Hemodialysis procedure time. "Without dialysis, a person dies of intoxication": How I live with kidney failure

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General information

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

Hemodialysis - what is it?

The term hemodialysis comes from the two words " haemo" And " dialysis", which in Greek means " blood" And " decomposition, separation". This term refers to an efferent method of blood purification in acute and chronic renal failure. Such purification is carried out using a special apparatus "artificial kidney". During its implementation, it is possible to extract from the body all the toxic components resulting from metabolism. In addition, this method allows you to restore various disorders of both water and electrolyte balance. Immediately, we note that specialists often use such a method of therapy as peritoneal dialysis, which has its own important features. So, for example, during hemodialysis, blood is purified using an “artificial kidney” apparatus, but during peritoneal dialysis, 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, problems related to blood purification began to be discussed in ancient times. In those days, 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 got 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 the numerous rather complex processes that take place in the human body. The first foundations of dialysis were laid by a Scottish scientist Thomas Graham. It happened in 1854. Already 50 years later, the first apparatus was created, with the help of 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. It happened in 1924 in Germany. The procedure took about half an hour.

Device "artificial kidney"

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 allow the extraction of components with a 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. An important role is played by some of the principles of ultrafiltration, which in turn help to remove water and toxic components with a higher molecular weight. To date, there is a huge number of different designs of this device. Despite this, they all have the same circuit and similar constituent components. They mainly consist 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 dialysis 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 a semi-permeable dialysis membrane. It is this membrane that allows you to divide the internal space of the dialyzer into 2 parts, one of which is for blood, and the other is for solution. If we talk about dialysate solution, then its composition resembles the ultrafiltrate of blood plasma. It is used exclusively to restore uremic disorders of the acid-base and salt composition of the blood.

Procedure - how is it carried out?

During the procedure, the specialist uses access to conduct blood through the device itself. To create such access allows a small surgical intervention. 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 used to connect an artery to a vein. As early as 7 days after surgery, a kind of maturation of the fistula is noted. Its size increases, as a result of which its appearance begins to resemble a cord under the skin. The duration of the process varies from 3 to 6 months. As soon as the maturation of the fistula comes to an end, dialysis needles are immediately inserted into it. If we talk about a stent, then it is allowed to use it already 2 to 6 weeks after its engraftment. As for 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 track 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 a vein. As a result, the vein becomes elastic and easily stretched, which significantly increases the effectiveness of this procedure.

Who performs?

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 received special training. The most important thing is to thoroughly rinse and sterilize the device before carrying out hemodialysis. The procedure lasts from 5 to 6 hours. All this time, it is necessary to carefully monitor the patient's pulse, his blood pressure, as well as the state of vascular access. Immediately after the procedure, a sterile dressing must be applied to the area.

How does it work?

For the procedure, a dialyzer is used, as well as a special filter designed to purify the blood. At 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 comes back through other tubes.

How often is this procedure allowed?

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

Materials and equipment

Here is a list of materials needed for one such procedure:

pumping station;
reverse osmosis for water purification;
hemodialyzer ( the device itself);
Consumables;
a sterile set in the face of tampons, wipes, as well as auxiliary tools;
disposable syringes;
medical scales;
drugs and emergency aid;
chair for the location of 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 translucent needles for puncture of an arteriovenous vascular prosthesis;
temporary central venous catheters;
bicarbonate and acetate concentrate in a special container.

Indications

The list of main indications for this procedure can include:

acute renal failure;
chronic renal failure;
alcohol intoxication;
serious violations of the electrolyte composition of the blood;
drug overdose;
poisoning with poisons that tend to penetrate the hemodialysis membrane;
hyperhydration, 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 can prolong the life of the patient. Moreover, hemodialysis in this case is considered to be a method of maintenance therapy.

Contraindications

Modern experts identify absolute and relative contraindications to this procedure.

Absolute contraindications include:

various lesions of cerebral vessels;
damage to the blood system in the form of leukemia or anemia;
serious damage to the central nervous system;
age over 80;
age over 70 with diabetes mellitus;
malignant neoplasms;
pathology of the lungs in the stage of obstruction;
chronic hepatitis;
pathology of peripheral vessels in the stage of decompensation;
mental illness such as epilepsy, psychosis or schizophrenia;
the presence of inclinations to drug addiction, vagrancy or alcoholism;
coronary heart disease with previous myocardial infarction;

The list of relative contraindications is presented:

diseases in which there is an increased risk of massive bleeding with the introduction of anticoagulants ( gastric or duodenal ulcer, uterine fibroids);
active forms of pulmonary tuberculosis and other vital organs.

Possible Complications

The kidneys take an integral part in the functioning of numerous systems of the human body. Given this fact, a violation of their work causes the failure of the functions of many other systems and organs.
As for the directly 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 pathologies of the kidneys, then experts recommend minimizing the use of both liquid and table salt. Prolonged lack of treatment for this condition can cause the development of both heart attack and stroke;

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

3. Damage to the nervous system: in medicine, this phenomenon is called peripheral neuropathy, which is accompanied by a violation of sensitivity in the area of \u200b\u200bboth the feet and legs, as well as the hands. There are plenty of reasons for this, namely diabetes mellitus, the accumulation of a large number of waste products in the body, a lack of vitamin AT 12 etc.;

4. Bone diseases: in patients with an advanced stage of renal failure, there are serious malabsorption of both phosphorus and calcium, as well as various vitamins, 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 in a form that facilitates the absorption of calcium. A clear imbalance of both phosphorus and calcium causes their deposition in the 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. the 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 the release of blood and heart contractions;

6. An increase in the total amount of potassium in the blood: this condition is called hyperkalemia. Patients on dialysis should follow a low potassium diet. Regular increases in the level of this component can provoke cardiac arrest.

Side effects

Most often, side effects such as:

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

Measures to prevent the development of complications

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

strictly follow the prescribed diet;
observe all hygiene rules;
consume the allowable amount of liquid;
regularly take prescribed pharmaceuticals;
immediately inform the doctor about the development of any symptoms of complications;
undergo preventive examinations with a doctor and take all the necessary tests.

Diet in dialysis therapy

In the fight against acute and chronic renal failure, both hemodialysis and special dietary nutrition are important, which is prescribed to all patients without exception. A properly selected diet can significantly reduce the waste accumulated in the blood due to the vital activity of the body.
Nutritionists advise such patients, in the very first place, to carefully monitor the level of potassium in the body. It's no secret that potassium is a mineral found in both milk and nuts, some vegetables and fruits, and chocolate. Its excessive amount or lack can have a detrimental effect on the heart. In the treatment of hemodialysis, it is necessary to consume a large amount of protein. Your choice should be chicken, lean beef, turkey and rabbit meat, as animal proteins are much better than vegetable 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 in case of any violations of the kidneys. Too much fluid can cause a variety of heart problems, swelling, and high blood pressure. It will not be superfluous to limit yourself in such products as nuts, milk, dried beans and cheese. The composition of all these products includes 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 are 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 preparations that 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 levels of calcium in the blood can be increased with the help of special forms of vitamin IN , as well as calcium preparations. Often, medications are also used to lower blood pressure, which is observed in 90% of cases out of 100.

Problems that arise

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 study 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 in no case can be avoided. 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 under such treatment are very often retarded in development, which distinguishes them from their peers. In adolescents, due to such treatment, self-esteem is significantly reduced. Elderly people cannot remain alone at all and move to live with their relatives. In general, psychological difficulties arise all the time. Given all this information, it is very important that both the patient and his relatives regularly consult a psychologist. This is especially necessary for obvious behavioral disorders, prolonged depression, as well as problems that are directly related to physical limitations or adaptation to such a rhythm of life.

Dialysis chairs

The chairs designed for this procedure are being improved more and more every year. This is not surprising, since they should 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 that the position of the chair can be easily changed during the procedure. Armchairs are characterized by both stability and ease of movement. The height of the footrest is also adjustable. Practically, 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 the conditions for reading, as it illuminates the entire manipulation field. There is also a special foot pedal used in emergency cases to move the chair to a horizontal position. To turn off the power supply of the chair, you do not need to reach for the outlet. It is enough to press the existing switch, which is located under the seat.

Home hemodialysis can replace kidney transplant

Canadian scientists conducted studies during which they came to the conclusion that home dialysis performed for various kidney pathologies can replace the transplantation of this organ, which was received from a deceased donor. The main feature of such 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. Moreover, at home, such procedures can be carried out almost every night. For 12 years, specialists have been monitoring their patients. All of them suffered from various pathologies of the kidneys. Some of them were treated at home, but the other part underwent surgery for a kidney transplant. After that, scientists compared mortality in the 2 groups. Their surprise knew no bounds, as it turned out that home dialysis is more effective than a standard transplant procedure. Scientists are confident that this particular procedure can become an excellent alternative to transplantation for all those patients for whom kidney transplantation is categorically contraindicated for one reason or another.

How to prevent the development of kidney pathologies?

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

do not sit on stones and cold ground;
do not abuse alcohol, especially beer;
after swimming in a cold pond, it is good to dry yourself with a dry towel and take off your wet underwear;
pay special attention to the medications taken, many of which tend to have a detrimental effect on the kidneys;
in no case should you carry colds and flu on your feet;
dress exclusively for the weather and cover your lower back at all times;
avoid hypothermia, which can cause vasospasm of the kidneys.

Before use, you should consult with a specialist.

Hemodialysis is a method that allows you to purify the blood of waste products (toxins, toxins, urea, protein decay waste, your own spent cells), normalize the level of electrolytes, and remove excess water using the device. With organ dysfunction, it is the only way to survive until transplantation, to prevent intoxication of the body and death due to kidney failure. You can live on hemodialysis if you follow the recommendations of doctors.

Hemodialysis is prescribed to the patient after diagnosis and when the condition is not corrected by diet, medications. The procedure involves filtering your own blood with an artificial kidney machine. It is used to cleanse the waste products of the body and remove excess fluid, which the body cannot naturally remove after kidney failure. Normally, the kidneys filter 1700 liters of blood per day, if one fails, the load on the second increases. When the second organ fails, the excretory system is blocked, the body tries to remove toxins from the skin and mucous membranes, which cannot cope with the task, resulting in death due to intoxication of the body.

An unpleasant moment is attachment to the hemodialysis center.

The procedure must be carried out several times a week, the duration is several hours. Hemodialysis at home is possible thanks to portable devices (common in Europe and America). After preparatory courses on working with the device, it becomes possible to carry out the procedure at home.

Indications for the procedure:

acute or chronic renal failure;
acute intoxication of the body due to the use of surrogate alcohol, medicines, poisons;
hyperhydration (excessive water content in the body, resulting in swelling of the lungs, brain);
nephropathy in diabetes mellitus;
when transplanting a donor kidney, before the organ takes root;
disturbed electrolyte balance (burns, cystic fibrosis);
pathological changes in the composition of blood plasma.

Contraindications:

active tuberculosis.
The likelihood of hemorrhage.
CHF (chronic heart failure).
Malignant hypertension (pheochromocytoma).
Cirrhosis of the liver.
Infectious diseases (will lead to sepsis, endocarditis)
Leukemia, DVZ, hemophilia.

Relative contraindications are: cancer, pregnancy, mental disorders (schizophrenia, epilepsy), age over 75 years.

Rules and frequency of the procedure

The blood purification process looks like this: the patient is injected into a vein with two cannulas connected to a hemodialyzer. The first supplies the body with a medical solution - a dialyzer, the second supplies blood to the device. Both containers have different density, which leads to liquid filtration and volume reduction. The purified blood is returned to the patient.

The second method of hemodialysis is indicated for diabetics, it consists of the procedure of introducing a dialysis solution into the abdominal cavity, which is drained after a certain period. The solution is changed up to 5 times per day. The procedure is called peritoneal dialysis, requires some preparation, but can be carried out at home after training and acquiring tools: a tonometer, a heating pad for a solution, scales, and a dropper support. The advantages of this procedure: a person is not tied to the hospital, the possibility of organ transplantation remains, there is less likelihood of heart pathologies and immunity from viral infections, kidney functions are partially preserved, and there are indulgences in the diet. The type of hemodialysis is selected by the doctor on an individual basis.

Cons - the occurrence of side effects from the procedure. There is nausea, vomiting, drops in blood pressure, convulsions and dizziness. If hemodialysis is not suitable for the patient, the body will react in the first session. The procedure is carried out in medical conditions under the supervision of doctors. If in the 20th century every fourth patient died from hemodialysis, then in the 21st century death is an exception to the rule.

Side effects:

the development of anemia due to a decrease in the number of red blood cells - erythrocytes;
pericarditis - an inflammatory process in the heart muscle;
dizziness;
body weakness.

Side effects adversely affect the process of blood purification, reduce the years of the patient's life. With an organ transplant, side effects indicate an unsuccessful transplant of a donor kidney.

The frequency of the procedure depends on: the age of the patient, the state of health, the presence of other chronic and infectious diseases, weight, lifestyle, diet. At least once a week, the patient will have to visit the hemodialysis center, but still happens 2-3 times a week.

Life expectancy with kidney hemodialysis

In Russia, life expectancy on hemodialysis is listed in the Guinness Book of Records and is over 30 years. In the world, cases of life expectancy with an artificial kidney apparatus are over 40 years. But it is impossible to answer exactly how long people live on hemodialysis. With strict adherence to the doctor's instructions, diet, regular procedures, accurately prescribed drugs, the patient's chances of prolonging life are great.

People rarely die from kidney failure, the main cause of death is diseases and infections that attack the body, weakened subsequently by kidney disease.

When asked what kidney hemodialysis is, how long they live with it, doctors give a positive prognosis. On average, patients under the age of 14 have a chance of surviving to 40 years or more, and older patients with organ transplants average 55 years of age.

How to increase life expectancy

The process of hemodialysis in the second decade of the 21st century is different from its conduct in the second half of the 20th century. Comfortable chairs that adjust the position of the patient allow them to take a nap, listen to pleasant music, watch an interesting movie. The procedure is comfortable, apart from the hours spent in the hospital, otherwise the patient lives a normal life. Medicine does not stand still, effective medicines and technologies appear.

In general, in order to prolong life, it is worth adhering to the following restrictions and recommendations:

avoid violations in the diet;
follow the daily routine;
visit the hemodialysis center regularly;
take prescribed medications, follow the treatment schedule, undergo additional examinations on time;
avoid contact with infectious patients.

In case of errors in nutrition, the patient must notify the attending physician about this for correction of therapy. The doctor forbids drinking more than 1 liter of water per day and prescribes diet number 7. Statistics say that in the absence of the possibility of a kidney transplant or the transplanted organ is rejected by the body, the patient will live as long as he visits the hemodialysis center.

Kidney and blood hemodialysis is an efferent method of extracorporeal detoxification of the body. It is carried out using a device called an "artificial kidney". It is used to cleanse the blood of electrolytes and nitrogenous wastes in cases where the kidneys cannot cope with this work.

The basis of hemodialysis is the metabolism through a semi-impermeable membrane, which is washed by blood flow on one side, and dialysis solution on the other. A hydrostatic pressure gradient is created between the dialysis fluid and the blood, with the help of which excess fluid is removed from the body by ultrafiltration. In the same way, harmful substances and metabolic products are removed from the blood.

The machine used for hemodialysis consists of three main components:

blood supply device
dialyzer,
devices for supplying and preparing dialysis solution.

A roller pump pumps blood through tubes into the dialyzer. Devices are attached to this system that measure the rate of blood flow and its pressure. The optimal blood flow is considered to be at a rate of 300-450 ml per minute. Once prepared, the dialysis solution enters the dialyzer from a dispenser or reservoir. In most machines, the dialysis solution passes around the membrane once at a rate of approximately 500 ml/min in the reverse direction of blood flow.

The composition of the dialysis solution is similar to blood plasma. Depending on the level of electrolytes in the blood, the composition of the solution can be adjusted. Most often it is necessary to change the concentration of potassium, and the content of chlorine, calcium and bicarbonate, as a rule, remains at a constant level. To regulate the amount of fluid removed from the blood in the dialysis solution, the sodium concentration is reduced or increased.

Indications for hemodialysis

Not for every disease, hemodialysis is prescribed: the indications for its implementation are strictly defined. These include the following states:

acute and chronic renal failure;
alcohol poisoning;
serious changes in the content of electrolytes in the blood;
drug overdose;
intoxication with poisons that tend to penetrate the hemodialysis membrane;
hyperhydration, not amenable to conservative therapy and threatening the life of the patient.

These conditions can lead to death without a hemodialysis procedure. The main indications are acute renal failure, as well as the terminal stage of chronic kidney failure, in which it allows to prolong the life of the patient. In addition, people on hemodialysis can continue their normal lives and even work.

The basis for the appointment of hemodialysis in chronic kidney disease are serum creatinine more than 800-1000 mmol/l, urea - 20-40 mmol/l, glomerular filtration rate - less than 5 ml/min. Metabolic acidosis is also taken into account when the content of bicarbonates is less than 15 mmol / l.

Contraindications

Even if there are appropriate indications, hemodialysis is not always used - contraindications can be relative and absolute.

Relative contraindications

active form of pulmonary tuberculosis;
diseases that threaten the occurrence of massive bleeding (Melory-Weiss syndrome, uterine fibroids, peptic ulcer, etc.).

Absolute contraindications

mental illness (psychosis, epilepsy, schizophrenia);
incurable malignant neoplasms;
diseases of the blood system (leukemia, aplastic anemia);
severe diseases of the nervous system;
age over 80 or over 70 with diabetes;
the presence of two or more concomitant pathologies: a malignant neoplasm, coronary heart disease with a previous myocardial infarction, heart failure, atherosclerosis with peripheral vascular occlusion in the decompensated stage, chronic hepatitis, liver cirrhosis, obstructive pulmonary disease;
vagrancy, alcoholism, drug addiction in the absence of interest in social rehabilitation.

Procedure and regimen of chronic hemodialysis

The regimen and program of hemodialysis are determined strictly individually. Most often, hemodialysis is performed 3 times a week, the procedure lasts about 4-5 hours. There is a sufficient choice of membranes for dialysis, differing in area of useful surface. This allows the use of hemodialysis according to various programs: from daily two-hour dialysis to twice a day every week. If there is residual renal excretory function, then hemodialysis can be performed less frequently.

Usually the procedure is performed on an outpatient basis, but there are portable devices that allow you to perform hemodialysis at home. The advantages of home hemodialysis are the possibility of its more frequent implementation and the absence of the need for constant visits to the medical center. It is more compatible with the patient's work, diet and lifestyle are closer to normal. Some hemodialysis machines can even be taken on trips or long trips. This type of hemodialysis has become widespread mainly abroad.

Some time before the start of the first procedure, it is necessary to make access to the circulatory system, which is usually performed on an outpatient basis. There are three types of access to ensure efficient blood flow to the dialyzer from the body and back: fistula, graft, and catheter.

A fistula is a direct connection between an artery and a vein through its own vessels, usually created on the forearm. At the same time, the blood flow in the vein increases, making its diameter larger and the wall stronger. Thus, the vein becomes suitable for frequent needle insertion.
A synthetic tube graft can also be used to connect an artery to a vein. It does not take time to heal the junction and remodel the vessels, so it is applied at an earlier time, for example, until the fistula becomes suitable. The disadvantage of this method is the more frequent occurrence of complications.
Sometimes a catheter is used for temporary access, a soft tube that is placed in one of the veins in the neck, chest, or thigh. For dialysis, needles are inserted into the catheter through which blood flows. This type of access is used for a single dialysis when there is no time to create another access.

diet for hemodialysis

Nutrition during hemodialysis implies a decrease in the accumulation of waste products in the blood. When choosing a diet, you must consider the following rules:

The daily menu should include a balanced amount of protein-rich foods, which include chicken, meat and fish.
It is necessary to control the intake of potassium. It is found in salt substitutes, some fruits (bananas, oranges), vegetables (potatoes), chocolate, dried fruits and nuts. If the potassium content in the blood rises, then complications from the heart are possible.
The degree of fluid restriction depends on the disease that led to kidney failure. Typically, the patient's weight should not increase by more than 5% of the initial body weight between treatments. If more fluid enters the body, then edema, complications from the heart, lungs and other organs, as well as arterial hypertension, may develop.
Restriction in food salt: salty food leads to thirst and fluid retention in the body.
The doctor may prescribe drugs to normalize calcium and phosphorus metabolism, which is often disturbed in people on hemodialysis. At the same time, the consumption of foods rich in phosphorus should be limited.

Recommendation: if the diet was nevertheless violated during the interdialysis period, for example, the patient could not resist salted fish or drank too much liquid, then this should not be hidden from the doctor. If the specialist is aware of the error in nutrition, he will prescribe a special mode and hemodialysis program to restore disturbed homeostasis in the body.

Complications of hemodialysis

During the procedure, nausea or vomiting, muscle cramps, arterial hypo- or hypertension may occur. In addition, a rare and formidable complication of hemodialysis can be an air embolism, which can lead to the death of the patient. The development of an air embolism is due to a malfunction of the apparatus or a violation of the technique of its use.

Most often, complications arise from the vascular access. When using a graft or catheter, they may become clogged with a thrombus. With a fistular junction of blood vessels, infection is dangerous, as a result of which sepsis, septic embolism, bacterial endocarditis and other dangerous diseases develop.

With a rapid decrease in the osmotic pressure of the plasma, disturbances of consciousness are possible in the form of stunning, confusion, epileptic seizures, which is called the dialysis syndrome. With a sharp decrease in the level of potassium, sodium or calcium in the blood, there may be heart rhythm disturbances. In rare cases, allergic reactions to membrane components are possible.

Important: if any discomfort appears during hemodialysis, then they should be reported to the specialist immediately. Sometimes, to eliminate them, you only need to adjust the composition of the dialysis solution or the rate of blood flow. With the development of serious complications, they begin to provide assistance.

Hemodialysis is a medical device procedure, with the help of which the lost functions of the renal system are artificially restored to patients.

Hemodialysis is considered a relatively new technique that has been used in practice for no more than forty years.

Thanks to this procedure, the blood of sick people who do not have a kidney or this organ does not work well is cleared of toxins. In the presence of indications, unfortunately, patients are shown a lifelong course of hemodialysis. How long they live with this method of treatment is of interest to all sick people. Hemodialysis is based on the principle of an artificial kidney. In most cases of medical practice, it is thanks to this procedure that patients can live with acute and chronic renal failure.

Of course, there is another method of dealing with this condition - kidney transplantation, however, organ transplantation in our country is considered a very expensive procedure, and a sick person can wait for the organ itself for years.

If we consider the statistics, the hemodialysis procedure (how many such patients live, no doctor can say for sure) prolongs a person’s life for decades. Despite this, each case is individual and largely depends on the lifestyle of the patient, his initial diagnosis and condition.

Hemodialysis itself is a special filtering system that has several catheters and one outlet for supplying a dialysate solution, which filters the blood with the help of special membranes.

Passing through these filters, the blood is cleansed, so most of the dangerous toxins are eliminated from it.

It should be noted that with an advanced form of renal failure, the patient needs not only to purify the blood, but also to control the level of fluid in the body in order to reduce the likelihood of edema.

The number of hemodialysis sessions is selected for each patient individually. There is no definite scheme here, since each patient's case is considered separately. As a rule, three hemodialysis sessions are performed per week.

The duration of one session is about five hours. Despite this, due to the fact that modern membranes may already be more efficient, hemodialysis can also be performed twice a week for two hours (provided that the blood is more purified).

In the event that the patient's kidneys restore their functions, the procedure can be performed less frequently (based on the indications and the person's condition). That is why a patient with kidney failure should be regularly tested and examined by a doctor.

Most often, hemodialysis is practiced in a hospital, but there are already modern portable devices that allow you to carry out this procedure at home.

Hemodialysis can be practiced not only in case of renal failure, but also in case of poisoning with heavy poisons. Also, this method can save a person's life in case of drug overdose. Moreover, it is important to note that hemodialysis is vital when conventional medical therapy fails to maintain normal renal function.

Should know

The sooner a person starts hemodialysis, the more chances he has to make his life expectancy longer.

At the same time, it is important to dispel the myth that this method should be practiced already when the kidneys have completely failed. In fact, this is not so, because the longer the patient delays with hemodialysis, the more harm his body receives. As for the procedure itself, in addition to the main indications, the number of sessions is also determined taking into account the weight, age and presence of additional chronic diseases of the patient.

Kidney dialysis: how long do they live, and what does it do to the body

Hardware dialysis is used in case of impaired renal function in a patient and their insufficiency at different stages.

Many patients are afraid of dialysis, explaining that this procedure has a high risk of mortality. Of course, this method can cause a blood clot in the catheter, an incorrectly prepared solution, or a malfunction in the device, but much more often the cause of death is inaction in treatment, that is, when a person delays starting hemodialysis and dies from the main problem - kidney failure. If we consider kidney dialysis, how long they live when performing this procedure, then we can say for sure that this method prolongs the life of the patient for at least another ten years. At the same time, there is still no precisely deduced life span of a person with kidney dialysis, how long patients live in this case depends on the severity of their condition and the initial functions of the kidneys in the body.

Kidney dialysis has the following effects on the body:

It cleanses the body of toxins and toxins, preventing their accumulation.
Cleanses the blood of excess salt and fluid.
Controls the level of important trace elements in the blood.
Regulates the patient's blood pressure.
Eliminates anemia.
Almost completely replaces the functions of the kidneys, that is, it performs their "work" in the body.

Due to the fact that modern medicine is constantly improving, today the need for a person in dialysis is not a death sentence at all, but only a necessary life measure. And if ten years ago, patients were tremblingly waiting for the next dialysis procedure, now they can listen to music or watch a movie during it.

Moreover, with some financial support, a person can install dialysis equipment in their home and go to the doctor only for a follow-up examination. While patients are waiting for a kidney transplant, which can take years, they have to undergo regular dialysis. As practice shows, the average life expectancy in people with complete kidney failure on dialysis is 12-15 years.

If the patient's condition is running, then this period can be shortened to six years. This statistic is justified by the fact that when the kidneys fail, a person has practically no immunity, so any, even a non-dangerous infectious disease, can become a death sentence for a person. This is also confirmed by the fact that patients with renal insufficiency usually die not from it, but from concomitant diseases.

In the early stages of dialysis, death is more likely, since this blood purification procedure itself is not suitable for everyone. That is why a person must understand that if the first dialysis was successful, then it is highly likely that he will live for at least another six years. In our country, people can live on dialysis for up to twenty years, although in the world, patients can lead a full life for more than thirty years.

Diabetes mellitus is one of the diseases of the endocrine system, in which the natural functioning of many internal organs is disrupted. The main problem of diabetes is that against its background, multiple diseases develop, which cause the death of diabetics.

Over time, due to elevated glucose levels, a large amount of under-oxidized metabolic products accumulate in the blood, which are gradually removed from the body through the kidneys. They filter the blood, removing excess harmful substances in the urine.

The filtering ability of the kidneys directly depends on cardiac activity, since filtration is carried out passively due to the pressure created in the renal arteries. If there are signs of disorders of the cardiovascular system, then this will certainly affect the whole body, including the kidneys, which will lead to

Unfortunately, it is not possible to make a correct diagnosis in the early stages of the disease, since it is asymptomatic, although it is at this moment that it can still be stopped with a special therapeutic diet.

With the gradual progression of diabetic nephropathy, chronic renal failure (CRF) will eventually develop with a pronounced decrease in glomerular filtration rate (GFR). When the GFR reaches a value of about 10 ml / min, then without the help of outside intervention it will no longer be possible to purify the blood, because the kidneys simply cannot perform their functions on their own.

If the water and electrolyte balance of the blood is not restored in time and toxins are not removed, then the person will simply die, because the blood flowing through his veins, in the truest sense of the word, will poison the whole body!

Hemodialysis (HD), which is also called the “artificial kidney machine”, helps to carry out extrarenal filtration. They also resort to his help in the early stages of nephropathy, if the doctor has reason to predict the development of the disease.

Kidney hemodialysis is an artificial filtering system through which blood is purified.

It consists of several double-sided catheters (introduced into the patient's vein) and attached to a hemodialyzer, through one outlet of which a special dialysate (chemical solution) is supplied, through the other the blood is “distilled”, passing through a special double-sided semi-permeable membrane. Due to the different density of substances (blood and the dialysate itself), blood diffusion occurs, as a result of which the concentration of biological substances is equalized.

Thanks to the membrane (it can be compared with a fine sieve, a filter through which only a substance with a certain molecular weight can penetrate), the blood is cleansed, and the amount of toxic substances in it is reduced.

However, with kidney failure, it is not enough just to clean the blood. It is also necessary to achieve a decrease in the concentration of fluid in the body in order to prevent edema (especially in the lungs).

This is possible only if the dialysate pressure does not exceed the blood pressure. Otherwise, it will result in reverse filtering. This manipulation of the blood is called ultrafiltration, which is due to transmembrane pressure and is able to remove excess fluid in the diffusion process.

Therefore, when a patient is being prepared for a procedure, blood pressure must be monitored before, during, and after the procedure.

The substance itself - dialysate, which I use in the process of filtering the blood, is prepared from purified water and a solution of salts, acids (water treatment consists in selecting a concentrated acid solution diluted in the right volume with water).

Depending on the patient's condition, the effect of kidney HD can be regulated by sodium, potassium, calcium, magnesium, bicarbonate, chlorine, glucose contained in the dialysate, its pH can be varied, etc.

But the most effective among them is sodium. The optimal value of this substance in solution is from 140 to 142 mmol / l, but this indicator directly depends on the individual parameters of a particular patient.

For example, if the sodium concentration is too low (below 135 mmol / l), then after an hour or even less, the patient, while on hemodialysis, will feel all the signs of hyponatremia with convulsions, nausea, vomiting, etc. If it is increased (on average above 145 mmol / l), then there is a high risk of getting signs of hypernatremia with high blood pressure, thirst, drowsiness, which can even lead to the death of the patient as a result of intracellular dehydration, leading to a hypertensive crisis, cerebral edema with irreversible consequences .

However, the above example is extremely abstract, because each patient, depending on his state of health, has his own threshold of sensitivity to sodium parameters. If his blood pressure was above normal before hemodialysis, then a sharp decrease in sodium to the recommended normal values will cause the patient to feel unwell during the procedure and after it.

Dialysate should correspond to the norm of a particular person with a gradual tendency to normalize indicators.

For example, to reduce the conductivity of the dialysate is not sharp, but by 0.1 - 0.2 mS / cm (millisiemens per 1 centimeter) per week.

To start the work, it is necessary to provide access to the patient's circulatory system. For such purposes use:

fistula

A direct connection of an artery to a vein is carried out using its own vascular system. The forearm area is more suitable. The vein in the cubital fossa and the brachial artery are connected.

catheter

Placed in one of the veins of the neck, chest, thigh. Needles are inserted into the catheter through which blood flows. This type of connection of the hemodialyzer with the veins can be classified as "disposable", because it is not used so often and is not suitable for repeated use.

graft

It is a sterilized synthetic tube that "replaces" the great saphenous vein.

Indications

Not all patients can undergo this procedure. It is strictly regulated and is prescribed for:

acute renal failure
acute glomerulonephritis
pyelonephritis
poisoning with alcohol-containing solutions (liquids)
a significant change in electrolytes in the blood, which pose a serious danger to human life and health
drug overdose
intoxication with poisons
hyperhydration, which cannot be stopped in other ways

But it is worth mentioning that HD significantly changes the strategy for monitoring glycemia and insulin. For example, the procedure significantly affects the secretion, clearance and sensitivity of cells to insulin. Therefore, it is recommended to reduce the dose of the hormone when undergoing HD treatment.

When it is preferable to use glurenorm (gliquidone), since it is almost completely eliminated (i.e. excreted from the body naturally) through the liver.

Contraindications

The relative ones are:

mild tuberculosis
diseases fraught with massive bleeding (these include: peptic ulcer, uterine fibroma, Melory-Weiss syndrome and others)

To absolute:

mental illness (epileptic seizures, psychosis, schizophrenia, etc.)
incurable forms of malignant tumors
leukemia
anemia
severe forms of diseases of the nervous system
patients with diabetes over 70 years of age
advanced age (over 80 years old)
the presence of two or more serious pathologies, which include: myocardial infarction, heart failure, advanced atherosclerosis, lung disease, cirrhosis of the liver, etc.
alcoholism, drug addiction without further social rehabilitation

Possible Complications

In the process of HD, some complications arise, the cause of which may turn out to be, for example, of a technical nature, when a failure occurs in the device itself. But most likely the following complications, which, however, occur extremely rarely:

hypertension
hypotension
hypernatremia
hyponatremia
convulsions
air embolism
blockage of the catheter
accidental infection of the patient during preparatory hemodialysis procedures
epileptic seizures
weakness
nausea
vomit
dizziness
cardiac arrhythmia
allergic reactions to individual components of dialysate

How often and how long do they live on hemodialysis?

The answer to this question will be very abstract, because everything largely depends on the individual and his state of health.

If the patient's kidneys have completely failed, then the blood purification procedure is carried out much more often, about 3 times a week. If on the face there are all signs of at least a residual preservation of the excretory ability of the kidneys, then the procedure is reduced to 1 time per week, sometimes even less often. The whole process takes 4 to 5 hours.

Of course, not everyone will be able to perform the procedure on an outpatient basis in the kidney hemodialysis department, since people in old age often simply do not have the opportunity to simply get to the hospital. For them, it is possible to carry out blood purification at home under the supervision of a specialist or a specially trained person.

Modern technologies make it possible to create special portable devices, but their cost is quite high! In addition, the language does not dare to call the first HD devices portable, because the weight of a relatively “cheap” device can exceed 10 kg. Those that are worn on the belt weigh from 4 to 7 kg.

All equipment and components are not sold in Russia (only consumables can be purchased). This "pleasure" is purchased abroad. In Russia, several medical councils have already been convened on this subject, but the issue has not been moved off the ground. Unless in a number of cities of the Russian Federation, within the framework of state support, hemodialysis points were organized in city hospitals. This is already considered the strongest breakthrough almost thirty years ago, when the first apparatus of the State Duma was created under the USSR.

With regards to the life expectancy of patients who are forced to resort to HD, there is no clear answer. Yes, and as such, there are simply no statistics in Russia on complications and mortality from kidney diseases.

In addition, the main problem that causes the death of patients does not depend on complications after the procedure, the cause of which is rather an accident due to equipment failure, the formation of a blood clot in the catheter, improperly selected and prepared dialysate solution, and so on.

The basis of everything is serious immune disorders.

Immunity becomes weak, and a person can die from pneumonia, intestinal problems, viral diseases.

If correct hemodialysis is combined with timely kidney transplantation, then the life expectancy of patients can be increased by more than 20 years.

On average, according to honey. US statistics, this period varies from 0 to 14 years. It all depends on the patient himself and his immunity, which is quite possible to maintain artificially by introducing the required amount of vitamins and so on.

Diet for HD

It is necessary to maintain health with a special diet, since without proper nutrition it will not be possible to normalize metabolic processes and reduce the load on the kidneys. Regulating this process with medication is very dangerous, since any drug has a number of serious side effects that will only aggravate the situation, and not correct it.

The diet is developed individually by a specialist nutritionist together with a group of attending physicians (nephrologist, neurologist, endocrinologist, etc.). Its main principles correspond to tables 7a and 7b (but only in the presence of kidney disease) and are as follows:

limit the amount of salt you eat
adjust the concentration of potassium in the blood with special foods (reduce the intake of potassium-containing foods: bananas, potatoes, chocolate, nuts, dried fruits)
monitor fluid intake (to prevent swelling)
balance protein intake to prevent albuminuria
reduce the amount of phosphorus-containing foods
control the balance of calcium in the body

In addition, if the patient is prescribed a specific HD schedule and he is on a diet, then the doctor should be warned in advance about any eating disorders!

For example, several forbidden foods were consumed: salted, smoked fish, pickled cucumbers, tomatoes, a lot of sweets, in the presence of diabetes, and so on. The medical worker must respond in time to this and correct the hemodialyzer (dialysate solution).

However, patients with diabetes mellitus without renal complications should limit their diet exclusively to foods rich in potassium, phosphorus, sodium (salt), since these substances are used in the preparation of the dialysate solution and are replenished by it. All other products are simply removed from the body during the 4 hours spent in the clinic under the device. To prevent protein-energy depletion, it is necessary to eat even better than normal healthy people without endocrine complications.

In addition, together with a normal balanced diet and a visit to the HD procedure, physical activity is also recommended, the intensity of which depends on the individual parameters of the person (age, complications, daily glycemia, etc.).

At an advanced stage of kidney disease, hemodialysis can be replaced by more radical methods - an operation to transplant a donor organ. To assign this procedure, it is necessary to pass many tests and conduct a planned

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