Dialysis - To Treat ESRD

Dialysis is the process of artificially removing wastes from the blood. This becomes necessary when the kidneys fail and are no longer able to function efficiently.

When there is complete and irreversible kidney failure, known as end stage renal disease (ESRD), dialysis helps to clean the blood and avoid the accumulation of toxins in the body.

Kidney failure can range from mild to severe, with end stage renal disease (ESRD) being to most severe stage.

"End stage renal disease (ESRD) is the most advanced and severe form of kidney disease. At this stage, the kidneys stop working completely, or function below 10% of their capacity."

Treatment of kidney failure is usually determined by the severity and type of kidney failure. Treatments can range from antibiotics (for infections), to ureteric stents (for blockage), or other medications for hypertension and diabetes.

Someone who is suspected of having kidney failure will undergo extensive blood tests to assess the levels of creatinine, blood urea nitrogen, uric acid, phosphate, sodium, and potassium in the blood. A full assessment of the kidneys is necessary to determine if the underlying kidney disease can be treated and whether the kidney failure is chronic or acute. This is normally determined by the use of magnetic resonance imaging (MRI), computed tomography (CT) scan, ultrasound, X rays, renal biopsy, and arteriogram (the recording of an arterial pulse) of the kidneys. These help to determine the cause of kidney failure and the level of remaining kidney function.

Kidney (or renal) failure is typically diagnosed and treated by a nephrologist (a doctor who specializes in treating the kidneys).

The treatment of kidney failure varies, depending on the condition and severity. For instance, the treatment of acute kidney failure is directed to the underlying condition or disease that has caused the kidneys to fail. Pre-renal conditions (conditions which do not cause kidney damage, but affect kidney function) may be treated with replacement fluids given through a vein, blood transfusion, diuretics (substance that increases urine formation and excretion), or other medications.

Post-renal conditions (conditions that causes obstruction of the urinary tract) and intra-renal conditions (causes direct injury to the kidneys) may require surgery and/ or medication.

If the kidneys fail completely, outside of a kidney transplant, the primary treatment of kidney failure includes hemodialysis (or haemodialysis), hemofiltration (or haemofiltration), and peritoneal dialysis. These treatments help to artificially remove toxins and other wastes from the blood, since the kidneys are no longer able to do so.

HEMODIALYSIS

Hemodialysis (commonly referred to as dialysis) is a kidney failure treatment that is administered in both acute and chronic renal failure cases.

Dialysis Machine Diagram

Dialysis involves circulating the blood outside of the body through an extra corporeal circuit (ECC) or dialysis-circuit. This circuit is made up of plastic tubing, a filter known as a dialyzer (or artificial kidney), and a dialysis machine.

The machine monitors and maintains blood flow and administers dialysate. Dialysate (dialysis fluid) is a sterile chemical solution that is used to draw waste products out of the blood. Fluid removal takes place after the blood leaves the body and passes through the extra corporeal circuit (ECC) and the dialyzer (filter).

Blood is pumped from the radial artery (in the arm) through the machine, where it is filtered. Harmful wastes and extra salt and fluids are removed. The clean blood is then returned to the body by way of a vein in the arm.

The duration of one course of dialysis (called a "run") may last for three to four hours, depending on the dialyzer used and the condition of the patient. Hemodialysis patients usually require three sessions per week. During a "run", waste products and excess water are carried from the bloodstream out of the body. At the same time, electrolytes and other chemicals are added to the blood. The purified and chemically balanced blood is then returned to the body.

Also, patients are typically given a hormone called erythropoietin (eh-RITH-ro-POY-eh-tin), by injection, to compensate for the lack of this vital hormone, which is normally produced by the kidneys.

Erythropoietin (EPO) is a hormone produced by healthy kidneys. It stimulates the bone marrow to produce red blood cells.

HEMOFILTRATION

Hemofiltration is another kidney failure treatment that helps to artificially remove waste and excess fluids from the blood. It is known as continuous renal replacement therapy (CRRT). This procedure is a slow continuous blood filtration therapy, used mainly to control acute kidney failure, in critically ill patients.

These patients are typically very sick and may have heart problems or circulatory problems. Consequently, they cannot handle the rapid filtration rates of hemodialysis. They frequently need antibiotics, nutrition, and other fluids administered through a vein, to treat their primary condition. Since hemofiltration is a slow continuous process, it is easier to give the required fluids to patients with kidney failure, without the risk of fluid overdose.

Hemofiltration also uses a dialysis circuit (ECC). A hollow fiber filter (hemofilter) is used instead of a dialyzer. This is responsible for removing excess fluids and toxins from the blood. Instead of a dialysis machine, hemofiltration uses a blood pump, which causes the blood to circulate through the ECC.

The volume of blood that flows through the ECC is much lower than in hemodialysis. The rates of filtration are slower and gentler on the circulatory system. This kidney failure treatment is generally used until kidney failure is reversed, in patients with acute kidney failure.

PERITONEAL DIALYSIS

This treatment is generally administered to patients with chronic kidney failure. It can also be uses by patients with acute kidney failure, once they are stable and not in immediate crisis.

Peritoneal Dialysis Diagram

This procedure uses the patient's peritoneum as a blood filter. The peritoneum is the membrane (thin flexible skin-like tissue) that lines the abdominal cavity. A flexible tube-like instrument (called a catheter) is surgically inserted into the patient's abdomen.

During this unique procedure, the catheter is used to fill the abdominal cavity with dialysate.

"Dialysate is a sterile chemical solution that is used to draw waste products out of the blood."

Waste products and excess fluids move from the patient's blood into the dialysate. After a period of time the waste-filled dialysate is drained from the patient's abdomen, and replaced with clean dialysate.

Even in the best situation, adjusting to the effects of kidney failure can be difficult. Dialysis takes up a lot of time and may leave the patient feeling weak. It may require some changes at home and at work... schedules may have to be changed and some activities and responsibilities may have to be given up. Additionally, dialysis and other kidney failure treatments can be expensive and become a financial burden to the patient and their relatives. The many challenges presented, can be overwhelming and difficult to adjust to.

If your kidneys are healthy and functioning well, please make every effort to keep it that way. If you are afflicted by kidney failure but your kidneys can still function relatively okay, you should take steps to minimize and prevent further kidney damage.

For those who may be suffering with end stage renal disease (ESRD) and may have to undergo dialysis, please do not despair. Do your best to keep a positive outlook and do not give up. Even if you have been waiting for a donated kidney for a long time, do not lose hope. If you begin to feel depressed, talk with you social worker, doctor, relatives, friends and most importantly, GOD.

Manage your diet well! Eating the right foods can help to improve your dialysis and your health. Talk with your dietitian to help you plan your meals and follow his/ her advice closely. Stay active and positive, and do all in your power to overcome the many challenges of kidney failure.