialysis solution, allowing only certain substances to pass through.

Due to the pressure that occurs during the interaction of blood and the mentioned solution, special filtration and removal of excess fluid from the body occurs. This procedure is designed to help eliminate human blood those components that can cause significant harm, as well as residual products remaining after metabolism.

Dialysis machine and special solution

The kidney hemodialysis procedure is carried out using a device that consists of three main parts:

a device that supplies blood;
dialyzer;
a device that supplies and prepares dialysate solution.

By means of a roller pump, blood flows through special tubes into the dialyzer itself; other devices that measure the flow rate and blood pressure must be connected to this design. Normal blood flow should be at a rate of 300-450 ml per 1 minute. Once the dialysis solution is prepared, it is supplied to the dialyzer. Basically, in such machines, the dialysate solution must pass near the membrane 1 time and its speed should be about 500 ml per 1 minute in the direction opposite to the blood flow.

In its composition, this solution is very similar to blood plasma, but it can always be adjusted by adjusting for the level of electrolytes in the blood. Often the adjustment consists of changing the amount of potassium that enters the body, since other elements (calcium, for example) generally try to be kept at the same level. If it becomes necessary to adjust the amount of fluid that is removed from the blood, the sodium concentration must be changed.

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Indications and contraindications for hemodialysis

Not all diseases can be treated with hemodialysis; it is prescribed especially when certain diseases occur:

renal failure (which can be either acute or chronic);
alcohol poisoning;
significant fluctuations in the mass of electrolytes in the blood;
severe drug overdose;
poisoning by any type of poison that can penetrate the dialysis membrane;
overhydration, which does not respond to conservative therapy.

Specified painful conditions may entail death, if hemodialysis is not performed on time. The main indication for it is severe renal failure and the last stage chronic failure, with them, carrying out this procedure can significantly prolong a person’s life. In addition, hemodialysis patients can safely live and work in a normal environment.

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Contraindications

There are cases when even with diseases requiring hemodialysis it may not be prescribed. Contraindications are divided into relative and absolute.

Relative:

active pulmonary tuberculosis;
the risk of very heavy bleeding;

Absolute:

mental diseases (schizophrenia, various psychoses);
malignant formations;
diseases of the circulatory system;
diseases of the central nervous system;
age contraindications (over 80 years of age, and also over 70 with diabetes mellitus);
the presence of two pathologies in the body (previous heart attack, heart failure, hepatitis, cirrhosis, etc.);
maintaining an antisocial lifestyle by patients.

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The course of the procedure and hemodialysis regimen

For each patient, an individual regimen and program for the hemodialysis procedure are assigned. Typically, hemodialysis is prescribed about 3 times a week, each session lasting from 4 to 6 hours. There are many different types of membranes for dialysis, the main differences being in the usable surface area. Different membranes are suitable for different programs: both daily for 2 hours, and for dialysis twice a week. If it turns out that excretory function kidneys are still preserved, the doctor can reduce the number of procedures performed.

Often the procedure is carried out during a hospital visit, but there are times when it is necessary to perform hemodialysis at home, for such moments there are portable machines. TO positive qualities Dialysis at home includes the ability to perform it more frequently if necessary. Dialysis can be combined with work, diet and normal lifestyle. Moreover, it can be taken on long trips or trips.

Before undergoing the first hemodialysis procedure, it is necessary to create access to your own circulatory system, this procedure is done in a medical facility. There are 3 different types of blood access: fistula, graft and catheter.

A fistula directly connects an artery and a vein; it is often located in the forearm. With this intervention, the blood flow in the vein increases significantly, its diameter becomes larger, and the wall is somewhat stronger. This makes the vein suitable for regular needle insertion.
A synthetic tube as a graft also connects a vein and an artery. When inserting a tube, no additional time is required for the healing of blood vessels, so it can be used on early stages. But with this method complications often arise.
The catheter is used purely for temporary access; it is installed in any of the available veins. During dialysis, needles are inserted into the catheter, through which blood flows. A catheter is placed during single dialysis, when there is no extra time to open access for a long time in another way.

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When a patient undergoes hemodialysis, he must adhere to certain dietary rules in order to cleanse the blood of toxins. The diet rules are not very complicated, but they should be strictly followed:

It is recommended to consume more foods containing protein, since hemodialysis cleanses the blood from the body. useful substances(however, before starting the hemodialysis procedure, protein consumption should be limited).
Potassium intake should be strictly controlled. Potassium is almost always included in salt substitutes, in individual species fruits and vegetables. When the amount of potassium increases, heart complications are possible.
Depending on the disease, you need to control your fluid intake. In the time interval from one procedure to the next, the patient’s body weight should not increase by more than 5% of the original. If you consume more liquid, edema and complications in the heart and some other organs may occur.
It is necessary to limit the amount of salt in food, since it leads to noticeable retention of water in the patient’s body.
If your doctor has prescribed medications that regulate the metabolism of calcium and phosphorus, you need to reduce the consumption of foods that contain a lot of phosphorus.

If a diet violation occurs during the period between procedures, there is no need to hide the fact from your attending physician. When malnutrition is known, the hemodialysis regimen will need to be adjusted to restore the imbalance in the body.

Kidneys - complex mechanism. Their functioning is of great importance for healthy life. Kidney hemodialysis is needed in case of decreased functioning of the organ, when chronic processes of urine separation in the body lead to the fact that the kidneys cannot cope with cleaning the blood from harmful metabolic products, poisons poison the blood, it is impossible to live without help and a person can become disabled.

What is kidney hemodialysis?

Nephrology and dialysis is a branch of science that studies the principles of functioning and kidney disease. Nephrology examines the principle of diagnosis, treatment, prognosis for recovery and the ability to live with the problem. Dialysis is the last chance to survive before transplantation. Kidney hemodialysis is an extracorporeal method of purifying blood from toxic elements and waste (urea, creatinine, poisons), carried out outside the body in case of acute renal failure.

The essence of hemodialysis is emergency cleansing of the body and regulation of water-electrolyte imbalance, acid balance, improving human life. On late stages oncology relieves intoxication.

Types of procedures

Depending on the venue

In a home environment

Special equipment (the new System One) allows you to replace the natural filter and cleanse your blood every day at home. The duration of the process is 2−4 hours. Hemodialysis at home is a program method that improves the quality of life and can replace organ transplant surgery. In our country due to high cost connecting the installation at home is not very popular, although a disabled person cannot always get to the hospital.

Pros: easy to use (the One system weighs no more than 30 kg), it is possible to combine the time of the procedure and the needs of the body, the likelihood of complications in the form of hepatitis is reduced.
Disadvantages: high cost of equipment, not all people can use vascular needles, training is required.

Outpatient

The duration of the procedure for one stage takes 4 hours.

The procedure is carried out in a special clinic 3 times in 7 days. The duration of one stage takes 4 hours. This method needed by a person with acute renal failure or at the stage chronic process when it is impossible to restore the functionality of the organ. Let's consider how many advantages the procedure has:

Pros: supervision of specialists, tracking test results to adjust treatment ( low content creatinine in urine, creatinine in blood, anemia), sterile cleanliness of the room, the ability to transport a sick disabled person for treatment and home (if necessary).
Cons: visiting the clinic several times a week, waiting in line, small risk of contracting hepatitis.

In the hospital

This type of therapy is used for patients with severe poisoning body, improving liver and kidney function. In any clinic there are rooms with “artificial kidney” equipment. Technically, a blood purification operation in a hospital is no different from an outpatient one. In addition, the equipment used for filtration is the same.

Pros: constant supervision by specialists.
Disadvantages: the need to stay in the hospital, there is a high possibility of contracting hepatitis.

Depending on the functionality of the device

Conventional dialysis

Filtration is done using equipment based on a cellulose membrane with a size of 0.8-1.5 sq.m. Using a low flow filter allows particles to pass through small size. Speed blood flow low and reaches 200−300 ml per minute. The duration takes 4-5 hours.

Highly efficient dialysis

Hemodialysis is done using a machine called a dialyzer. The dialyzer surface size is 1.5-2.2 sq.m. Blood moves at a speed of up to 350-500 ml per minute, in reverse side dialysate is sent at a rate of 600-800 ml per minute. By increasing the efficiency of the membrane, the blood flow rate increases, the application time is reduced to 3-4 hours and the number of procedures per week is reduced.

Hemodialysis using highly permeable membranes

During the procedure, the patient's blood is passed through a dialyzer multiple times.

This type combines hemodialysis and hemofiltration. The idea is to use special highly permeable surfaces. High-flow hemodialysis promotes the passage of molecules big size. Thanks to the highly permeable membrane, the likelihood of complications is reduced. But the likelihood of substances from the dialysate entering the blood increases, so a sterile apparatus is needed.

In medicine, an alternative to the hemodialysis described above is the peritoneal method. It is worth replacing hemodialysis with the peritoneal method when individual intolerance when it is impossible to get access to connecting an artificial kidney apparatus. It is often used in oncology. There is no need to use expensive sets of instruments; in the peritoneal method, the abdominal cavity acts as a filter. The peritoneal filtration method has disadvantages:

duration;
risk of infection;
development of peritonitis.

Indications for testing

Not every disease requires extracorporeal filtration. Requirements for carrying out are determined strictly and include signs of the following conditions:

renal failure (acute or chronic);
in case of severe poisoning (alcohol, poison, drugs);
significant changes in the electrolyte composition of blood plasma;
excess water content in the body (swelling of the lungs).

Chronic renal failure (CRF) cannot be cured with conservative methods and is assigned to disability. Without hemodialysis, the quality of life deteriorates and death occurs.

The main indicator for cleansing procedures during renal pathologies indications are:

when creatinine in the blood is more than 1 micromol per liter;
urea 20-40 mmol per liter;
the filtration rate is less than 5 ml per minute.

Contraindications

Hemodialysis is contraindicated in active pulmonary tuberculosis.

There are situations in which, in the presence of the above-described indications, the hemodialysis procedure is not performed. For example, during pregnancy there is a high probability of complications. But with the development of sudden acute failure already during pregnancy, there is no way out, the installation of an “artificial kidney” is connected. Emergency has no contraindications. Contraindications:

Absolute:
- cirrhosis of the liver;
- active pulmonary tuberculosis;
- diseases dangerous due to the sudden onset of heavy bleeding.
Relative:
- mentally ill conditions (seizures, schizophrenia, mental illness);
- advanced oncology;
- blood pathologies (anemia, oncology);
- serious nervous disorders;
- pregnancy;
- age restrictions (over 80 years or 70 years with diabetes);
- acute syndrome of alcohol or drug dependence;
- presence of two or more violations.

Dialysis machine and special solution

For the extracorporeal filtration procedure, “artificial kidney” devices (dialyzers) are used. The main task of the equipment set is to purify blood from urea, the end product of protein metabolism, calcium, potassium, sodium, and water. IN modern medicine equipment designs are varied. The kit includes: a dialyzer, a blood supply system, a system for preparing and supplying a special solution under pressure. The devices differ from each other in the structure of their semi-permeable membrane.

Plate type dialyzer

The system consists of lamellar grooves through which the acid dialysate passes. The plates are connected to each other by vertical cylindrical channels and are covered with a membrane on top. Liquid flows across the plates, and blood flows across the membrane. The device is difficult to manufacture, but its operation has a number of advantages:

slight resistance to blood flow, reducing the risk of blood clots;
the dosage of the anti-clotting drug is reduced;
free control of the degree of filtration;
Filling the dialyzer does not require a large volume of blood, so the body does not experience a shortage of it.

Capillary dialyzer

The most effective and safe device. Sets of synthetic, biologically inactive materials were used to manufacture the membrane. A set of parallel tubes represents a system that passes blood through itself. Their number reaches 10 thousand, diameter 0.3 mm. Externally, dialysate fluid flows in the opposite direction. Thanks to this design, the quality of cleaning is higher.

If hemodialysis is carried out in children or the initial procedure in adults, a lightweight method of program filtration is used, in which the hemodialysis concentrate is sent along the blood flow. This reduces discomfort and the likelihood of negative consequences.

Advantages of a capillary device:

high quality, achieved by a large filter surface;
constant circulation and purity of the dialysate fluid, which reduces the likelihood of blood contamination by viruses, microbes and bacteria.

The procedure goes through the following stages:

Preparation of equipment and material.
The person lies down in a special chair in a reclining position.
The device is installed next to the chair. The venovenous or arteriovenous line communicates it with the body.
The operation of the pump creates pressure under which the blood is discharged into the filter for contact with a special liquid.
Through the connected second vein, purified blood returns to the body.

The severity of the disease determines how much filtration is needed. For some, one procedure is enough, for others, chronic hemodialysis is necessary. Typically, blood cleansing is carried out up to 3 times a week for 4-5 hours. The mode and time of hemodialysis are set according to individual indicators. The adequacy of hemodialysis depends on biochemical and other blood parameters. An antibiotic may be administered to avoid infection. At the end of the procedure, a bandage is applied to the site of access to the vessels.