Personal experience “Without dialysis a person dies from intoxication”: How I live with kidney failure

What is dialysis

Dialysis Dialysis is a method of purifying the blood of harmful substances and excess fluid using a special hypertonic solution.
It contains electrolytes, like blood plasma, as well as a high concentration of glucose. During the procedure, such a solution is placed on one side of a semi-permeable membrane, and blood is placed on the other. As a result, glucose draws water from the blood with uric acid, small proteins and other toxic substances dissolved in it. In a healthy person, this filtering of blood and production of urine is carried out by the kidneys. This occurs in the choroid plexuses (glomeruli). But when they are damaged, metabolic products, electrolytes and other compounds accumulate in the body. If all this is not removed by dialysis, the person may die.

Diet

If a patient needs to be treated or maintained with dialysis, diet becomes an important part of his recovery. Often, doctors also adjust the drinking regime to further relieve the load on the kidneys.

Patients will need:

• exclude too salty foods from the diet;
• give up sweets;
• refuse baking;
• avoid mayonnaise;
• do not drink black tea and sweet soda;
• don't eat anything spicy.

It is recommended to consume various vegetarian dishes, vegetable soups, fruits and vegetables in large quantities. Sweets in the diet can be replaced with honey and nuts. You will have to saturate your diet with plenty of carbohydrates, fats and proteins.

Who gets dialysis?

Most often, the procedure is prescribed for chronic renal failure, which can develop for various reasons. Hemodialysis. Here they are:

• diabetes;
• arterial hypertension;
• glomerulonephritis, or immune inflammation of the kidneys;
• vasculitis - inflammation of blood vessels;
• polycystic kidney disease - the formation of a large number of cavities with fluid in them.

Sometimes dialysis is required Dialysis - hemodialysis for acute renal failure. This condition, Acute kidney failure, develops quickly, within two days. It may be associated with drug or drug poisoning, shock due to a burn, blood loss or sepsis, as well as blockage of the urinary tract with a stone or kidney blood vessels with blood clots.

The main criterion for Dialysis - hemodialysis, which the doctor focuses on when prescribing dialysis, is a decrease in kidney function to 10-15%. To determine this, a glomerular filtration rate test is performed. The study shows how small renal vessels allow various substances to pass through them.

Albumin dialysis machine MARS: artificial liver

The problem of treating liver failure remains of great relevance and is one of the most important and complex problems of medicine, since from year to year there is an increase in incidence, in particular, severe forms of acute viral hepatitis, as well as toxic alcoholic and drug-induced liver damage. Violation of the synthetic, metabolic and detoxification functions of the liver leads to the accumulation of various toxic substances, such as: ammonia, bile acids, nitric oxide, lactate (lactic acid), arachidonic acid metabolic products, endogenous benzodiazepines, indoles, mercaptans, inflammatory cytokines. As a result, systemic lesions develop - circulatory disorders leading to a hypertensive type of blood circulation, coagulation and immunological disorders. In addition, secondary organ damage occurs due to an excess of inflammatory mediators, leading to the clinical manifestation of multiple organ failure with the subsequent addition of septic complications.

Despite certain successes in modern intensive care, the mortality rate of patients with acute liver failure or decompensation of a chronic process remains unacceptably high and does not decrease below 60% even in specialized hepatology centers. Thus, according to the World Health Organization (WHO), among the causes of death, liver failure consistently ranks sixth (Kamath PS, 2001; Cardenas A., et al., 2005; D, Amigo G., et al., 2006). The current standard drug therapy (SMT) for liver failure is aimed at the possibility of spontaneous liver regeneration in acute lesions, as well as at treating complications and preventing the progression of the process in patients with chronic liver failure. However, in patients with fulminant liver failure and end-stage chronic failure, standard medical therapy (SMT) is completely ineffective. It should be noted that traditionally, most hepatology clinics adhere to conservative patient management tactics.

The hopes and successes of modern hepatology are largely related to the significant progress of modern medicine, and first of all, to the possibility of liver transplantation in previously hopeless patients. However, this treatment method cannot provide for all those in need due to a shortage of donor organs, high costs and long waiting times. However, the liver is a unique and only organ that has not only a large number of functions, but also the possibility of regeneration and functional restoration when its functions are temporarily replaced by hardware extracorporeal methods. Therefore, the creation and use of artificial systems to support liver function is the main idea of ​​modern intensive care for patients with liver failure, which has reduced mortality from 85% to 60% (Kim WR, Brown RS, 2002; Wilmer A., ​​et al., 2002; Isoniemi H., et al., 2005; Laleman W., et al., 2006; Ronco C., 2007). Currently, in world practice, the early use of extracorporeal hemocorrection has been proven and introduced in the complex therapy of acute and fulminant liver failure, including the development of liver graft dysfunction in recipients who have undergone surgery, as well as decompensation of chronic diffuse liver lesions. This made it possible to prevent the development of multiple organ failure and significantly improve the results of complex treatment of patients. Thus, the modern approach to restoring liver function includes the removal of pathological metabolites, inflammatory factors and vasoactive substances from the bloodstream using extracorporeal hemocorrection with the MARS albumin dialysis machine (Jalan R., Williams R., 2002; Stange J., et al., 2002 ; Davenport A., 2003; Evenepoel PW, et al., 2005).

The albumin liver dialysis machine "Artificial Liver" is a molecular adsorption recirculation system MARS

—
Molecular Adsorbent Recirculation System
and is intended for extracorporeal detoxification in liver failure of various origins, including those caused by: toxic hepatitis, liver cirrhosis, infectious hepatitis and pre-transplant preparation of patients. Albumin dialysis is hemodiafiltration using an albumin-enriched dialysate that helps remove protein-bound toxins. This technique requires an albumin perfusion device with monitoring of a closed circuit of the albumin dialysate (albumin liver dialysis), as well as a hemodialysis machine (artificial kidney). The proposed equipment should be a separate “Artificial Liver” unit (albumin dialysis unit) designed to control the flow intensity parameters of the albumin circuit, duration of therapy, pressure and temperature control, capable of being combined with the “Artificial Kidney” device (hemodialysis unit) from various manufacturers: Gambro , Fresenius Medical Care, B.Braun Melsungen AG, Bellco Spa, Nipro Corporation, etc.

The albumin dialysis system, Artificial liver, consists of:

1. I. MARS device ( MARS monitor),
   which works in conjunction with any known hemodialysis machine “artificial kidney” (the User must already have a hemodialysis machine in the hospital).
2. II. Therapeutic kits " MARS - Set ",
   which are consumables according to the principle: 1 set, consisting of 4 special cartridges for 1 procedure, lasting from 8 to 24 hours
   .

Each therapeutic set " MARS - Set " includes:

— MARS®FLUX DIALYZER

to remove protein-bound toxins using 20% ​​donor albumin, 500 ml (HAS dialysate).

— DIALYZER diaFLUX

for the removal of water-soluble low molecular weight toxins from the HAS dialysate in the MARS circulation system. Effective surface area: 1.7 sq.m.

— diaMARS® AC250 adsorption cartridge containing uncoated activated carbon

— serves to purify the HAS dialysate and remove low molecular weight non-polar compounds, bile and fatty acids, as well as aromatic polycyclic compounds in the MARS circulation system.

— diaMARS® IE250 adsorption cartridge containing anion exchange resin

for the removal of anionic compounds and bilirubin in the MARS circulation system.

—

The AS-02 hose system connects the above components of the MARS system and is equipped with air traps and a fine particle filter.

MARS
technology - Molecular Adsorbent Recirculation System
requires the use of a hemodialysis companion device (or a module for continuous venovenous hemofiltration), as well as a Gambro “MARS monitor” albumin dialysate perfusion device with monitoring of a closed albumin circuit. For blood perfusion through the device, venovenous access is required (most often a double-lumen catheter is used). Anticoagulation in the circuit is achieved by infusion of heparin, the dose of which is adjusted according to the time of activated coagulation and maintained at a level between 150-200s. Blood perfusion is carried out by the pump of the hemodialysis machine, or, otherwise, by the blood pump of the module for continuous venovenous hemofiltration. The blood flow rate is kept in the range from 150 to 200 ml/min, depending on the hemodynamic stability of the patient. The blood passes through the albumin-impermeable MARS-flux membrane. The closed albumin circuit is filled with 500 ml of 20% donor albumin and perfused with the MARS monitor roller pump at a rate of 150 ml/min. The albumin dialysate passes through the filter on the dialysis side of the membrane, after which it is regenerated by bicarbonate dialysate (the dialysis machine or module for continuous replacement therapy is responsible for its flow rate), after which the HAS dialysate enters a column with uncoated carbon, then into a second column with anion exchange resin. Treatment time varies depending on the methodology adopted in the clinic and the indications for therapy. On average, it lasts from 6 to 8 hours (intermittent technique), or, in the case of a continuous technique, 24 hours a day, which is most often used in intensive care units.

!
Attention!: It is very important for potential clients to indicate the brand of the companion hemodialysis machine, because The connecting hose system AS -02 has a different order number for the Gambro Prizma . Children's therapy kits also have a different order number for hoses.

What are the risks of dialysis?

Any method of blood purification can cause Side effects - Dialysis a feeling of fatigue and increased fatigue. This may have more to do with the kidney disease itself.

In addition, each dialysis method has specific complications. For hemodialysis, these are Side effects - Dialysis:

• Low blood pressure. This occurs due to a sharp decrease in the level of fluid in the vessels during the procedure.
• Blood poisoning, or sepsis. It develops when bacteria enter the blood.
• Muscle cramps. This complication also occurs due to fluid loss.
• Skin itching. It gets worse between dialysis treatments.
• Less common side effects. These are insomnia, joint pain, decreased libido, dry mouth and anxiety.

Peritoneal dialysis has fewer side effects - Dialysis complications. It can cause peritonitis, an infectious inflammation of the abdominal cavity. Also, people who undergo this procedure have an increased risk of developing an abdominal hernia.

Complications

Kidneys that for some reason cannot perform their functions are a serious problem. However, the dialysis procedure is associated with a number of complications, the treatment of which can be difficult, especially after the first few procedures.

If a patient undergoes hemodialysis, nausea and vomiting, anemia, which is accompanied by weakness, decreased performance, loss of consciousness and other unpleasant phenomena, may develop.

The peritoneal procedure, if done incorrectly, can lead to peritonitis, which is a life-threatening complication. It is also possible that the wound through which the device is installed becomes infected and various hernias develop.

How is dialysis performed?

The technique depends on what method of blood purification the doctor recommended.

Hemodialysis

First you need to prepare for the procedure, and this may take Hemodialysis several weeks or months. To do this, the surgeon will perform an operation on the vessels to which the device will be connected. There are three options for Hemodialysis intervention:

• Creation of an arteriovenous fistula. This is the safest way. On the arm that a person uses less often, an artery and a vein are connected.
• Installation of arteriovenous graft. If the vessels are too small to make a fistula, they are connected using a flexible synthetic tube.
• Insertion of a central venous catheter. This method is used in emergency cases when there is no time for planned preparation. To do this, a temporary tube is inserted into a large vein under the collarbone or in the groin.

When the postoperative wound has healed, they proceed to the procedure. Hemodialysis can be performed at home, using a portable machine, or in a hospital. Some people undergo blood cleansing with Hemodialysis two or three times a week for 5–6 hours. Sometimes dialysis is performed daily, but for 2–3 hours.

Before the procedure begins, the person weighs himself, his blood pressure, pulse and temperature are measured, and he is seated in a chair. The skin around the access point is cleaned with an antiseptic. Two needles are inserted into the vessels. The first is into the artery, from which blood is sucked into the device. Filtration takes place there. Then, through a second needle - in a vein - the purified blood returns to the body. During hemodialysis, fluctuations in fluid levels in the body may cause discomfort, pressure surges, nausea and abdominal cramps.

After the procedure is completed, the needles are removed, the skin is covered with a sterile tape, and the person is weighed again.

Peritoneal dialysis

You also need to prepare for it Dialysis. To do this, an incision is made in the skin near the navel, into which a thin tube called a catheter is inserted. After surgery, it should take 10–14 days for the wound to heal. The tube remains in place as long as dialysis is needed. Through it, a hypertonic solution will be infused into the abdominal cavity.

Further actions depend on the method of cleansing. There are two of them Dialysis - peritoneal:

• Continuous ambulatory peritoneal dialysis. In this case, the person’s stomach is filled with a solution. Then he can go about his business, since he does not need to connect to any device. After 4–6 hours, this liquid is drained. You will have to do this three to four times a day.
• Continuous cycle peritoneal dialysis. At night, the patient is connected to a special machine that injects dialysis water into the abdomen and removes it. Three to five such cycles occur during sleep.

Lifespan

How long do people live on kidney dialysis? Previously, when the technique had just appeared in medicine, life expectancy did not exceed 10 years, but it was already a significant breakthrough, given that before this kidney pathologies were generally difficult to correct.

Now that both the technique itself and medicine in general are improving, it becomes possible to live for years on artificial blood purification. There are patients who lived 20, 30 and even 50 years. The main thing is not to develop complications that significantly reduce survival.

The technique of artificial blood purification for various kidney pathologies has become a real salvation for a large number of patients. If the procedure is carried out correctly and recommendations are followed, it significantly increases life expectancy.

general information

Dialysis is a widely used method in medicine, which refers to extrarenal artificial filtration of blood.

This procedure is vital for patients with kidney failure. However, it is important to understand that kidney dialysis is not a treatment. The method allows you to rid the body of accumulated toxins and cleanse it of metabolic products.

Kidney cleansing is carried out in a hospital, using special equipment, under the supervision of medical personnel. As a rule, the dialysis procedure lasts a long time, which often negatively affects the well-being of patients and their general mood.