How much does hemodialysis cost? Dialysis - what is this procedure and how is it carried out? What medications are needed for kidney dialysis? Age limit for hemodialysis

Hemodialysis in medicine is the process of extracorporeal (outside the body) purification of the blood from toxic metabolic products, as well as excess amounts of water in the blood plasma. Similar tasks in the body are performed by the kidneys, but in some cases, for example, with various forms of renal failure, hemodialysis is vital.

Indications for hemodialysis

Indications for hemodialysis can be any process that results in the saturation of the blood with toxic products of its own metabolism or substances that enter the blood from the outside.

In what situations is hemodialysis used most often?

• For acute or chronic renal failure when the kidneys fail to cope with their tasks of purifying the blood and removing excess water from the body. Urea most often becomes an autotoxic breakdown product., accumulated in the blood plasma as a result of the breakdown of complex proteins, and creatinine- a residual product of energy metabolism in muscle tissue.
• In case of drug poisoning, mainly from the groups of barbiturates, salicylates, tranquilizers, neuroleptics, as well as containing bromine salts, iodine and sulfonamides.
• In case of poisoning with large doses of ethyl alcohol, when the fastest possible blood purification is vital even with healthy kidneys.
• In case of poisoning with methylates- a common occurrence among patients with chronic alcoholism who accidentally or unknowingly drink a certain amount of methyl alcohol.
• Some pathologies, the pathogenesis of which leads to excessive accumulation of toxic products in tissues and blood plasma. A classic example of such a disease is compartment syndrome, in which hemodialysis is performed regularly due to acute renal failure.
• For diseases whose symptoms include active accumulation of fluid in vital cavities and organs. This is pulmonary edema, cerebral edema, acute heart failure, leading to the accumulation of large volumes of water in the pleural cavity.

It is not a method that is necessary for the pathogenesis of any complexity of the above reasons. His used only in the presence of such strict indications:

• amount of urine, released during the day physiologically, less than 500 ml;
• kidney function maintained at the level no more than 15%, which is equal to purifying 200 ml of blood per minute;
• urea concentration in blood plasma more than 35 mmol/l;
• concentration creatinine - more than 1 mmol/l;
• hyperkalemia - more than 6 mmol/l;
• concentration blood bicarbonates below 20 mmol/l;
• vivid symptoms edema of the brain, pericardium, lungs, not amenable to conservative treatment methods;
• Clinical signs acute poisoning large volumes ethyl alcohol;
• use any quantity methyl alcohol in the anamnesis.

Contraindications for hemodialysis

As already stated, hemodialysis is a procedure that should only be used when needed.

However, there are some contraindications that limit or completely exclude hemodialysis, regardless of the strict indications.

• Acute or chronic infectious diseases, including focal ones.
  During hemodialysis, blood pressure increases and the speed of blood flow increases, which can contribute to the spread of microorganisms through the bloodstream and cause general blood poisoning - sepsis or inflammatory phenomena in the area of ​​the inner lining of the heart cavities, that is endocarditis. The lungs can also be a primary target for colonization by pathogenic microflora.
• Psychopathological disorders and diseases of the schizoid, epileptic and psychotic series.
  The hemodialysis procedure causes slight swelling of the patient's brain, which is almost always provokes an epileptic attack or the manifestation of acute symptoms of schizophrenia. In addition, twilight states and the absence of any intellectual activity make the hemodialysis procedure impossible.
• At .
  In any phase of the pathological condition, hemodialysis is completely excluded due to the same cerebral edema.
• Any form of tuberculosis.
  It interferes with hemodialysis due to active spread of Koch bacillus throughout the body, as well as possible infection of other patients.
• Malignant oncological pathologies.
  Increased blood flow can contribute to the spread of metastases throughout the body.
• Arterial hypertension.
  If it is characterized by an increase in readings to 300 ml of mercury in systole and 160 mm in diastole. During hemodialysis, as is known, blood pressure increases, and this process is practically uncontrollable by medications. If the procedure coincides with an attack of hypertension, the risks of heart attacks or strokes due to rupture of blood vessels.
• Age over 70 years.
  There are many objective contraindications for hemodialysis - age-related organic disorders in the heart muscle and walls of blood vessels, diabetes as a risk factor for vascular weakness, reduced immunity, promoting infectious infection.
• Some blood pathologies.
  This is, for example, decreased coagulability, blood cancer, aplastic anemia. In the process of hemodialysis, in any case, the formed elements of the blood, in particular red blood cells, are damaged, which further increases anemia, which is the main symptom of the above diseases.

It is worth noting that, regardless of any contraindications, if there is a serious danger to the patient’s life, hemodialysis is carried out in any case. After all, there is a chance of salvation.

What is the hemodialysis procedure and the equipment used?

The hemodialysis procedure is based on the physical phenomena of diffusion and convection - the ability of the membrane to pass certain chemicals and retain others. To remove excess water volumes, the so-called ultrafiltration process is used.

An artificial membrane installed in a hemodialyzer, selective to chemicals, replaceable structure - depending on the need to filter certain structures, install the appropriate membrane. The main physical criterion of a membrane is the diameter of the pores and their number located on its area, porosity. In this way, the quality of filtration is regulated.

On one side of the membrane the patient’s blood is passed through, on the other there is a dialysate solution that has the ability to “attract” certain chemicals. The composition of the dialysate solution also depends on the indications for a particular pathological condition.

In addition to the blood purification function, a hemodialyzer or “artificial kidney” has the ability to saturate the blood with various chemicals, so this opportunity is often used during hemodialysis. For example, in order to restore the electrolyte composition of blood plasma. A prerequisite for hemodialysis is additional blood purification from infectious agents.

Ultrafiltration is ensured by increasing the pressure of the blood mass on the membrane intended for this purpose, and The dialysate solution contains hydrophilic elements that attract water. This reduces the concentration of water in the plasma.

Always taken for hemodialysis only venous blood, as the most saturated with decay products. Blood from the venous catheter circulates through the hemodialyzer and returns to the body further up the vein or through an artery.

Depending on the indications and severity of pathological processes, hemodialysis can be carried out under different conditions.

• At home, using a portable hemodialyzer. It is more often performed in cases of acute renal failure, when the filtering capacity of the kidneys is reduced.
• In an outpatient setting on stationary equipment often in acute renal failure or at the end stage of chronic.
• In hospital settings in particularly severe cases of renal failure or acute poisoning.

Given the weak capabilities of portable devices, hemodialysis at home is often prescribed daily, for 2-4 hours. Stationary equipment is characterized by better filtration quality, so the process is carried out 2-3 times a week. The quality of hemodialysis is determined by the amount of urea in the blood, as well as by the general clinical condition of the patient.

Complications during hemodialysis and quality of life of patients

One of the most common reasons for the use of hemodialysis is increased water content in the blood plasma when ultrafiltration is indicated. Side effects caused by a sharp decrease in the liquid part of the blood - plasma loss - often manifest themselves in different forms.

• Active reduction in blood pressure.
• Manifestation of fatigue.
• Drowsiness.
• The appearance of painful sensations in the legs.
• Spasms of skeletal muscles, usually of the lower extremities
• Nausea.
• Excruciating headaches.

The severity of these symptoms is highly dependent on the volume and rate of fluid removed.

With the massive use of hemodialyzers, infection with infectious diseases, in particular tuberculosis and hepatitis B, is possible.

Increased blood flow during hemodialysis can provoke the spread of pathogenic microflora throughout the body, which can lead to:

• sepsis;
• endocarditis;
• osteomyelitis.

The first use of a hemodialyzer may provoke allergic reactions in the patient, due to the entry of allergens into the blood from the surface of the membrane, which is due to its chemical structure and the use of aseptic measures for its cleaning. However, in order to reduce allergic manifestations, modern nephrology uses gamma irradiation to sterilize membranes.

Long-term complications With frequent use of hemodialyzers, the following may occur:

• liver amyloidosis;
• neuropathy of various trunks;
• The latter are caused by an enlargement of the left half of the heart due to increased blood pressure and blood flow during hemodialysis.

In a healthy person, the kidneys work normally, filtering waste and liquids even in large volumes. In some cases, the body cannot cope with its work and the concentration of toxins becomes extremely high. This state is called.

This problem lies in the complete or partial loss of the ability of internal organs to process and excrete urine. If this problem is not treated, the person may die from intoxication, so special procedures are carried out. In subsequent paragraphs of the article, the topic of hemodialysis will be covered in more detail - what it is and why do it.

Principle of operation

The concept of program hemodialysis refers to a special procedure that involves removing toxins from the blood.

For this, the efferent method and a special apparatus are used, which is called "artificial kidney".

With hemodialysis it is possible to:

• extract toxins that are formed during metabolism;
• restore the balance of water and electrolytes.

The procedure is mainly carried out in stationary conditions and involves the use of a device with a set of special membranes that have selective permeability. The body is cleansed by removing toxins and high molecular weight substances from the blood that can pass through the membrane.

Depending on its type and the type of dialysis solution, the blood can be cleansed of certain toxins and even certain proteins. In addition, some solutions can be used to replenish mineral deficiencies in the human body.

The “artificial kidney” consists of several elements:

1. perfusion device;
2. dialyzer;
3. apparatus for mixing and supplying dialysis solution;
4. monitor.

The machine works using a special perfusion device that helps blood flow to the dialyzer. Its operating principle is similar to a pump. After cleansing, the device directs the blood back into the human body.

The dialyzer is the basis of the machine. It is in it that there is a special membrane that allows blood filtration.

It is a reservoir divided into two parts by a special membrane. Blood is supplied to it, and on the other side - dialysis solution. Interacting through a membrane with a certain degree of permeability, the blood is purified and reintroduced into the body.

An apparatus for mixing and supplying the solution is necessary so that the blood is purified and pure dialysate is supplied to the membrane, and the dialysate with waste enters a separate reservoir.

The monitor on the device is designed to track the speed of blood flow. Normally, this indicator should be about 300-450 ml/min. If the blood flow is slow, then the duration of the procedure increases, and if it is higher, then the blood does not have time to be completely cleansed.

In order to normalize the speed of blood flow or, if frequent dialysis is necessary, a special fistula(see photo).

It facilitates the connection of the device and connects the vein and artery. To install it, a special operation is required. Within six months, the fistula matures and reaches the required stage for dialysis.

In general, the entire procedure takes about 5-6 hours. During the session, the patient can engage in any quiet activities.

The procedure must be carried out by specially trained personnel.

Types of hemodialysis

Hemodialysis is divided into several types depending on whether the procedure is carried out in a hospital or at home, as well as on the functionality of the device.

Also distinguished:

• hemodialysis;
• peritoneal dialysis.

In the first case, an artificial membrane is used to filter the blood, and in the second, the peritoneum is used.

By venue procedures include hemodialysis:

• at home;
• outpatient;
• during inpatient treatment.

Hemodialysis at home involves the purchase of a special device by a person.

Outpatient procedure is carried out in the hospital on a first-come, first-served basis three times a week, but the equipment for them is more specialized. The duration of the procedure is 4 hours.

In this case, the person is under the control of the attending physician, who can change the fluid circulation speed settings, control the volume of blood and dialysate, and also monitor the pressure and level of hemoglobin in the blood. However, many patients do not like the need to wait and regularly visit the clinic.

Inpatient hemodialysis involves the patient staying in the hospital. There are not many differences from the outpatient procedure. The advantages also include constant monitoring by a doctor, while the disadvantages are the need to stay in a hospital in an inpatient department. In addition, if doctors are not careful enough, a person can become infected with hepatitis B.

Functionality of the devices for hemodialysis are also different, so there are three types of procedures:

• regular;
• highly efficient;
• highly accurate.

Each method has its own characteristics depending on the type of membrane in the device. Conventional hemodialysis involves using a device with a membrane area of ​​up to 12.5 sq.m. This material allows you to filter out small molecules at low speed (200-300 ml/min). In this case, the entire procedure takes about 5 o'clock.

Highly effective hemodialysis is carried out using a membrane with an area of ​​2.2 sq.m. At the same time, the speed of blood passage increases to 350-500 ml/min. At the same time, the dialysis current is also approximately twice as high. This cleanses the blood 1-2 hours faster, and it itself is better filtered and becomes cleaner than with conventional dialysis.

High-precision hemodialysis is applied using a high-sensitivity membrane. It allows the passage of not only small, but also large molecules, thereby allowing the blood to be purified from a greater number of toxic substances.

A feature of this type of procedure is the possibility of penetration of more substances from dialysis through the membrane, so it is necessary to monitor its quality.

At what creatinine level is it prescribed?

The main problem for which hemodialysis is prescribed is renal failure, since the procedure is necessary for such a patient and makes it possible to prolong his life. However, it is not always prescribed, but only at a certain concentration of creatinine in the blood. With indicators over 800-1000 µcol/l hemodialysis is already prescribed.

Indications also include:

• alcohol intoxication;
• disturbances in the electrolyte composition of the blood;
• drug overdose;
• pericarditis;
• poisoning with certain poisons;
• overhydration.

With all its advantages, the procedure also has contraindications. Some of them are absolute, that is, use hemodialysis strictly prohibited. This:

• cirrhosis of the liver;
• cerebral vascular lesions;
• leukemia;
• anemia;
• CNS lesions;
• age from 80 years (70 if diabetes mellitus is present);
• malignant tumors;
• lung diseases;
• chronic form of hepatitis;
• pathologies of peripheral vessels in the stage of decompensation;
• epilepsy;
• schizophrenia;
• psychoses;
• alcoholism;
• coronary heart disease against the background of a previous myocardial infarction;
• heart failure;
• addiction.

In other cases, the decision to carry out a blood purification procedure can only be made by the attending physician:

• diseases with a high risk of developing massive bleeding after administration of an anticoagulant;
• active forms of tuberculosis.

How many years do people live on hemodialysis - statistics

Considering that most often regular hemodialysis is prescribed mainly for kidney failure or problems with kidney disease, the overall life expectancy of a person has already been reduced.

If you do not replace the affected organ with a donor one, but use an “artificial kidney” directly, then life expectancy can be even about 20 years, depending on the characteristics of a person’s health and general condition. The maximum age is 40 years.

A person who requires regular hemodialysis due to weakened heart muscle is predicted to live for about 4 years.

The average life expectancy is about 6-12 years. In this case, the patient dies not from kidney disease, but from infectious or inflammatory diseases and their consequences.

This happens as a result of the fact that the kidneys cannot fully perform their tasks and the person’s immunity is greatly weakened. As a result, any infection or virus can cause irreparable harm to health, even with...

Not every person is suitable for artificial blood purification, so a fairly high percentage of deaths occur in the first year. If the human body functions normally for a year, then in 76% of cases he will live for at least another 5 years if all the doctor’s requirements are met.

Complications of hemodialysis

Since the kidneys are an important system for cleansing the body, disturbances in their functioning cause problems with the functioning of other internal organs. Complications may include:

• arterial hypertension;
• anemia;
• CNS lesions;
• bone diseases;
• pericarditis;
• hyperkalemia.

Arterial hypertension is an increase in blood pressure. If such a problem arises, the doctor prescribes a special one. If the problem is not addressed promptly or neglected, it may contribute to the development of a heart attack or stroke.

Anemia is a decrease in the concentration of red blood cells in the blood. This reduces the saturation of the body's cells with oxygen. Anemia is caused by a lack of erythropoietin, which is produced by healthy kidneys. The development of this condition is also caused by large blood losses or lack of iron and vitamins in the diet.


Disturbances in the functioning of the nervous system suggest a decrease in the sensitivity of the limbs. This condition can be caused by diabetes, B12 deficiency, or an excess of toxins in the blood.

Bone diseases occur when kidney problems are advanced, when the body cannot obtain vitamins and minerals from the blood. The patient has brittle bones and severe bone destruction because the kidneys cannot allow calcium to be absorbed more easily by converting vitamin D.

In addition, there is deposition of excess calcium and phosphorus. As a result, it happens formation of ulcers and inflammations.

Pericarditis is inflammation of the pericardium, or lining of the heart. This happens when fluid accumulates around the organ, which causes a decrease in blood output and heart contractions.

An increase in the concentration of calcium in the blood or hyperkalemia occurs when diet is abandoned during hemodialysis. Its peculiarity lies precisely in reducing the consumption of this mineral with food. If the concentration of potassium in the blood increases, it may become cause of cardiac arrest.

To prevent the development of complications, it is necessary:

• strictly follow a diet;
• maintain personal hygiene;
• drink a strictly limited amount of liquid;
• take prescribed medications promptly and regularly;
• Tell your doctor if you have symptoms of complications;
• undergoes regular examinations;
• submit the prescribed items in a timely manner.

If all preventive measures are followed, the risk of complications is minimized.

At home - is it possible and how?

Hemodialysis can be performed at home. A special device is required, which is intended specifically for home use. Some of them are quite large, but modern models are small and weigh from 4 to 7 kg and can be attached to the body.

The advantages of the procedure at home are relative safety, since only one person uses the device. In addition, dialysis can be performed at any time and there is no need to correlate the schedule with the working hours of the clinic and doctor.

The disadvantages of home hemodialysis are the need to train a loved one to operate the machine. At first, the procedure must be carried out under the supervision of a visiting medical professional. In addition, the cost of the device for home use is high and amounts to about 15-20 thousand dollars.

Kidney transplant

Hemodialysis is prescribed to people suffering from kidney failure. Procedure cannot completely replace an organ, so the person’s condition gradually worsens. In addition, the disease requires regular examinations by a doctor and visits to the hospital for the procedure.

Modern medicine allows some patients to improve their quality of life with the help of a donor kidney transplant. The method is quite complex and there is a high risk of organ rejection. In addition, the wait for a donor organ can last for years, and after a transplant, a person will take drugs that suppress the immune system for the rest of his life.

Peritoneal dialysis

Peritoneal dialysis is also artificial blood purification method. But to carry it out, it is not artificial material (membrane) that is used, but a part of the human body or its peritoneum. It is a thin membrane that covers the internal organs of the abdominal cavity.

The advantages of this dialysis method are that the peritoneum, unlike the membrane, has a more selective permeability and allows substances with a higher molecular weight to pass through it. Thus, more types of toxins pass through it.

The procedure is carried out quite slowly. The dialysate itself is placed in the patient's abdominal cavity and blood is filtered through it through the vessels in the peritoneal walls.

The advantage of the method is its ability to be used by patients with end-stage renal failure, as well as if there is no possibility of installing a fistula.

For the procedure, an improved apparatus and peritoneal catheters are used, which provide high-quality drainage of the abdominal cavity. The catheter is fixed with a Dacron cuff in the subcutaneous fat. The catheter is surgically inserted.

This procedure may have some complications. The main ones include peritonitis or inflammation of the peritoneum. Other features are approximately the same as with standard hemodialysis.

The procedure is usually performed while the patient is in the hospital, since requires constant medical supervision to change the dialysate and monitor the patient's health.

Nutrition and diet

Hemodialysis requires strict adherence to certain dietary habits. They consist in reducing the intake of products into the patient’s body, which can increase the rate of endotoxin production.

The main principle of the diet is to limit the patient’s fluid intake. His kidneys can produce from 500 to 800 ml of diuresis per day. But at the same time, the overall increase in body weight should not exceed 2.5 kg. If there is an increase in fluid loss through sweat, the volume of fluid consumed may be slightly higher.

An important feature of nutrition in chronic renal failure and acute renal failure is complete abstinence from salt or its minimal use. You are allowed to eat no more than 8 g per day.

Find out the principles of treatment for acute renal failure in our article.

In addition to limiting the consumption of salt and salty foods, it is necessary to limit the consumption of foods rich in potassium. Their list is as follows:

• bananas;
• citruses;
• dried fruits;
• potatoes and some vegetables;
• natural juices;
• bran;
• greenery;
• cereals;
• chocolate;
• cocoa;
• nuts.

If a person counts the potassium consumed, then its volume per day is should not exceed 2000 mg.

As with potassium, you should limit your intake of foods with phosphorus (fish, cheeses, etc.).

With the above restrictions, a person should eat a sufficiently varied diet and get enough protein and energy.

When adhering to a diet, it is also necessary to take into account the individual characteristics of the body, as well as follow the recommendations of the attending physician.

In case of any problems, you must contact him immediately to avoid worsening the condition.

How the hemodialysis process is carried out, see in detail in the video:

Hemodialysis is a method of purifying the blood by selectively removing toxins through an artificial semi-permeable membrane. It is used in patients with acute and chronic renal failure.

The “father” of hemodialysis is considered to be the Scottish chemist Graham, who in 1856 described the process of diffusion, which he called “dialysis.” By the process of diffusion, he understood the movement of water-soluble substances with small molecular weight through a semi-permeable membrane from a more concentrated solution (urine) to a less concentrated one (distilled water). The first hemodialysis session in humans was performed by Georg Haas in 1911 in Strasbourg. Colloidal membranes in the form of thin tubes were used as filters for blood purification. At first, hiruidine (a drug obtained from the secretion of the salivary glands of a medicinal leech), and then heparin (an extract from the liver of cattle) were used as blood thinners. The dialysis machine designed by Haas was impressive in size. It consisted of eight cylindrical containers filled with dialysate fluid, inside which were tubes through which blood flowed.

Between 1926 and 1928, he performed about 20 hemodialysis sessions for patients with acute renal failure. Each hemodialysis session lasted about 60 minutes. Unfortunately, all patients died in a short time from intoxication and blood poisoning.

In 1943, W. Kolff first used cellophane membranes as filters. Fifteen patients with acute kidney injury died after hemodialysis sessions. And only the sixteenth patient survived after two dialysis sessions; renal failure was cured. This method of treatment was sharply criticized by members of the scientific community. And only the invention of J. Merril flame photometry - a method for assessing the chemical composition of blood, made it possible to significantly reduce the mortality of patients from disturbances of water and electrolyte balance.

Currently, the widespread use of hemodialysis in medicine has saved the lives of millions of patients with acute and chronic renal failure.

Indications for hemodialysis procedure

A hemodialysis session is indicated for the following conditions.

Signs of uremic (caused by the accumulation of harmful substances in the blood that are not eliminated during kidney disease) intoxication: nausea, repeated vomiting, weakness, slight increase in temperature, unstable blood pressure.

Excess fluid, which manifests itself in the form of treatment-resistant edema, as well as an increase or decrease in the concentration of potassium, sodium, and chlorine in the blood.

Severe renal dysfunction: glomerular filtration rate below 10 ml/min (in children and patients with diabetes mellitus less than 15 ml/min).

Decompensated acidosis is a condition associated with an increase in blood acidity (pH) less than 7.35.

Life-threatening edema of the brain and lungs associated with intoxication of the body.

Contraindications for hemodialysis

The following contraindications are identified for chronic hemodialysis:

A marked decrease in blood pressure associated with significant blood loss or the release of large amounts of urine, for example, in the initial period of nephrotic syndrome.

Blood clotting disorder with a high probability of developing profuse bleeding

Cardiovascular diseases in the stage of decompensation, in which a hemodialysis session can dramatically complicate the patient’s condition.

Active inflammatory process, for example, tuberculosis of internal organs, sepsis.

Oncological diseases with metastasis

Mental illness of the patient.

In an emergency situation, there are no contraindications for an acute hemodialysis session.

Hemodialysis procedure

An acute hemodialysis session is indicated for patients with acute renal failure who are in critical condition. As a rule, it is carried out in the intensive care unit. The number and frequency of procedures is determined by the severity of the patient’s condition. As a rule, these are daily long sessions. Under favorable conditions, it is possible to restore defective kidney function either completely, or, in severe cases, develop chronic renal failure.

Chronic hemodialysis is performed for patients with end-stage chronic renal failure. There is no need for hospitalization for it. Patients travel from home to outpatient centers or hospital-based dialysis units. After the procedure, they return home, meaning their quality of life remains virtually unchanged.

To conduct a hemodialysis session, the patient must be connected to an artificial kidney machine. The patient is first provided with permanent or temporary vascular access. Temporary vascular accesses, such as catheterization of large veins (subclavian, jugular, femoral veins) in modern conditions are applicable only for emergency procedures.

Central catheter in the subclavian vein.

Their long-term use is prohibited due to their possible suppuration during prolonged standing and the development of catheter-associated sepsis.

Currently, the gold standard for adequate vascular access is the formation of an arteriovenous fistula. As a rule, during the operation the radial artery (forearm fistula) or brachial artery (shoulder fistula) is sutured to the saphenous vein. As a result, the vein discharges blood from the artery under high pressure. Vein wall thickens, its lumen becomes wider, the vein does not collapse at a high speed of blood sampling.

This process is called arterization of the vein. This makes it possible to puncture a vein with thick needles for hemodialysis.

Permanent vascular accesses include placement of a permanent (permanent) catheter and bypass surgery. Indwelling catheters are specially treated to prevent infection and, when used correctly, last for several years. In bypass surgery, an artery and vein are connected by a synthetic prosthesis. Indwelling catheters and arteriovenous shunts are preferable if it is impossible to form a natural arteriovenous fistula, for example, with a loose type of vessel structure or a very thin afferent artery.

The “artificial kidney” device is a product in the form of a small block, equipped with electrical and hydraulic systems that guarantee a safe and effective process of cleansing the blood of toxins.

Modern devices are mobile and easy to operate and maintain. Each artificial kidney device consists of several blocks. The circulatory unit includes pumps that move blood to the dialyzer. A standard hemodialysis session takes place at a blood flow rate of 250-350 ml/min. In the dialysate unit, ultrapure water and salt concentrate are mixed in a certain proportion to prepare the finished dialysate solution. The correct composition of the dialysate solution plays a significant role in ensuring patient safety during dialysis. The extracorporeal unit includes a dialyzer and blood lines. A dialyzer is a filter in which the process of cleansing the blood of toxins and saturating it with useful substances occurs.

The main characteristics of a dialyzer are the active surface area, the size of which directly determines the cleaning ability, and the method of sterilizing the dialyzer. Dialyzers sterilized by gamma irradiation or hot steam are currently preferred. Current guidelines do not recommend reusing dialyzers. Capillary dialyzers with synthetic membranes made of polysulfone, Helixon, polyamix, etc. are currently considered the safest and most effective.

The blood purification control and monitoring system consists of many sensors, the main task of which is to ensure an effective blood purification process and patient safety.

Currently, it is recommended to conduct chronic hemodialysis sessions 3 times a week for at least 4 hours. Dialysis time, blood flow rate and type of dialyzer are calculated based on the patient's body weight, age, and residual renal function.

The patient arrives to the hemodialysis site with an ambulance team, special transport or independently. He leaves his outerwear in the locker room, changes into clean change of clothes and shoes, and goes up to the dialysis room. Before each procedure, medical staff weighs the patient (to assess the increase in fluid during the interdialytic period), measures blood pressure, heart rate, and evaluates some other physical characteristics. If the patient’s condition is stable, the doctor decides to start a hemodialysis session.

To connect to the “artificial kidney” device, a vein is punctured in the area of ​​the fistula, prosthesis, or, if there is a catheter, the blood supply lines are connected to the catheter ports. When the lines are filled with blood, heparin is administered to prevent the formation of blood clots. During a hemodialysis session, medical personnel assess the patient’s condition (blood pressure, heart rate, body temperature) and, if necessary, adjust the treatment program.

After completing the session, the patient is weighed (to assess the volume of fluid taken and determine the “dry” weight, that is, weight without excess fluid), receives doctor’s recommendations for the interdialysis period, and goes home.

Once a month, blood is taken from the patient for analysis, which allows us to assess the degree of blood purification and, if necessary, adjust the hemodialysis program. Also, a blood test determines the concentration of hemoglobin, red blood cells, hematocrit, indicators of iron metabolism in the body to determine further tactics for treating anemia, as well as the level of calcium, phosphorus, parathyroid hormone and vitamin D metabolites to correct disorders of phosphorus-calcium metabolism. Every 6 months, hepatitis B, C, HIV and Treponema pallidum viruses are determined in the blood of patients. All patients receiving hemodialysis treatment must be vaccinated against hepatitis B and C viruses. If necessary, other laboratory and instrumental tests, as well as specialist consultations, can be performed.

Possible complications of hemodialysis

Despite its apparent simplicity, each hemodialysis session is a serious procedure that can easily lead to serious complications.

A drop in blood pressure is one of the most common complications of a hemodialysis session. Predisposing factors are old age and concomitant diseases of the cardiovascular system. Typically, a decrease in blood pressure is associated with a large volume or rate of fluid withdrawal during dialysis. Treatment is carried out by reducing the intake parameters and restoring fluid deficiency.

High blood pressure is also a serious complication that, if left untreated, can lead to a heart attack or stroke. In the treatment of hypertension, adequate fluid intake and the use of hypertensive drugs become a priority.

Muscle cramps are usually associated with excessive fluid intake. Treatment consists of stopping fluid withdrawal and introducing solutions that are hypertonic to blood plasma.

Nausea and vomiting are associated with a drop in blood pressure, as well as dysfunction of the gastrointestinal tract. Treatment should be aimed at increasing blood pressure, administering antiemetics, and treating concomitant diseases of the gastrointestinal tract.

Often headaches on dialysis are associated with high or low blood pressure. Treatment consists of correcting blood pressure and administering painkillers.

An increase in temperature is usually associated with an infection or a biocompatibility reaction. If an infectious disease is suspected, antibacterial drugs are indicated.

The biocompatibility reaction is the response of the human body to blood contact with the components of the artificial kidney apparatus. It manifests itself in the form of an allergic reaction such as anaphylactic shock, or a pyrogenic reaction, which is accompanied by an increase in temperature, a decrease in the number of blood leukocytes, and back pain. Anaphylactic shock is characterized by a pronounced drop in blood pressure, difficulty breathing and requires immediate cessation of dialysis and emergency care. In case of a pyrogenic reaction, continuation of dialysis with the use of symptomatic treatment is indicated. Subsequently, it is recommended to identify the material to which the patient is reacting and replace it with a safer analogue.

Patients with such severe complications as disequilibrium syndrome, arrhythmias, cerebral and pulmonary edema should be in the intensive care unit under the supervision of specialists.

The life expectancy of patients undergoing hemodialysis sessions is on average 10-15 years, subject to compliance with the water and drinking regime, adequate vascular access and correct treatment tactics.

General practitioner, nephrologist Sirotkina E.V.

Hemodialysis is a multifunctional device, an artificial kidney, used to purify blood plasma. Prescribed to patients to remove toxins, urea and creatinine. Used in patients with renal failure.

The process involves passing the blood through a special solution that cleanses the plasma of toxins and restores the salt balance in the body.

Indications for hemodialysis are tests and a doctor’s referral to save the lives of patients and maintain stable indicators. Using dialysis and a membrane filter, the blood is purified and returned. The method allows people with kidney disease to live an additional 30 years. The solution (dialyzer) removes excess H2O and harmful substances from the blood plasma.

The concentrated dialysis solution is enriched with sodium, potassium, magnesium, and sodium ions. The principle of the method is to restore electrolyte balance. The pump creates a pressure difference between the dialysis system and the patient's body, removing fluid and helping to eliminate swelling. The required dosage can be determined and calculated by assessing the results of laboratory tests.

Purpose of the procedure.

1. Cleanliness of the kidney from substances dangerous to the body.
2. Uric acid.
3. Remove creatinine.
4. Removal of toxins and medications.
5. Acute methyl and ethyl poisoning syndrome.
6. Restoring electrolyte balance.
7. Cleansing the body's blood.
8. To avoid disability, kidney hemodialysis is performed.

After passing the examination, individual dialysis is carried out for each patient. Drugs are added to the composition to prevent the formation of blood clots. High-quality production of a dialyzer and membrane filter affects your well-being after the procedure. An alternative to organ replacement and avoiding complications.

Types of hemodialysis

There are 3 types of procedures and the differences between them:

1. In stationary conditions.
2. Use at home.
3. Outpatient view.

Using a portable device for home use is expensive. The quality of purified blood depends on the equipment and technology used in its production. These are the disadvantages of a portable device. The advantage is its compactness and purification of blood plasma without visiting the hospital. The daily duration of therapy is four hours, treatment is prescribed by a doctor.

Outpatient treatment is used for any degree of renal failure; there is the possibility of ultrafiltration of the blood circulation. Limitation of hemodialyzer filtration three times a week.

The doctor corrects the process by changing the procedure technique. The medical instruments used undergo sterile processing; the possibility of infectious infection is reduced to zero.

Inpatient treatment is carried out similarly to outpatient treatment. Poisoning with dangerous drugs and barbiturates, leading to acute renal failure. The dialysis solution is injected into a vein through an installed catheter in order to maintain the efficiency of the organ. There is a danger of contracting an infection. The protocol contains ICD 10, code N°18.

Indications and contraindications for the procedure

Hemodialysis is prescribed in emergency cases when the disease is not amenable to therapeutic treatment. Such diseases include: ethyl and methyl alcohol consumption, acid and electrolyte imbalance, drug intoxication, poisoning, diseases related to the type of hyperhydration (excess fluid in the body), heart disease.

Renal failure is one of the main indications for the use of hemodialysis to preserve life. Hemodialysis therapy makes it possible to normalize the child’s condition when the medical prognosis is unfavorable.

Hemodialysis, its indications and contraindications are extensive. Impaired kidney function has a negative impact on other organs.

Possible complications after blood filtration.

• increased blood pressure (hypertension);
• anemia;
• nervous system disorder;
• heart disease and bone pain.

Observation by doctors revealed contraindications for the procedure: liver disease (cirrhosis), circulatory disorders in the brain, blood diseases (leukemia), anemia, schizophrenia and any mental health disorder. Elderly people over eighty years old, over seventy years old with signs of diabetes, oncology, hepatitis B and C, after a heart attack and stroke, heart failure, vascular dystonia.

The method of extracorporeal blood purification is contraindicated for people with tuberculosis and lung diseases.

For what diseases and creatinine levels is it indicated?

Before prescribing hemodiafiltration of plasma, diagnostics and tests are carried out to determine the level of creatinine and acidity of urine, volume per day, content of calcium, magnesium, potassium ions, serum balance and blood cells. Blood for general analysis, testing for coagulation after administration of the solution.

The daily volume of urine is more than 450 ml, the kidney purifies more than 200 ml of blood per day, which is 16% less than the standard volume, the level of uric acid in the blood<36 моль/л, креатинин <1,5 моль/л, калий <6,5 моль/л, бикарбонат натрия >20 mol/l.

The appearance of edema of the brain, lungs and fluid surrounding the heart, which did not give a positive result, after drug intervention.

Portable devices temporarily relieve pain.

Decoding the value of creatinine concentration in daily urine

Creatinine is excreted from the body by the kidneys. It is the end product of the breakdown of protein compounds in muscle mass. The larger the muscle, the more creatinine is produced. It is present in constant amounts in plasma. The female body contains 52-98 mol/l, the male 60-117 mol/l. A child up to one year old is 16-34 mol/l, up to fourteen years old it is 25-63 mol/l.

The terminal stage occurs when the creatinine level reaches 1.5 mol/l, urea increases 9 times the norm - up to 20 mol/l. Uremic coma occurs with creatinine values ​​of 1.1 mol/l, a decrease in filtration to 11 mol/l, an increase in ammonium content to 60% of the norm, and an increase in the amount of urea to 35 mol/l.

Basic hemodialysis parameters

A conventional basic device uses a membrane of 0.7-1.6 square meters, a blood flow rate of three hundred ml/min. The procedure lasts five hours.

Dialysis with high efficiency develops a speed of five hundred ml/min, in the direction from the dialyzer eight hundred ml/min. Saves time by two hours.

High flow with large molecules helps remove poisons and toxins from the circulatory system and reduces seizures. An absolute indicator of the benefits of hemodialysis on the lives of patients, the formation of balance in the body system, thanks to the therapy carried out by doctors.

How the procedure works and alternative methods

Before starting work, the equipment is sterilized and disposable elements are replaced. After passing through the filter, the blood returns through a valve that does not allow air bubbles and foam to pass through.

For patients who need ongoing long-term care, surgery is performed to insert a shunt connecting the vein and the aorta. The time required for wound healing and the use of a shunt is three months. The operation is performed before the start of the procedures.

When using a blood filter temporarily, surgery is not required. Drugs that block the formation of blood clots are added to the injected drug. The hemodialysis process does not cause pain.

A special feature of dialysis is the variety of alternative methods. Use at home and in medical institutions. The diagnosis of “renal failure” is not a death sentence; if you follow the diet and intensive treatment, symptoms will not appear.

Filtration is performed in three ways.

1. The peritoneal method involves introducing special solutions into the abdominal cavity and then replacing them with a new one. Provide dialysis to patients in need of plasma purification who are unable to visit the hospital. The essence of the method is to use a catheter, which is installed in the abdominal cavity below the navel. The single-needle method does not cause discomfort or pain.
2. Intestinal filtration is similar to an enema. It contains a solution with ionic components. Prescribed during poisoning in patients with chronic kidney disease. The advantage is that it can be done at home.
3. The automatic method involves execution without a person. The program performs dialysis according to the commands entered into it. Performance is improving. Before the procedure you need to prepare.

How does hemodialysis affect life expectancy?

Thanks to new technologies, hemodialysis has increased life expectancy to thirty years. You should prepare for the procedure, follow a diet before and after it, in order to avoid negative consequences. Clinical studies have proven that the extracorporeal method is effective in the treatment of renal failure.

People suffering from excess fluid in the body and kidney failure have a chance to live longer. The drug purifies water by filtering and enriching it, restoring metabolic processes and acid-base balance.

Each patient is approached individually. The number of sessions for using an artificial kidney depends on the history of the disease. The mortality rate of patients from renal failure is high. The sooner the filtration process begins, the higher the likelihood of preventing exacerbation and worsening of the condition. The frequency of the procedure depends on the reserves of the human body.

Inactivity is the leading cause of death. The use of hemodialysis in the early stages will lead to an increase in life by tens of years. Replaces the kidney, performing its functions. An organ in advanced form and with weakened immunity functions 3 times less.

In severe forms of renal failure, a problem arises with blood purification: urea, breakdown products, salts, creatinine remain in the body, and intoxication develops. Hemodialysis is performed to help weakened organs.

What it is? How does the device purify blood in the body? Indications and contraindications for hemodialysis. What is the life prognosis with regular visits to a medical facility for artificial removal of toxins? What diet is effective for severe kidney pathologies? The answers are in the article.

• What is hemodialysis
• Types and classification
• Contraindications
• Preparation
• Stages of implementation
• After the procedure: recommendations
• Diet and nutrition rules
• Medicines
• Complications and prognosis

What is hemodialysis

An extracorporeal method of removing harmful substances, purifying blood outside the body, is carried out in acute forms of renal failure. The affected organs cannot remove toxins; without the use of a special technique, poisons, creatinine, and urea accumulate, and the patient dies.

Hemodialysis allows a person to survive until a kidney transplant. The essence of the method is to cleanse the body, normalize acid, water and electrolyte balance, improve general condition, and remove substances with different molecular weights. For oncological pathologies of various organs, dialysis reduces intoxication.

Every three days the patient visits a hemodialysis room in a specialized medical institution. Session duration is 4 hours. An artificial kidney device is used to filter blood. Installations are distinguished according to the structure of the semi-permeable membrane.

A set of high-tech equipment consists of several components:

• blood supply system;
• dialyzer;
• systems for preparing and supplying a special medical solution under a certain pressure.

In the USA and Europe, many patients with kidney failure can purchase special equipment to replace the natural filter and perform hemodialysis at home. The One system is effective and quite expensive, but the weight of the device is acceptable - about 30 kg. Positive aspects: you can carry out procedures at a convenient time; connecting the installation at home saves people with disabilities who have difficulty moving due to various diseases.

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Types and classification

Kidney hemodialysis is carried out:

• in hospital;
• outpatient;
• at home.

Classification by level of blood purification apparatus:

• conventional dialysis. The duration of the procedure is from 4 to 5 hours, the basis of filtration is a cellulose membrane. The throughput of the installation is up to 300 ml per minute;
• highly efficient dialysis. Doctors use a dialyzer, the speed of the dialysate (a special solution with a certain set of substances) is from 600 to 800 ml per minute, the speed of blood flow is up to 500 ml per minute. The membrane allows less harmful substances to pass through, the quality of cleaning improves, and the time is reduced to three to four hours;


• dialysis using highly permeable membranes. The most effective method is the synthesis of hemofiltration and hemodialysis. Highly permeable surfaces reduce the risk of complications and increase flow rates. The only negative is the possibility of penetration of dialysate components into the blood; strict adherence to sterility is required.

Indications for the procedure

• acute glomerulonephritis;
• acute renal failure;
• poisoning by poisons and alcohol-containing liquids;
• overhydration, with little effectiveness of other methods of removing excess fluid;
• medication overdose;
• pyelonephritis;
• severe chronic renal failure with ineffectiveness of other methods of therapy;
• serious disturbance of water and electrolyte balance, threatening serious complications;
• accumulation of a large volume of fluid, against the background of which cerebral or pulmonary edema may develop;
• blood levels of creatinine, protein, glucose, and uric acid are significantly higher than normal;
• intoxication with pronounced symptoms;
• severe exhaustion of the body.

Contraindications

Blood purification using special equipment is not suitable for all patients. When choosing a procedure, the doctor prescribes tests and additional examinations to make sure there are no restrictions.

Relative contraindications:

• peptic ulcer;
• Melory-Weiss syndrome;
• uterine fibroid;
• pulmonary tuberculosis.

Absolute contraindications:

• anemia;
• patient age 80 years or older;
• severe nervous system disorders;
• a combination of two or more pathologies: advanced forms of atherosclerosis, heart failure, pulmonary diseases, myocardial infarction, liver cirrhosis;
• malignant formations (stage IV);
• diabetes mellitus aged 70 years or more;
• schizophrenia, epilepsy, psychosis, other disorders of this kind;
• drug addiction, alcoholism, if the patient is not committed to social rehabilitation.

Preparation

• conversation with the patient, explanation of the essence of the method;
• a week before the first session, doctors create vascular access. An arteriovenous fistula under the skin is the main way to prepare vessels for the procedure;
• an alternative is the use of prostheses. The synthetic material is implanted under the skin in the operating room by the doctor. The result is a cavity resembling a cord for convenient needle insertion;
• before the session, the doctor measures blood pressure, pulse, temperature;
• monitoring of body condition indicators is carried out not only before, but also during the procedure, as well as after blood purification.

Stages of implementation

Stages of dialysis:

• preparation of the device and patient;
• the patient lies down in a chair, “reclining” position;
• There is an installation near a special chair. The doctor connects an arteriovenous or venovenous line to communicate with the body;
• after turning on the pump, a certain pressure is created, under the influence of which the blood is filtered and comes into contact with the dialysate;
• the purified liquid returns to the bloodstream through the connected second vein;
• After the procedure, a bandage is applied to the needle insertion site.

To maintain health and reduce the load on weakened kidneys, doctors recommend adhering to the following rules:

• do not drink alcohol, stop smoking, drugs;
• spend more time outdoors;
• Healthy food;
• avoid heavy physical activity;
• take prescribed medications and vitamins;
• do a set of therapeutic exercises daily;
• inform the nephrologist about any deviations in health, and visit a specialist in a timely manner.

Diet and nutrition rules

• moderate protein intake;
• limiting salt in the diet;
• do not exceed the fluid limit to prevent swelling;
• replace red meat and offal with poultry, legumes in moderation, and soy protein;
• reduce potassium intake from food. Potassium-rich foods: nuts, bananas, dried apricots, raisins, potatoes, chocolate;
• Eat fish in moderation: the phosphorus concentration should not be exceeded;
• monitor calcium balance, do not overuse dairy products and hard cheeses;
• refusal of spicy, peppery, fried foods;
• portions are small, meals 5 to 6 times a day;
• a balanced diet, mandatory inclusion of non-acidic fruits, a variety of vegetables, seafood, vegetable oils in the menu;
• limiting heavy animal fats;
• It is prohibited to consume carbonated drinks with preservatives or artificial colors. Mineral water is allowed without gas (only as prescribed by a doctor).

If the patient has received recommendations for diet 7a or 7b, then in case of any violations of the nutritional rules, it is important to warn the doctor performing dialysis about the deviations. The doctor will promptly adjust the concentration of components in the dialysate solution. For example, shortly before the procedure, the patient consumed smoked meats, alcohol, a lot of sweets, tomatoes, salted tomatoes or cucumbers, and lightly salted herring. The doctor supervising hemodialysis should definitely know about this.

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Medicines

The optimal drug for each patient is selected by a nephrologist based on test results, taking into account the degree of kidney damage, and the condition after the extracorporeal blood purification procedure. During long-term hemodialysis, it is important to take the medications prescribed by the doctor: a weakened body is attacked by infections, and the risk of complications increases.

Common cases:

• for anemia, the human hormone erythropoietin is recommended;
• Pregnant women are often prescribed multivitamins and magnesium sulfate;
• when hemoglobin decreases, iron supplements are effective;
• If you have urolithiasis, you should not overuse vitamin C;
• if there is excess iron content, you should not take additional medications with this component;
• Support the body with compounds containing phosphate.

Complications and prognosis

During HD, equipment malfunctions, catheter blockage, and allergic reactions to the components of the dialysis solution are possible. In rare cases, accidental infection occurs during preparatory procedures due to violations of sterility rules. Sometimes doctors incorrectly select the concentration of the solution components: they mistakenly reduce or increase the sodium level, which negatively affects the patient’s well-being.

With individual sensitivity, negative manifestations are possible:

• epileptic seizures;
• nausea;
• heart rate fluctuations;
• weakness;
• convulsions;
• decrease or increase in blood pressure;
• dizziness;
• vomit;
• air embolism;
• a decrease or increase in sodium concentration.

Many patients ask how long they live after starting blood purification procedures outside the body. Doctors give only approximate forecasts - from 6 to 14 years. Some patients die earlier, others tolerate the procedures quite well, and life expectancy with a transplanted kidney reaches 20 years. The main cause of complications after procedures is severe immune disorders. With a decrease in protective forces, death is possible due to intestinal pathologies, pneumonia, and dangerous viral infections.

This video shows in an accessible form the principle of operation of a hemodialysis machine:

vseopochkah.com

What is hemodialysis and how long do they live?

In a normal state, the kidneys are a kind of filter that cleanses the body of unnecessary substances - chemical and biologically active. Their other function is to remove excess fluid. But sick kidneys cannot bear such a load - their filtration capacity decreases, the body becomes clogged with various toxins and excess fluids. This is called kidney failure.

Since the filtering organs cannot cope with their task on their own, they need medical assistance. In such cases, dialysis is performed. What it is? In medicine, it is essentially a replacement for diseased organs. The procedure involves the use of a special membrane apparatus, which filters the blood, actually taking on the role of a natural purifier. It is not surprising that people call it an artificial kidney.

Simplified, this manipulation looks like this: the device contains a special cleaning solution. The patient's blood enters him through tubes. There it gets rid of harmful substances and returns to the human vein in its pure form.

How long do people live with hemodialysis?

There is no clear answer to the question of how long people live on an “artificial kidney”. Everything depends on the work of other organs. More often than not, people undergoing dialysis die not from pathology of the kidneys themselves, but from a general drop in resistance and from concomitant cardiovascular diseases. There are cases where a person lived on an artificial kidney for more than forty years. But this is the exception rather than the rule. The average life expectancy, subject to medical prescriptions, is 20 years.

What is a hemodialysis fistula?

To carry out medical procedures to cleanse internal fluids, it is necessary to provide access to the veins. For this purpose, a special mini-operation is performed: creating a fistula for dialysis.

During it, arteries and veins are sewn together. The result is one vessel. The quality of the arterial blood flow in it allows for cleansing measures. Usually the fistula is created on the arm. Sometimes it is necessary to use stents instead - synthetic tubes made of hypoallergenic materials or catheters.

Hemodialysis indications and contraindications

Indications for hemodialysis are as follows::

• renal failure: acute and chronic;
• severe electrolyte disturbances;
• swelling, including of internal organs, which does not provide positive dynamics from conservative treatment;
• dangerous poisoning with drugs and poisons and alcohol-containing liquids;
• a drop in glomerular filtration rate to a level of 15 ml per minute;
• symptoms of uremia: polyneuropathy, vomiting, pericarditis, itching;
• acute urinary retention.

Such conditions in patients can lead to death.

Absolute contraindications:

• malignant tumors of any location;
• serious diseases of the nervous system;
• mental disorders;
• chronic renal failure, causing irreversible complications to other organs;
• the patient's advanced years.

During the entire period of dialysis, it is mandatory to undergo examinations and tests.

How often should hemodialysis be done?

How many times should I cleanse? It is necessary to understand that “artificial for now” is not a panacea, it does not cure, but only takes over the functions of diseased kidneys. It is best carried out in specialized centers, but it can also be carried out in the therapeutic departments of regular hospitals.

The frequency of manipulations can only be determined and prescribed by the attending physician. It depends on individual parameters - weight, height, blood flow characteristics and the characteristics of the dialyzer itself. There are formulas based on which doctors calculate the optimal frequency of dialysis.

Hemodialysis at home

No matter how complicated the procedure is, it can be done at home. But for this you need to prepare the blood flow, as described above. This cannot be done without medical intervention. It is also unlikely that you will be able to connect the device yourself - this is dangerous and fraught with complications.

Complications of hemodialysis

These exist, and they are divided into two large groups:

• early. They arise in the process itself. Reasons: technical imperfection of the hemodialysis device, irregularities in the administration of medicinal products, etc.;
• late. They are caused by a lack of kidney function. These complications can be corrected with diet and supportive therapy.

It is necessary to carefully monitor the serviceability of the device in order to avoid technical problems, which often end in failure.

rus-urologiya.ru

Extrarenal blood purification - hemodialysis. What is a dialyzer?

Hemodialysis is a type of renal replacement therapy that can replace kidney function. The device allows you to filter the blood, remove excess fluid and maintain normal electrolyte balance. The hemodialysis procedure involves removing blood from the body and then filtering it in a special device - a dialyzer. Otherwise, the device is called an “artificial kidney.”

It is known that, on average, a person has about 5-6 liters of blood. During hemodialysis, only about 500 ml is outside the human body at one time. The first dialyzers were quite bulky, multi-kilogram devices, inside of which a cellulose membrane was placed. Modern dialyzers are quite compact and easy to use. They perform their functions perfectly and simultaneously monitor many important variables: blood flow and pressure, the amount of fluid removed, etc. The “artificial kidneys” have two sections:

• section for dialysate solution;
• section for blood.

These two compartments are separated from each other by a semi-permeable synthetic or semi-synthetic membrane, so blood and solution never mix. This membrane consists of capillary fibers with a diameter of 0.2 mm. It is “packed” into a cylinder, 30 cm long and 5–6 cm in diameter. A semi-permeable membrane has microscopic pores that allow only certain substances to pass through. Including, it allows water and toxic substances to pass through: urea, uric acid, excess sodium and potassium, but does not allow red blood cells to pass through.

Functions of dialysate

A special dialysate solution enters one of the dialyzer sections. In its composition, it is similar to blood plasma, or rather, to its liquid part. It consists of pure water with electrolytes and salts, such as sodium bicarbonate. Its composition varies depending on the electrolyte content of the patient's plasma, including changes in the concentration of chlorine and sodium. The main function of the dialysate is to remove toxic substances from the patient's blood. This is made possible by diffusion. The patient's blood is pumped through tubes into the dialyzer compartment. In a person with kidney failure, it contains a large amount of waste: breakdown products, sodium, potassium. These toxic substances pass through the semi-permeable membrane. And the dialysate solution “washes” its walls, thereby removing all harmful substances. Thus, the patient’s blood is cleansed of waste and toxins.

In addition, the dialyzer removes excess fluid from the blood. Ultrafiltration is carried out due to transmembrane pressure maintained by a special pump. On average, during one hemodialysis session, the patient gets rid of 1.5 to 2 liters of excess fluid. Modern hemodialysis machines are equipped with units that automatically determine the required pressure to remove water. After filtration, the blood is returned to the patient's body.

How is the blood purification procedure carried out? Connecting the Patient to the Dialyzer

If during the procedure the patient feels worse, he can ask the healthcare provider to adjust the dialysis speed or the composition of the solution.

When a patient comes in for hemodialysis, a nurse or other health care worker checks vital signs such as blood pressure, body temperature, and weight. It reflects the amount of excess fluid that needs to be removed during the therapeutic procedure. Next, the patient is connected to the device. How does this happen? When performing hemodialysis, to ensure blood flow into the dialyzer from the body and back, the following can be used:

• arteriovenous fistula;
• central venous catheter;
• transplant.

A fistula allows you to increase blood flow in the vein, strengthening its wall and making its diameter larger. It is the fistula that is recommended by many doctors, as it allows the vein to be made suitable for regular needle insertion. For temporary access, during one-time dialysis, a central venous catheter is used, a soft tube that is inserted into a vein in the chest, neck or thigh. In some cases, for example, when it is not possible to place a fistula, a graft is used - a synthetic tube, but various complications often arise because of it. Two needles are inserted into the body of a patient with a fistula or graft and secured with a plaster. Each of the needles is attached to a plastic tube that leads to a dialyzer. Through one tube, the blood will flow into the apparatus, where it is filtered and cleansed from waste and toxins. The second tube will return the purified blood to the patient's body.

After inserting the needles, the dialyzer is programmed, and the immediate purification of the blood begins. During the procedure, pulse rate and blood pressure must be monitored, since the removal of a significant amount of fluid can cause fluctuations in these indicators. At the end of hemodialysis, the healthcare professional removes the needles from the patient's body and applies a pressure bandage to the puncture sites to prevent bleeding. Finally, the patient is weighed again and the amount of fluid removed is determined.

It is worth noting that during the procedure a person may experience unpleasant symptoms: nausea, cramping abdominal pain, etc. They appear due to the removal of a large amount of accumulated fluid. If you experience discomfort, you can ask medical staff to adjust the hemodialysis rate and the composition of the dialysate fluid.

How often is hemodialysis necessary?

The blood purification procedure takes quite a long time. Over the course of several hours, the dialyzer removes toxic substances and excess fluid from the blood. Typically, patients with kidney failure require hemodialysis three times a week, for four hours each session. The attending physician selects for each patient an individually appropriate duration of procedures. One hemodialysis session can last on average from 3 to 5 hours. One procedure can only be shorter in time if the patient has residual renal function. Some patients find that hemodialysis takes too long. But it is worth remembering that healthy kidneys work constantly, and an artificial kidney should do its job in 12 or even less hours a week.

In addition to visiting the medical center three times a day, there is also an alternative treatment schedule. It includes night and day procedures. They are offered to patients who undergo hemodialysis at home. The nightly blood purification procedure lasts for 8 hours while the patient sleeps. It is longer than a regular session, so patients note that they feel better than after standard hemodialysis. Many medical centers have begun offering an overnight blood purification procedure based on patient requests, improved health, and excellent laboratory results. Short daytime treatments are performed five or six times a week for 2 to 3 hours. Talk to your doctor if you are interested in home hemodialysis or overnight treatments offered at medical centers.

Pros and cons of hemodialysis

Hemodialysis is an effective treatment for those who have end-stage kidney failure. But still, it alone cannot fully replace the work of healthy kidneys. Complex treatment for patients with renal failure also includes diet and fluid intake restriction. The diet involves limiting the consumption of foods containing phosphorus, potassium and sodium. In addition, you may need to take various medications to regulate your blood pressure and stimulate the production of red blood cells to prevent anemia.

Outpatient treatment, which involves regular visits to a medical center to receive hemodialysis, has its advantages and disadvantages. The most important advantage is that the patient is under the supervision of competent specialists and can always count on the professional conduct of the procedure and attentive attitude of the staff. During the procedure, people can relax: sleep, read books, write, watch TV, listen to music, chat quietly with neighbors. On four other days of the week they are not required to come to the center. The disadvantage of this type of treatment may be the need for regular and long trips to the treatment center. In addition, some patients note that they feel tired and exhausted after hemodialysis, so when they come home, they rest and sleep.

Patients who have chosen nightly hemodialysis (at home or in the center) say that the feeling of fatigue, as well as unpleasant, painful symptoms do not appear. Due to the fact that the blood purification procedure is carried out during sleep, people note that they feel more free, because they do not need to allocate time for hemodialysis during the day. This improves the quality of life and makes patients feel “normal.” People who perform hemodialysis at home enjoy a sense of control over their lives. Instead of going to the center at a specific time, they perform the procedures themselves, choosing the appropriate moment in their schedule.

There is another, alternative method of blood purification: peritoneal dialysis. It is a treatment method in which a silicone catheter is implanted into the patient's abdomen. Through this tube, several liters of dialysate solution are injected into the body, which cleanses the body of toxins and waste. The spent solution is drained. During the day, the procedure is repeated from 4 to 10 times. The patient also needs to adhere to a diet and limit the amount of fluid consumed. Peritoneal dialysis is performed daily. Typically, this procedure is performed at home, and therefore the patient does not need to visit medical centers three times a week. Peritoneal dialysis is often carried out at night, which makes life easier for the patient, allowing him to work, attend school or travel without fear.

All types of treatment have their advantages and disadvantages. Based on your preferences and medical treatment needs, you and your doctor can discuss all the options and choose which one is most suitable for you.

Why is hemodialysis necessary?

The most common causes of kidney failure are:

• diabetes;
• high blood pressure - hypertension;
• inflammation of the kidneys (glomerulonephritis);
• inflammation of blood vessels (vasculitis);
• kidney cysts (polycystic kidney disease).

Sometimes the kidneys can fail suddenly (acute kidney injury) - after a serious illness, major surgery, or heart attack. The use of certain medications can also cause kidney failure.

Your healthcare provider will help you determine when you should start hemodialysis based on several factors: overall health, kidney function, signs and symptoms, quality of life, and personal preferences. Kidney failure (uremia) is often accompanied by unpleasant symptoms such as nausea, vomiting, excessive swelling or chronic fatigue. The doctor, after listening to your complaints, will conduct the necessary diagnostics and tests, will definitely evaluate the glomerular filtration rate (GFR), and draw a conclusion about the functioning of the kidneys. GFR is calculated based on various variables: blood creatinine levels, gender, age, etc. Normally, GFR values ​​change with age. Estimating GFR will allow you to plan a course of treatment and set a date for hemodialysis. As a rule, blood purification begins before the kidneys completely stop performing their functions, preventing life-threatening complications. Hemodialysis will help your body control your blood pressure and maintain a balanced amount of fluids and various minerals, such as potassium and sodium.

Some people with chronic kidney failure may choose a different route: conservative treatment. It includes the active elimination of the underlying disease that led to impaired renal function and the complications that arose as a result, including edema, high blood pressure, and anemia. Conservative treatment focuses on managing symptoms that affect quality of life, nutritional therapy, and adequate fluid intake.

Hemodialysis results

The blood enters the hemodialysis machine through a tube, where it is purified and returned to the body through another tube.

If a patient has acute kidney injury, hemodialysis may be required for a short time until kidney function returns. In the presence of chronic renal failure, blood purification by artificial means may be required for a significant period of time. In this case, the chances of recovery and subsequent independence from hemodialysis are seriously reduced. If blood purification is prescribed in a critical situation, hemodialysis may be required for the rest of the patient's life. In this case, the attending physician will help you choose the optimal course of therapy.

Patients with kidney problems can receive hemodialysis in a health center, at home, or in a hospital. The frequency of treatments will depend on their individual situation and health indicators. The vast majority of patients receive hemodialysis on an outpatient basis, visiting medical centers three times a week and devoting 3 to 5 hours to the procedure.

Some studies show that home dialysis can improve the quality of life, reduce or completely eliminate unpleasant symptoms: headaches, shortness of breath, cramps, improve appetite, improve sleep and increase performance.

Daytime hemodialysis involves shorter but more frequent procedures: 2 – 3 hours, 6 – 7 days a week. A simple hemodialysis machine makes home treatments less labor-intensive. Once trained, any patient will be able to perform blood purification independently. This includes hemodialysis during sleep. Now patients with kidney failure have the opportunity to enjoy life and travel: in different countries there are hemodialysis centers where you can always get the required medical care. The main thing is to plan your visit in advance.

What other measures should a patient with renal failure take?

To achieve the best results in restoring kidney function, in addition to hemodialysis, the patient is recommended to adhere to a diet. You should eat the right, healthy foods and carefully monitor your intake of fluid, protein, sodium, phosphorus and potassium. It is recommended to develop an individual nutrition plan under the guidance of a nutritionist and strictly adhere to it. The daily menu should include protein-rich foods: fish, chicken, lean meat. Foods containing significant amounts of potassium should be avoided. Eating bananas, potatoes, chocolate, dried fruits and nuts can lead to complications. You should limit the consumption of salt, smoked meats, sausages, and pickles. Proper nutrition will help improve your hemodialysis results and overall well-being.

In addition to diet, you should limit your fluid intake. It is believed that the weight of a patient with renal failure in the intervals between hemodialysis should not increase by more than 5% of the total body weight. Large fluid intake can cause edema and hypertension. In addition, patients with kidney failure should take their prescribed medications. Strict adherence to your doctor's instructions will allow you to recover faster and restore the functioning of your body systems.

Finally, you need to trust your doctor and not be afraid to discuss any questions you have with him. Your doctor will carefully monitor your health to make sure hemodialysis is cleaning your blood properly. This will include regularly checking your weight and blood pressure before, during and after treatment. In addition, once a month you will undergo tests, including a biochemical blood test, a total urea clearance test, etc. Based on the results obtained, the attending physician will adjust the intensity and frequency of hemodialysis.

So, hemodialysis is an achievement of modern medicine that can significantly improve the quality of life of a patient who has kidney problems. But every person himself is able to help his body function normally with proper prevention of kidney diseases, and if problems arise, by following a diet and proper lifestyle.

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General information

Under normal conditions, every person's kidneys tend to function normally. However, sometimes these organs fail to filter a sufficient amount of both waste and liquid. As a result, the amount of these components reaches dangerously high levels, 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. Leaving this condition without proper attention 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 translated from Greek 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 of 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 rather complex processes that take place 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, and 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 of which is the 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 are talking 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 surgery, a kind of maturation of the fistula is observed. Its size increases, as a result of which its appearance begins to resemble a cord located 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 performed in a medical facility 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 of 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 disturbances in the electrolyte composition of the blood;
• drug overdose;
• pericarditis ( heart damage);
• poisoning with poisons that tend to penetrate the hemodialysis membrane;
• overhydration, which threatens the patient’s life and is not treated with 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:

• cirrhosis of the liver;
• 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;
• pathologies of 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;
• coronary heart disease with previous myocardial infarction;
• heart failure.

The list of relative contraindications is presented:

• diseases in which there is an increased 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 the immediate possible complications of dialysis, these are:

• 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 the consumption of both liquid and table salt to a minimum. If left untreated for a long time, this condition can cause both a heart attack and a stroke;

2. Anemia: accompanied by a significant decrease in the total level of 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 a hormone that is synthesized by healthy kidneys in order to stimulate the formation of red blood cells in the bone marrow. Anemia during this period can also develop against the background of 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 stages of renal failure, serious disturbances in the absorption of both phosphorus and calcium, as well as various vitamins, are observed, which causes the development of renal osteodystrophy. This condition refers to increased bone fragility. As a result, all these changes lead to the destruction of 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. The deposition of these substances in the skin provokes the development of 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

The most common side effects that make themselves known are:

• vomit;
• nausea;
• heart rhythm disturbances;
• muscle cramps;
• bronchospasm;
• chest pain;
• 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;
• consume an acceptable amount of fluid;
• take prescribed pharmaceuticals regularly;
• Immediately inform your doctor if any symptoms of complications develop;
• undergo preventive examinations with a doctor and take all 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 large amounts of protein. You should opt for chicken, lean beef, turkey and rabbit meat, since animal proteins are much better than plant proteins. Both butter 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 various heart problems, 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. Salt should also be consumed in minimal quantities, after which you will be very thirsty. The calorie content of the daily diet should not exceed 35 kcal per 1 kg of body weight.

Medications

Patients undergoing hemodialysis therapy require both special dietary nutrition and medications. 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 calcium levels in the blood can be increased using 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 stressful 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 the medical staff 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 change the appearance of the patient, 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 this 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 it will not be difficult to take a comfortable position before the procedure.
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 a 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 the transplantation of this organ, which was received 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.