Every year, tens of thousands of new cases of chronic renal failure are diagnosed in the world. The disease has a chronic progressive course, and there are not many ways to effectively treat it. One of them is hemodialysis, a method of treatment that successfully replaces healthy kidneys and allows you to cleanse the blood of unnecessary and toxic substances for the body. Despite the advantages, the procedure has its own difficulties. Let's try to figure out how long life on hemodialysis can last, how often it should be done, and what you need to know for patients with CRF.

When you can't do without blood purification

Hemodialysis is a blood purification that takes place outside the kidneys. The main goal of the procedure is to maintain the constancy of the internal environment, as well as rid the body of:

• urea - the end product of protein metabolism in the body;
• creatinine - a substance formed during active energy metabolism in muscle tissue;
• substances poisoning the body (for example, strontium, arsenic, plant and animal poisons);
• medicines - preparations of salicylic acid, barbiturates, sedatives, sulfonamides, etc.;
• ethyl alcohol (alcohol);
• "Extra" electrolytes (potassium, sodium) and fluids.

The main indications for hemodialysis are:

• chronic renal failure with symptoms of uremia (occurs when the functional activity of the kidneys is reduced to 20-30%);
• acute renal failure that occurs with inflammatory diseases (pyelonephritis, glomerulonephritis), acute urinary retention, crush syndrome, etc .;
• poisoning with poisons, toxic substances, alcohol, drugs and medicines;
• hyperhydration - "water poisoning" of the body;
• violations of the ionic composition of the blood with extensive burns, dehydration, prolonged intoxication, intestinal obstruction.

Although in many of the conditions listed above, the patient's kidneys partially retain their functional activity and do not need hemodialysis, in some cases only this procedure can save the patient's life. Clear criteria for the need for hemodialysis include:

• oliguria (daily diuresis is 500 ml or less);
• the kidneys filter less than 200 ml of blood within 1 minute, their functional activity is lost by 80-90%;
• the level of urea in the biochemical blood test exceeds 33-35 mmol / l;
• the level of creatinine in the blood plasma is above 1 mmol / l;
• potassium concentration - more than 6 mmol / l;
• bicarbonate level - less than 20 mmol / l;
• increasing signs of uremia, swelling of the brain and internal organs.

The principle of operation of the device for hemodialysis

Hemodialysis is a relatively “young” treatment technology: it has recently turned only 40 years old. Over the years, it has become widespread throughout the world and has even grown into a separate branch of medicine.

The apparatus of the "artificial kidney" is simple and consists of two interconnected systems:

1. for processing (purification) of blood;
2. for the preparation of dialysate.

The patient takes venous blood, which is fed through a soft catheter into the filtration system. The main component of the filtration system is a semi-permeable membrane, consisting of cellulose or synthetic materials. Pores of a certain size allow the separation of substances harmful to the body, as well as excess fluid and plasma with branded elements. The purified blood is returned to the patient, and the dialysate with unnecessary substances is disposed of. On average, this procedure lasts 4-5 hours and is carried out in an intensive care unit.

During hemodialysis, the doctor carefully monitors the patient's blood pressure and other vital signs. With a sharp deviation from the norm, the procedure is suspended. Before blood sampling, the patient is given heparin or other antiplatelet agents that prevent the formation of blood clots, which invariably form on the vascular wall when using a soft catheter.

Note! Today, it is possible to carry out hemodialysis at home. To do this, the patient needs to purchase a portable "artificial kidney" device, the cost of which ranges from 15-25 thousand dollars, and take a course on how to use the device on their own.

Features of home hemodialysis include:

• convenience and comfort for the patient;
• no risk of infection with blood-borne infections (HIV, hepatitis B, C);
• lack of medical supervision, the possibility of developing complications of the procedure.

Negative effects of hemodialysis

Hemodialysis refers to quite traumatic procedures for the body. It can cause the following side effects in the patient:

• loss of essential mineral salts, electrolyte disturbances;
• muscle pain, cramps, spasms, provoked by a lack of sodium, magnesium, chlorides, potassium and other elements in the blood;
• pathology of the heart rhythm, atrial fibrillation, extrasystole, blockade of the right or left leg of the His bundle;
• hypotension;
• anemia caused by the destruction of red blood cells during the procedure;
• bone pain.

How long does this therapy last?

Kidney dialysis remains the main method of symptomatic treatment of chronic renal failure: how long patients live with it depends largely on the course of the pathology and the characteristics of the organism.

Subject to the hemodialysis schedule (with a persistent decrease in the functional activity of the organ - usually 2-3 times a week) and the absence of progressive signs of cerebral edema, the patient feels well and can maintain his usual lifestyle for years.

On average, the life expectancy of patients with chronic renal failure, regularly undergoing a blood purification procedure, is not inferior to the life expectancy of healthy people. Hemodialysis can be done until a donor kidney is found for the person. Sometimes it takes years: on average, 1,000 transplants are performed in Russia annually, while at least 24,000 patients are waiting for their turn.

Every hemodialysis patient should understand how important blood purification sessions are for him. Compliance with medical recommendations and regular visits to the clinic where the “artificial kidney” apparatus is located will allow a patient with chronic renal failure to live a long and active life, and patients with acute disorders will quickly return to health.

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:

1. It cleanses the body of toxins and toxins, preventing their accumulation.
2. Cleanses the blood of excess salt and fluid.
3. Controls the level of important trace elements in the blood.
4. Regulates the patient's blood pressure.
5. Eliminates anemia.
6. 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.

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

Indications for hemodialysis

Indications for hemodialysis can be any processes, the result of which was the saturation of the blood with toxic products of its own metabolism or substances that entered the blood from the outside.

In what situations is hemodialysis used most often?

• In acute or chronic renal failure, when the kidneys do not cope with their tasks of cleaning the blood and removing excess water from the body. The most common autotoxic breakdown product is urea. accumulated in 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, antipsychotics, as well as containing salts of bromine, iodine and sulfanilamide drugs.
• In case of poisoning with large doses of ethyl alcohol when the fastest blood purification is vital even with healthy kidneys.
• With methylate poisoning- a frequent occurrence among patients with chronic alcoholism, drinking by chance or ignorance of a certain amount of methyl alcohol.
• Some pathologies, the pathogenesis of which leads to excessive accumulation of toxic products in tissues and blood plasma. The classic example of such a disease is long-term compression syndrome in which hemodialysis is carried out regularly due to acute renal failure.
• In 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 use only in the presence of such strict indications:

• amount of urine secreted during the day in a physiological way, less than 500 ml;
• kidney functionality remains at the level no more than 15%, which is equal to cleaning 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;
• bright symptoms edema of the brain, pericardium, lungs, not amenable to the methods of conservative therapy;
• Clinical signs acute poisoning large volumes ethyl alcohol;
• use any quantity methyl alcohol in history.

Contraindications for hemodialysis

As already mentioned, hemodialysis is a procedure that should be used only when necessary.

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

• Acute or chronic infectious diseases, including focal.
  In the process of hemodialysis, blood pressure rises and the blood flow speed increases, which can contribute to the spread of microorganisms through the bloodstream and cause a general infection of the blood - sepsis or inflammation in the area of ​​​​the inner lining of the heart cavities, that is endocarditis. The lungs can also be a prime target for colonization by pathogenic microflora.
• Psychopathological disorders and diseases of the schizo-like, epileptic and psychotic series.
  The hemodialysis procedure causes a slight cerebral edema in the patient, which is almost always provokes an epileptic seizure 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 active spread of Koch's bacillus throughout the body and 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 indicators up to 300 ml of mercury in systole and 160 mm in diastole. During hemodialysis, as is known, blood pressure rises, and this process is practically uncontrollable by drugs. If the procedure coincides with an attack of hypertension, the risk of heart attack or stroke 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, contributing to infection.
• Some pathologies of the blood.
  This, for example, decreased clotting, blood cancer, aplastic anemia. In the process of hemodialysis, in any case, blood cells, in particular erythrocytes, are damaged, which further enhances 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 for salvation.

What is the hemodialysis procedure and equipment used

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

Artificial membrane installed in a hemodialyzer with selectivity 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 pores and their number located on its area, porosity. In this way, the quality of the filtration is regulated.

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

In addition to the function of purifying the blood, 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 provided by increasing the pressure of the blood mass on the membrane intended for this purpose, and dialysis solution contains hydrophilic elements that attract water. Thus, the concentration of water in the plasma decreases.

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

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

• at home, using a portable hemodialyzer. It is more often carried out in cases of acute renal failure, when the filtering ability of the kidneys is reduced.
• In an outpatient setting on fixed equipment often in acute renal failure or in the terminal stage of chronic.
• In stationary conditions in especially severe cases of renal failure or acute poisoning.

Given the weak capabilities of portable devices, hemodialysis at home is more often prescribed daily, for 2-4 hours. Stationary equipment is characterized by the best quality of filtration, 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 an increased content of water 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 ways.

• Active lowering of blood pressure.
• Manifestation of fatigue.
• Drowsiness.
• The appearance of pain in the legs.
• Skeletal muscle spasms, usually in the lower extremities
• Nausea.
• Excruciating headaches.

The severity of these symptoms is highly dependent on the volume and speed of fluid being 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 can provoke allergic reactions in a patient, due to the ingress 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 purification. However, in order to reduce allergic manifestations, modern nephrology uses gamma irradiation to sterilize membranes.

Long term complications with frequent use of hemodialyzers may be:

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

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

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

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

What is hemodialysis

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

Hemodialysis allows a person to live to receive a kidney transplant. The essence of the method is cleansing the body, normalizing the acid, water and electrolyte balance, improving the general condition, removing substances with different molecular weights. With oncopathologies of various organs, dialysis reduces intoxication.

Every three days the patient visits the hemodialysis room in a specialized medical facility. Session duration - 4 hours. An artificial kidney is used to filter the blood. There are installations according to the structure of a semipermeable membrane.

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

• blood supply system;
• dialyzer;
• systems for the preparation and supply of a special medical solution under a certain pressure.

In the US and Europe, many patients with kidney failure can purchase special equipment to replace the natural filter, perform hemodialysis at home. The One system is effective, 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 against the background of various diseases.

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Types and classification

Kidney hemodialysis is performed:

• in a hospital;
• outpatient;
• at home.

Classification according to the level of the blood purification apparatus:

• conventional dialysis. The duration of the procedure is from 4 to 5 hours, the basis of filtration is a cellulose membrane. Throughput capacity - up to 300 ml per minute;
• high performance dialysis. Doctors use a dialyzer, the speed of dialysate (a special solution with a certain set of substances) is from 600 to 800 ml per minute, the blood flow rate is up to 500 ml per minute. The membrane passes less harmful substances, the quality of cleaning increases, the time is reduced to three to four hours;


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

Indications for the procedure

• acute glomerulonephritis;
• acute renal failure;
• poisoning with poisons and alcohol-containing liquids;
• hyperhydration, with low efficiency of other methods of removing excess fluid;
• drug overdose;
• pyelonephritis;
• severe course of chronic renal failure with the ineffectiveness of other methods of therapy;
• a serious violation of the water and electrolyte balance, threatening severe complications;
• the accumulation of a large volume of fluid, against which edema of the brain or lungs may develop;
• indicators of creatinine in the blood, protein, glucose, uric acid significantly exceed the norm;
• intoxication with pronounced signs;
• severe depletion of the body.

Contraindications

Purification of blood with the help of special equipment is not suitable for all patients. When choosing a procedure, the doctor prescribes tests, additional examinations to make sure there are no restrictions.

Relative contraindications:

• peptic ulcer;
• Melory-Weiss syndrome;
• fibroma of the uterus;
• pulmonary tuberculosis.

Absolute contraindications:

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

Training

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

Stages

Stages of dialysis:

• device and patient preparation;
• the patient lies down in a chair, the position of "reclining";
• near a special chair there is an installation. 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 passes through filtration, contacts with dialysate;
• the purified fluid returns to the bloodstream through the connected second vein;
• after the procedure, a bandage is applied to the injection site of the needle.

To maintain health, reduce the burden 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 exertion;
• take prescribed medications and vitamins;
• do a complex of therapeutic exercises daily;
• inform the nephrologist about any deviations in well-being, visit a specialist on time.

Diet and nutrition rules

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

If the patient has received recommendations for diet 7a or 7b, then in case of any violations of the rules of nutrition, it is important to warn the doctor performing dialysis about the deviations. The doctor will promptly adjust the concentration of the components in the dialysate solution. For example, shortly before the procedure, the patient consumed smoked meats, alcohol, a lot of sweets, tomatoes, pickled tomatoes or cucumbers, salted herring. This must be known to the doctor in charge of hemodialysis.

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Medicines

The optimal drug for each patient is selected by a nephrologist based on the test results, taking into account the degree of kidney damage, the condition after the extracorporeal blood purification procedure. With prolonged hemodialysis, it is important to take the formulations 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, magnesium sulfate;
• with a decrease in hemoglobin, iron preparations are effective;
• with urolithiasis, vitamin C should not be abused;
• with an excess of iron, you should not additionally take drugs with this component;
• support the body compositions containing phosphate.

Complications and prognosis

With HD, malfunctions of the equipment, blockage of the catheter, 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 the rules of sterility. Sometimes doctors incorrectly select the concentration of the components of the solution: they mistakenly reduce or increase the level of sodium, which negatively affects the patient's well-being.

With individual sensitivity, negative manifestations are possible:

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

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

In this video, in an accessible form, the principle of operation of the hemodialysis machine is shown:

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 handle 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 do not cope with their task on their own, they need medical help. In such cases, dialysis is performed. What it is? In medicine, it is essentially a replacement for diseased organs. The procedure involves a special membrane apparatus, which filters the blood, in fact, taking on the role of a natural purifier. It is not surprising that the 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 the tubes. There it gets rid of harmful substances and returns to the human vein in its pure form.

How long do they live with hemodialysis?

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

What is a hemodialysis fistula?

In order to carry out medical manipulations to purify internal fluids, it is necessary to provide access to the veins. For this, a special mini-operation is performed: the creation of a fistula for dialysis.

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

Hemodialysis indications and contraindications

The indications for hemodialysis are::

• renal failure: acute and chronic;
• severe violations of electrolyte indicators;
• edema, including internal organs, which do not give 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 of patients threaten with a lethal outcome.

Absolute contraindications:

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

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

How often should hemodialysis be done?

How many times to cleanse? It must be understood that “artificial yet” is not a panacea, it does not cure, but only takes on the functions of diseased kidneys. It is better to carry it out in specialized centers, but it is also possible in the therapeutic departments of ordinary hospitals.

The frequency of manipulations can be determined and prescribed only 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, it can be done at home. But for this you need to prepare the bloodstream, as described above. Medical intervention is indispensable here. Connecting the device on your own is also unlikely to succeed - it is dangerous and fraught with complications.

Complications of hemodialysis

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

• early. They arise in the process. Reasons - technical imperfection of the device for hemodialysis, violations during the introduction of medicinal products, etc.;
• later. They are caused by a lack of kidney function. These complications can be corrected with diet and adjuvant therapy.

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

rus-urology.ru

Extrarenal blood purification - hemodialysis. What is a dialyzer?

Hemodialysis is a type of renal replacement therapy that can replace the functioning of the kidneys. The device allows you to filter the blood, remove excess fluid and maintain normal electrolyte balance. The hemodialysis procedure involves the removal of blood from the body and its subsequent filtration 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 at the same time track many important variables: blood flow and pressure, the amount of fluid removed, etc. There are two sections in "artificial kidneys":

• dialysate section;
• blood section.

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" in 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. In particular, 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 the dialysate

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

In addition, excess fluid is removed from the blood in the dialyzer. Ultrafiltration is carried out by transmembrane pressure maintained by a special pump. On average, for one session of hemodialysis, the patient gets rid of 1.5 to 2 liters of excess fluid. Modern hemodialysis machines are equipped with units to 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 the patient feels unwell during the procedure, they may ask the health worker to adjust the dialysis rate or the composition of the solution.

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

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

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

After the introduction of the needles, the dialyzer is programmed, and the direct purification of the blood begins. During the procedure, monitoring of the pulse rate and blood pressure is mandatory, since the withdrawal of a significant amount of fluid can provoke fluctuations in these indicators. At the end of hemodialysis, the health worker removes the needles from the patient's body and applies a pressure bandage to the puncture site 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 withdrawal of a large amount of accumulated fluid. In case of discomfort, you can ask the medical staff to adjust the speed of hemodialysis and the composition of the dialysis fluid.

How often is hemodialysis necessary?

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

In addition to a three-time visit to the medical center, there is an alternative treatment schedule. It includes night and day procedures. They are offered to patients who carry out hemodialysis at home. The overnight blood purification procedure lasts for 8 hours while the patient sleeps. It is longer than a regular session, so patients report that they feel better than after standard hemodialysis. Many medical centers have begun to offer overnight blood purification procedures based on patients' requests, their better health and excellent laboratory results. Short daily 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 by medical centers.

Pros and cons of hemodialysis

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

Outpatient treatment, which involves regular visits to a medical center for hemodialysis, has its advantages and disadvantages. The most important advantage is that the patient is under the supervision of competent specialists, can always count on the professional conduct of the procedure and the attentive attitude of the staff. During the procedure, people can relax: sleep, read books, write, watch TV, listen to music, talk quietly with neighbors. On the other four 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, therefore, when they come home, they rest and sleep.

Patients who choose night hemodialysis (at home or in the center) say that they do not feel tired, as well as unpleasant, painful symptoms. Due to the fact that the blood purification procedure is carried out during sleep, people report that they feel more free, because they do not need to set aside time for hemodialysis during the day. This improves the quality of life, and patients feel "normal". People who do hemodialysis at home enjoy a sense of control over their lives. Instead of going to the center at a certain time, they carry out the procedures themselves, choosing the right moment in their schedule.

There is another, alternative way to purify the blood: peritoneal dialysis. It is a treatment method in which a silicone catheter is implanted into the patient's abdominal cavity. Through this tube, several liters of dialysis solution are injected into the body, which cleanses the body of toxins and waste products. 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. As a rule, this procedure is carried out at home, and therefore the patient does not need to visit medical centers three times a week. Often peritoneal dialysis is performed at night, which makes life easier for the patient, allowing you to work, attend school or travel without fear.

All types of treatment have their advantages and disadvantages. Based on your preferences and the medical treatment required, you and your doctor can discuss all options and decide which one is best 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 the blood vessels (vasculitis);
• kidney cysts (polycystic kidney disease).

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

Your healthcare provider will help determine when you should start dialysis based on several factors: general health, kidney function, signs and symptoms, quality of life, and personal preference. 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, be sure to assess 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 changes with age. Evaluation of GFR will allow planning a course of treatment and setting a date for hemodialysis. As a rule, blood purification begins before the kidneys completely cease to perform their functions, preventing life-threatening complications. Hemodialysis will help your body control blood pressure and keep fluids and various minerals, such as potassium and sodium, in balance.

Some people with chronic kidney disease may choose another path: conservative treatment. It includes the active elimination of the underlying disease that led to impaired renal function and the complications that appeared as a result, including edema, high blood pressure, anemia. Conservative treatment focuses on the elimination of symptoms that affect quality of life, therapeutic nutrition and adequate fluid intake.

Results of hemodialysis

Blood through the tube enters the hemodialysis machine, it is purified and returned to the body through another tube.

If the patient has acute kidney injury, hemodialysis may be required for a short time until kidney function is restored. In the presence of chronic renal failure, artificial blood purification 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 an emergency, hemodialysis may be required for the rest of the patient's life. In this case, the attending physician will help you choose the best course of therapy.

Patients with impaired kidney function can receive hemodialysis at a medical 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 quality of life, reduce or completely eliminate unpleasant symptoms such as headaches, shortness of breath, cramps, improve appetite, improve sleep and increase efficiency.

Day 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. Having learned, any patient will be able to perform blood purification independently. Including 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 be taken in a patient with renal insufficiency?

In order to achieve the best results in restoring kidney function, in addition to hemodialysis, the patient is advised to follow a diet. You should eat the right, wholesome foods, carefully control the 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 a significant amount of potassium should be discarded. Eating bananas, potatoes, chocolate, dried fruits and nuts can lead to complications. It is necessary to limit the use of salt, smoked meats, sausages, pickles. Proper nutrition will help improve the results of hemodialysis and overall well-being.

In addition to diet, fluid intake should be limited. It is believed that the weight of a patient with renal insufficiency 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 renal insufficiency should take their prescribed medications. Strict adherence to the instructions of your doctor will allow you to recover faster and restore the functioning of body systems.

Finally, you need to trust your doctor and not be afraid to discuss any questions that arise with him. The doctor will carefully monitor your health indicators to make sure that hemodialysis cleans the blood properly. Including he will regularly measure weight and blood pressure before, during and after treatment. In addition, once a month you will take tests, including a biochemical blood test, a total urea clearance test, etc. Based on the results, the attending physician will adjust the intensity and frequency of hemodialysis.

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

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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 renal failure by experts, 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);
• expendable materials;
• 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;
• pericarditis ( heart failure);
• poisoning with poisons that tend to penetrate the hemodialysis membrane;
• overhydration, which threatens the life of the patient 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:

• cirrhosis of the liver;
• various lesions of the vessels of the brain;
• 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;
• 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;
• ischemic heart disease with a previous myocardial infarction;
• heart failure.

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 lead to the development of both a heart attack and a 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:

• 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 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, which is prescribed to all patients without exception, are important. 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.

Kidney hemodialysis is a process that replaces the natural function of the kidneys. That is, it removes excess fluid and toxic substances, urea and creatinine from the body, maintains the content of potassium and phosphorus in the body at an acceptable level. Sometimes you can hear another name - "artificial kidney", this is also about hemodialysis. To date, this process has been quite successful in helping people with severely impaired kidney function or with completely failed organs to lead a whiter or less fulfilling life.

First of all, the new artificial organ needs blood vessels. Therefore, a small preparatory surgical operation is performed on the forearm. During it, qualified specialists form a vessel with sufficiently thick walls and suitable blood flow for the future organ. After the intervention, the vessel continues to form on its own, the whole process takes about a month.

Hemodialysis itself consists in the fact that a needle is inserted into the prepared vessel, to which a flexible tube is connected. The tube carries the blood to a special dialysis machine, where it is cleansed of excess electrolytes, excess fluid, and toxins. The blood is then sent back to the patient's vessels. In order to prevent clotting, heparin is administered before the procedure.

When there is no time to prepare a special vessel for hemodialysis, they are limited to inserting a catheter into the area where the circulatory system can withstand this process.

To lead a relatively fulfilling life, hemodialysis is necessary for a person with impaired kidney function three times a week. The duration of each procedure will be at least 4 hours. All at this time, the patient should be in a special chair connected to the hemodialysis machine. At this time, you can read a book, listen to music, sleep or watch a movie.

Indications for the procedure

Hemodialysis is needed for people who have severely damaged kidneys or who have acute kidney failure. In case of acute damage to the procedure, hemodialysis can be stopped with the end of organ regeneration.

In cases where the kidneys fail completely due to serious damage or a severe course of the disease, the patient needs constant hemodialysis until the transplantation of a new organ or for life.

The need for the procedure is determined by a qualified nephrologist. It focuses on the general condition of the patient, as well as on complaints, test results and the presence of certain symptoms.

Most often, the procedure is prescribed if the patient has the following indications for hemodialysis:

• The glomerular filtration rate is reduced to less than 10 ml per minute;
• Impaired brain activity due to the influence of uremic toxins;
• The level of potassium exceeds 6.5 mmol per liter;
• Difficulties with blood pressure control;
• On the serous membranes of the body, toxic substances begin to be deposited, which for the patient can be expressed by severe itching;
• Violated acid-base balance;
• Severe nausea, sometimes vomiting, general weakness;
• Edema of various organs is dangerous because pulmonary edema or cerebral edema may occur;
• Sharp weight, which becomes more noticeable with the further progression of the disease.

All of these symptoms, often together with the corresponding test results, are just the reason for prescribing a hemodialysis procedure to the patient.

Types of hemodialysis

This process is classified depending on the device used for the procedure, as well as on the chosen place of execution.

Depending on the location of the procedure

There are several possible options for hemodialysis - at home, outpatient or in a hospital.

home option

For the procedure at home, special portable preparations are used. They can be used even by a simple layman, the field of special training courses. True, you will have to use the device every day and devote two to four hours to this. This option in Western countries often replaces kidney transplant surgery for a large number of patients.

The use of portable devices is easy and safe. The patient is relieved of the need to visit a medical facility and stand in queues. In addition, there is no risk of contracting hepatitis and other infectious diseases. And there is an opportunity to lead an almost full life. However, portable preparations are quite expensive. In order to learn how to deal with them, you will need to take special courses, but even so, in the first few procedures, you cannot do without the help of a medical worker.

Suitable for patients with acute and chronic renal failure, if the restoration of kidney function is not expected. The desired duration and frequency of the procedure is 4 hours three times a week.

The procedure is carried out under sterile conditions under the supervision of doctors, sometimes it is possible for the patient to be transported from home to the procedure and back. However, in this case there is some risk of contracting hepatitis. In addition, there is a need to visit the medical center three times a week for at least 4 hours a day, and if there are queues, even for a longer time period. With such a schedule, it is more difficult to lead a fulfilling life.

Stationary

Used for patients with acute renal failure or for those who have been seriously poisoned. For the procedure, almost the same drugs are used as for outpatient hemodialysis, with the only difference being that in this case, patients are in a hospital or in a semi-hospital.

The procedure is carried out under the constant supervision of medical personnel. However, in order to receive it, you must be in the hospital. In addition, there is a small risk of contracting hepatitis.

Depending on the device

According to the functionality of the equipment, the procedure is divided into conventional, high-efficiency and high-flow.

Plain

In the usual procedure, blood purification is performed using an apparatus having a filter with low permeability. It only allows small molecules to pass through. The area of ​​the filter membrane is 0.8 - 1.5 square meters. In this case, the blood flow is small, and the duration of the session is 4-5 hours.

highly efficient

In this case, the membrane surface already has a large area, from one and a half to about two square meters. The blood flow is noticeably higher, so the session time is reduced to 3-4 hours.

high flow

With this type of procedure, preparations with a special membrane that can pass large molecules are used. Thus, more excess substances can be removed from the blood, which significantly increases the chances of the patient's survival. However, when using such equipment, it is important to remember that not only will harmful substances be removed from the blood, but also some molecules from the hemodialysis fluid will be able to enter the blood, so you should use only a sterile solution.

Features of hemodialysis

The procedure is carried out as follows. Venous blood enters the hemodialysis machine, where it is purified using a special filter. The filter consists of a membrane, on opposite sides of which venous blood flows and a special solution that draws out harmful substances and excess fluid from it, which are usually excreted by the kidneys. The solution must be selected individually for each patient, but modern devices can do this automatically.

This solution normalizes the level of electrolytes in the blood, removes metabolic products, maintains a normal acid-base balance, helps prevent blood clots and air embolism, and also removes excess water.

The effect of the procedure is checked by the level of urea after it is carried out. With hemodialysis twice a week, this level should be reduced by 90%, if it is possible to carry out the procedure three times a week, then the percentage of purification should be at least 65.

Contraindications

Hemodialysis is not prescribed to patients with the following conditions:

• Violation of the hematopoietic system, especially the presence of anemia and impaired blood clotting, since hemodialysis can significantly aggravate these conditions;
• The presence of infectious diseases in which pathogens can enter the bloodstream and cause, for example, sepsis;
• Old age, over 80 years old, and with diabetes - over 70. These people have weak veins and reduced immunity, so hemodialysis is very risky for them;
• The presence of a stroke or various mental disorders, since the procedure can provoke a deterioration in the condition;
• The presence of malignant tumors, since hemodialysis can provoke metastases;
• Tuberculosis of the lungs and other internal organs in the active stage. The infection may start to spread faster. In addition, the risk of infecting other patients increases;
• A period of several months after a heart attack, as well as chronic heart failure, as the risk of blood clots increases.

In emergency cases, when a person is close to death due to kidney failure, hemodialysis is carried out urgently, neglecting the existing contraindications.

Side effects

The most common side effects of hemodialysis are:

• Jumps in blood pressure, both up and down;
• Headaches;
• muscle cramps;

Headaches - possible side effects of hemodialysis

Of the more rare phenomena, one can name nausea, malfunctions of the heart, thrombosis.

In order to reduce the risk of side effects, patients can be prescribed various types of drug therapy in parallel with hemodialysis. For example, taking drugs that normalize blood pressure. Between treatments, it is recommended to follow a special diet with limited fluid intake. In between courses, it is also important to control body weight. It shouldn't rise too much.

In addition, it is necessary to ensure that the body receives adequately all the necessary vitamins and minerals, in particular calcium, phosphorus, vitamin D3. It is important to remember that taking drugs that regulate blood clotting can indirectly affect hemodialysis, so drugs of this class can only be used as prescribed by the attending physician.

Diet in dialysis therapy

Patients with impaired renal function receiving a hemodialysis procedure must adhere to certain norms in the diet. Here are a few simple rules: limit fluid intake, and reduce the amount of foods containing potassium (potatoes, nuts) and phosphorus (fish, various types of cheeses).

In addition, it is important to monitor the daily intake of protein. The desired amount is 1.2 g of protein per 1 kg of body weight. Half of the total amount of protein consumed should be of animal origin.

If, while observing all the norms, nutrition is insufficient and weight loss is observed, then the following measures are taken to avoid exhaustion. Additional protein mixtures are added to the diet, if this does not help, the patient is given food through a tube, and if there is no effect, they are administered intravenously.

You can not use salt and its substitutes with potassium, and also eat salty foods. In parallel with hemodialysis, vitamins C, D, and also group B can be prescribed. Often, iron-containing drugs or stimulating hematopoiesis are required.

Impact of hemodialysis on life expectancy

The need to receive a hemodialysis procedure imposes some restrictions, especially considering the fact that there are practically no portable devices in Russia. That is, the patient needs to visit a special center at least three times a week to undergo the procedure. The consolation is that in Russia for such patients three sessions a week are free. And if you want to go on vacation to another city, you can contact the center at the place of rest in advance and undergo the procedure there, again free of charge.

So in general, patients receiving such a procedure can live a full life, study, work, play sports, and relax. According to statistics, the average life expectancy on an "artificial kidney" is currently 20-30 years, and this is a long time. For people who have reached the age of 75, the prognosis is no longer so rosy, but, as a rule, it is still years, especially in the absence of diseases that worsen the condition of the body.

In order to live 20 to 30 years while receiving hemodialysis, you need to get used to interacting with medical professionals, as well as diet, monitor your own weight and diet. In addition, it is important to at least roughly understand the effect of all prescribed medications and learn to determine when the state of the body is critical and urgent help is required. You should not take any medication without consulting your doctor.