Dialysis

Introduction-

The lower back of our body is provided with a pair of organs called the kidneys, one on each side of the spine. The main function of the kidneys is to purify the blood and remove toxins from the body. The toxins pass through the bladder and are eliminated during urination. Some of the factors which affect the kidneys health are exposure to a toxic environment, severe dehydration, inadequate supply of blood to the kidneys, chronic kidney disease and kidney trauma.

Dialysis Definition:

Dialysis is a term that is derived from the Greek words “Dia” and “lysis”. “Dia” means “through” and “Lysis”means loosening or splitting. Dialysis is a process where excess solutes, toxins and water are removed from the blood. This process is employed in people who suffer from kidney failure or a condition in which the kidneys can no longer perform their natural functions.

The basic dialysis definition can be summed up to be the process of separating the excess water, solute and toxins from the blood in a person’s body, suffering from chronic kidney disease.

Need for Dialysis

End-Stage Kidney Disease (ESRD)

End-stage kidney disease or end-stage renal disease is a chronic kidney condition that causes the kidneys to stop functioning over time. This means that the kidneys may be barely functioning or not at all functioning. ESRD is the fifth stage of chronic kidney disease. The stage of ESRD is not reached until 10 to 20 years after the diagnosis of chronic kidney disease. The progression of chronic kidney disease is measured by the glomerular filtration rate (GFR).

Abnormal Blood Creatinine

Abnormal blood creatinine levels cause an autoimmune disease that in turn causes the blood vessels to swell. Urinary infections pertaining to the kidneys cause these abnormal and threatening levels of creatinine. These levels measure the functioning of the kidneys and are often increased with damage to the kidneys or blood vessels related to the kidneys.

Abnormal BUN Level

In certain conditions and diseases, the Blood Urea and Nitrogen(BUN) levels drastically increase. These conditions are caused by the following:

•     High Protein Diets
•     Chronic Diseases
•     Diabetes
•     Heart Failure
•     Heart attack
•     High Blood Pressure

Dialysis Classification

When we consider dialysis classification, there are many things that come to mind. However, dialysis classification can be done in five main categories. These categories are as follows:

1.   Haemodialysis

Haemodialysis is processed in which use of an artificial kidney for removing excess water  and toxins from the blood. The filtered blood is then passed through a dialysis machine and then returned to the body. 

In order to get the blood to pass to the artificial kidney, an entry point is surgically created in the blood vessels – this is called the vascular access. There are three types of vascular entrances:

•     Arteriovenous (AV) fistula

This type connects an artery or vein to the machine.

•     AV graft

This is a looped tube

•     Vascular access catheter

This is done by inserting a catheter into a large vein, usually present in the neck.

The AV fistula and AV graft are both methods designed for long term treatments. 

2.   Peritoneal dialysis

The peritoneal membrane is a membrane in the abdomen. When a catheter is inserted into the abdomen to help filter the fluid, it absorbs excess water from the body through the peritoneal membrane. 

These are the different peritoneal dialysis classifications:

•     Intermittent peritoneal dialysis (IPD)
•     Continuous cycling peritoneal dialysis (CCPD)
•     Continuous ambulatory peritoneal dialysis (CAPD)

3.   Continuous Renal Replacement

The process of hemofiltration or continuous renal replacement therapy is primarily used for people in the intensive care unit with acute kidney failure. This process is performed for 12 to 24 hours a day, usually every day.

4.   Hemodiafiltration

Acute kidney injury is a condition in which the kidneys stop functioning due to an external force that causes its rupture. In such a condition, hemodiafiltration is used, which is a combination of haemodialysis and haemofiltration.

5.   Intestinal dialysis

Acacia fibres are ingested, and these are digested by the bacteria in the colon. This process helps supplement soluble fibres in a diet. This alternative approach helps eliminate about 1 to 1.5 liters of non-soluble polyethylene glycol or mannitol in four hours.

Symptoms of Kidney Diseases:

There are two broad categorisations of the symptoms relating to kidney diseases. These can be summed up as follows:

•     Acute

The patients with an acute kidney injury undergo the following conditions:

1. Acidemia from metabolic acidosis occurs due to the impartial correction in sodium bicarbonate resulting in fluid overload.
2. Electrolyte Abnormality
3. Intoxication
4. Overload of fluids
5. Uremia or gastrointestinal bleeding

•     Chronic 

The Glomerular Filtration Rate (GFR) is taken as the measure to begin dialysis treatment. The GFR – if it is between the range of 5-9ml/min/1.73m2 – indicates a total failure of the kidneys. 

Advantages of Dialysis:

1.     Dialysis helps the blood not to clot, reducing the pressure.
2.     The amount of food or water intake does not have to be restricted.
3.     In peritoneal dialysis, not a lot of equipment is required. It can be carried out from the comfort of home.
4.     The procedure has to be performed three days a week, so there are four free days in a week.
5.     The procedure has to take place in a hospital with professionals, but in some cases, with adequate training and equipment, people can perform dialysis at home.
6.     Dialysis centers are around the world and can be approached very easily.

Disadvantages of Dialysis:

1. Although the diet intake does not have to be restricted, the components of the diet are regulated by dieticians.
2. The whole lifestyle of a person is scheduled around these dialysis sessions.
3. In peritoneal dialysis, the catheter is always attached to the abdomen. This may be upsetting for some people.
4. The disease called peritonitis is caused when the peritoneal membrane of the abdomen is infected because of dialysis.
5. Dialysis is a lifelong process if there is a condition in which there is no scope of improvement of the kidneys.

Conclusion

The process of dialysis was first brought about by Leonard Rowntree and John Abel, of Johns Hopkins Hospital, in 1913. Dialysis is a treatment that has helped a large number of people over the years. Dialysis helps clear solute from the blood. It has a very low rate of failure and is an early measure to detect if further treatment is needed. Dialysis also reduces the chances of bleeding or clotting of the blood, preventing infections.