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Tuesday, September 15, 2009

Dialysis: Treatment Options of End Stage Renal Disease

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• Is the process of cleaning the blood by removing wastes and fluid that build up when the kidneys fail.
• Is a way to replace some, but not all, kidney functions.
• The goal of dialysis is to help keep people with kidney failure as healthy as possible.
• Dialysis can't fully clean the blood.

Normal Kidney Function Compared to Dialysis
Removes all excess fluid each dayRemoves some fluid on treatment days
Removes waste product each dayRemoves some wastes on treatment days
Control electrolyte and acid/baseHelps restore electrolyte and acid/base balance
Controls blood pressure by fluid removal, sodium balance, and hormonal actionHelps control blood pressure by removing fluid and balancing sodium on treatment days
Makes erythropoetin, a hormone that triggers the bone marrow to make red blood cellsCan't make erythropoetin, but recombinant or genetically engineered erythropoetin is given
Controls calcium / phosphorus balance each dayCan change serum calcium levels somewhat by adjusting calcium in dialysate, can remove some phosphorus, but not as well as healthy kidney
Plays a role in hormonal balanceHas little, if any, effect on hormones
Activates vitamin DCannot activate vitamin D, vitamin D sterols can be given.

• Blood is pumped out of the patient's body, through an artificial kidney, or dialyzer, then back into the patient.
• Both blood and dialysate fluids are pumped through different parts of the dialyzer at the same time.
• A semi permeable membrane keeps the blood and the dialysate from mixing.
• Excess water and wastes pass out of the blood through pores in the membrane, into the dialysate.
• The used dialysate is sent down a drain.
• Only a small amount of blood is out of the body at one time.

In-center Hemodialysis
• Some patients feel safer getting treatment in a center with nurses and technicians there to help.
• They like the chance to meet other people who need dialysis and may make friends at the center
• Patient has days off between treatments not to think about dialysis.

Conventional Hemodialysis
• Patients and their partners are trained for a few weeks in how to put in needles, order supplies, run the machine, take blood samples, report problems, and respond to emergencies.

Nocturnal Hemodialysis
• Patients are trained to do their treatments from 3-7 nights each week, for about 8 hours, while they sleep
• Special connectors keep the needles from coming out in case patients toss or turn.
• Bedwetting alarms, placed beneath the needle insertion area, may be used to detect moisture and wake the patient up if even a drop of blood is lost.
• In some programs, the machine is linked by a modem to the hospital so a nurse or technician can follow each treatment.
• Patients who receive 48 hours of treatment each week ate a normal diet and had normal blood pressure without drugs.
• They did not need phosphate binders.
• Most had no fluid limits.
• They also had fewer symptoms - including less fatigue, cramping, dizziness, shortness of breath, or feeling cold.
• They felt more in control, and had better physical functioning.
• They have less heart damage than patients on conventional in-center hemodialysis                   .
• Longer treatments also remove much more b2m, the protein that causes amyloidosis

In-center nocturnal Hemodialysis
• Patient sleep in the center while getting their treatment.
• They get about 24 hours of treatment a week instead of the 9-12 they would normally get in-center

Short Daily Hemodialysis
• 2-3 hours treatment done 5-7 days per week

Newest type of home Hemodialysis

Dialysis: Treatment Options of End Stage Renal Disease - Related Hemodialysis Article


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