Dialysis

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Dialysis and Kidney
Dialysis

Dialysis is a treatment used as an artificial replacement for lost kidney function in cases of renal failure, poisoning as well as increased potassium level in the blood.

Hemodialysis

Hemodialysis uses a special apparatus called dialyzator.  The dialyzator is connected to the patient's circulation. The patient's blood passes through tubes to special „capillaries“ in the dialyzator. In these capillaries the blood is cleaned and after that it is returned to the patient's circulation.

Special solutions are used during the cleaning process. They have a particular concentration of minerals and organic compounds (these solutions are very similar to the human's blood plasma). The principle of the cleaning process is diffusion, where materials from higher concentration move into lower concentration through a selectively permeable membrane of capillaries. That is how toxic materials (urea, creatinin) as well as the excess of potassium and fluids are removed from the blood. Intoxication with alcohol surrogates and some drugs is also treated that way.

Scheduled dialysis is performed to patients with chronic renal insufficiency, which is the terminal stage of almost every chronic renal disease. The patients are chosen using special criteria - clinical signs and laboratory test results. To evaluate renal function, glomerular filtration rate is always counted. Scheduled hemodialysis is usually performed in special centers of dialysis, three times a week. The procedure lasts 3 - 4 hours.

Before starting scheduled hemodialysis a special blood-vessel in the arm (mostly in the forearm) is formed surgically. When hemodialysis is planned, a surgeon forms an arteriovenal shunt (fistula) to expand and thicken the vein of the hand. This vein is used after 2 - 4 weeks (when it „matures“) to install needles used in dialysis.

Emergency dialyses are used in cases of acute renal insufficiency, intoxication, hyperpotassemia (life threatening excess of potassium, mostly in the cases of renal failure) also in the cases of chronic renal insufficiency when sudden decline occurs.

It is obvious that when an emergency dialysis is needed, we cannot wait until the fistula in the hand „matures“ Instead, a bigger vein (under the clavicle, or in the neck) is used. In this procedure a special catheter is used. Only an experienced reanimatologist or nephrologist can implant the central catheter.

Peritoneal dialysis

This method is based on the idea that humans have their own selectively permeable membrane - peritoneum. A special hole is surgically formed in the abdomen. This hole is used to pour solution used in dialysis. After a few hours the solution is replaced with a new one. The principle is the same as in hemodialysis - diffusion. This method is used for active, independent patients with terminal renal failure, who cannot come to centers of dialysis three times a week to perform a four hour long dialysis.

Peritoneal dialysis has its own side effects - the risk of infection. That is why the solution used in dialysis should be replaced under strict hygiene.

   

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