What is Dialysis
Dialysis is a treatment that is done when by healthy kidneys fail to do their work. It is needed when your own kidneys can no longer take care of your body’s needs. Dialysis replaces only some functions of the kidney. Dialysis is a life saving treatment.
When is dialysis needed?
Patient needs dialysis when he develop end stage kidney failure or sometimes temporary shutdown of the renal function – by then patient loses about 85 to 90 percent of kidney function and have a GFR of <10-15ml/min.
What does dialysis do?
When kidneys fail, dialysis keeps bodys function in balance by:
- removing waste, salt and extra water to prevent them from building up in the body
- keeping a safe level of certain chemicals in blood, such as potassium, sodium and bicarbonate
- helping to control blood pressure
Is kidney failure permanent?
Usually, but not always.
Some kinds of acute kidney failure get better after treatment. In some cases of acute kidney failure, dialysis may only be needed for a short time until the kidneys get better.
In chronic or end stage kidney failure, kidneys do not get better and one will need dialysis for the rest of their life. In such condition one may require kidney transplantation
Where is dialysis done?
Dialysis can be done in a hospital, in a dialysis unit , or at home.
, based on medical condition
Are there different types of dialysis?
Yes, there are two types of dialysis –hemodialysis and peritoneal dialysis.
What is hemodialysis?
In hemodialysis, an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from blood. To get blood into the artificial kidney, the doctor needs to make an access (entrance) into blood vessels. This is done by minor surgery to arm or leg.
Sometimes, an access is made by joining an artery to a vein under skin to make a bigger blood vessel called AV fistula.
However, if blood vessels are not adequate for a fistula, the doctor may use a soft plastic tube to join an artery and a vein under your skin. This is called AVgraft.
Occasionally, an access is made by means of a narrow plastic tube, called a catheter, which is inserted into a large vein in your neck. This type of access may be temporary, but is sometimes used for long-term treatment.
How long do hemodialysis treatments last?
The time needed for dialysis depends on:
- how well the kidneys work
- how much fluid weight one gains between treatments
- how much waste one has in body
- body surface area and
- the type of artificial kidney used
Usually, each hemodialysis treatment lasts about four hours and is done three times per week.
A type of hemodialysis called high-flux dialysis may take less time.
What is peritoneal dialysis and how does it work?
In this type of dialysis, your blood is cleaned inside your body. The doctor will do surgery to place a plastic tube called a catheter into your abdomen (belly) to make an access. During the treatment, your abdominal area (called the peritoneal cavity) is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate. There are two major kinds of peritoneal dialysis.
What are the different kinds of peritoneal dialysis and how do they work?
There are several kinds of peritoneal dialysis but two major ones are:
Continuous Ambulatory Peritoneal Dialysis (CAPD) and
Automated Peritoneal Dialysis (APD).
Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. Patient does this on their own, usually four or five times a day at home and/or at work.
Patient needs 3-4 exchanges per day depending on the condition. While the dialysate is in peritoneal cavity, one can do usual activities at work, at school or at home.
Automated Peritoneal Dialysis (APD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night while patient sleeps.
Will dialysis help cure the kidney disease?
No. Dialysis does some of the work of healthy kidneys, but it does not cure the kidney disease. Cure of the kidneys depends on the nature of the illness wether the disease is acute (temporary) or chronic( permanent)
Is dialysis uncomfortable?
The dialysis treatment itself is painless. However, some may have some discomfort when the needles are put into the fistula or graft, but most patients have no other problems some patients may have a drop in their blood pressure, but the trained medical personale can handle this with out any problem. With frequent treatments, those problems usually go away.
How long can one live on dialysis?
Dialysis treatment is life saving treatment .If both kidneys have failed permaenently, they will need to have dialysis treatments for whole life unless they are able to get a kidney transplant. Life expectancy on dialysis can vary depending on other medical conditions and how well they follow the treatment plan. Average life expectancy on dialysis is 5-10 years, however, many patients have lived well on dialysis for 20 or even 30 years.
Do dialysis patients feel normal?
Many patients live normal lives except for the time needed for treatments. Dialysis usually makes you feel better because it helps many of the problems caused by kidney failure.
Do dialysis patients have to control their diets?
Yes. They may be on a special diet. They may not be able to eat everything they like, and they may need to limit how much to drink. Diet may vary according to the type of dialysis.
Can dialysis patients travel?
Yes. Dialysis centers are located in every part of India and in many foreign countries. The treatment is standardized. they must make an appointment for dialysis treatments at another center before they go. The staff at dialysis center may help make the appointment.
Can dialysis patients continue to work?
Many dialysis patients can go back to work after they have gotten used to dialysis. If the job has a lot of physical labor (heavy lifting, digging, etc. ), one may need to get a different job.
What does kidneys do?
Kidneys are very important organs of the body they do a variety of functions to keep the body healthy.
Cleaning your blood is only one of their jobs.
They also control chemicals and fluids in the body, help control blood pressure and help make red blood cells, help bones to be strong by helping in calcium metabolism.
Chronic kidney failure
Chronic Kidney failure (CKD), is a clinical condition where in kidneys underwork permanently. There are 5 stages of CKD depending on the degree of kidney dysfunction. End-stage renal disease (ESRD), is the last stage of chronic kidney disease, When kidneys fail, or stopped working well enough for one to survive without dialysis or a kidney transplant.
Who are at high risk for chronic kidney disease (CKD)?
Anyone can get CKD. Some people are more at risk than others. Some things that increase your risk for CKD include:
- High blood pressure (hypertension)
- Heart disease
- Having a family member with kidney disease
- Being African-American, Hispanic, Native American or Asian
- Being over 60 years old
What causes kidney failure?
Diabetes mellitus is the most common cause.
High BP is the second
Other problems that can cause kidney failure include:
- Autoimmune diseases, such as systemic lupus (SLE) and IgA nephropathy
- Genetic diseases such as polycystic kidney diease (ex-ADPKD)
- Chronic glomerulo nepritis ex- FSGS, MPGN
- Urinary tract problems congenital or acquired
- Kidney infections like chronic pyelonephritis
- Renal artery stenosis
Symptoms of chronic kidney disease
Chronic kidney disease (CKD) usually gets worse slowly, and symptoms may not appear until the kidneys are badly damaged. Many times CKD has no detectable or specific symptoms.
In the late stages of CKD, as you are nearing kidney failure (ESRD), they may notice symptoms that are caused by body waste and extra fluid building up in body.
There may be one or more of the following symptoms:
- Muscle cramps
- Nausea and vomiting
- Not feeling hungry
- Swelling in your feet and ankles
- Too much urine or not enough urine
- Shortness of breath
- Trouble sleeping
If the kidneys stop working suddenly (acute kidney failure), there may be one or more of the following symptoms:
- Abdominal (belly) pain
- Back pain
Treatment of kidney failure
In patients with end-stage renal disease or (ESRD), they need dialysis or a kidney transplant as a life saving treatment.
There is no cure for ESRD, but many people live long lives while on dialysis or after having a kidney transplant.
There are just a few options for treating kidney failure, including kidney transplant and several types of dialysis.
Kidney failure treatment
There are several treatments for kidney failure. The type of treatment you need will depend on the reason for your kidney failure.
Hemodialysis filters and purifies the blood using a machine. The machine performs the function of the kidneys. Depending on the type of dialysis, you may be connected to a large machine or a portable catheter bag.
You may need to follow a low-potassium, low-salt diet along with dialysis.
Dialysis doesn’t cure kidney failure, but it can extend your life if you go to regularly scheduled treatments.
Another treatment option is a Kidne transplantation. A transplanted kidney can work normally, and dialysis is no longer needed.
There’s usually a long wait to receive a donor kidney that’s compatible with your body. If you have a living donor the process may go more quickly.
You must take
Immunosuppressive drugs after the surgery to prevent your body from rejecting the new kidney. These drugs have their own side effects, some of which are serious.
Transplant surgery might not be the right treatment option for everyone. It’s also possible for the surgery to be unsuccessful.
Kidney failure diet
The guidelines for what to eat will often depend on the stage of kidney disease and patients individual health. Some recommendations might include:
- Limit sodium and potassium. Patients should Keep track of how much they are taking in of these two nutrients. They should Aim to eat fewer than 2,000 milligrams per day of both.
- Limit phosphorus. Like sodium and potassium, it’s good to keep a cap on the amount of Phosphrous eaten in a day. Try to stay below 1,000 milligrams.
- Follow protein guidelines. In early and moderate kidney disease, patient might need to cut back on protein consumption. In end-stage kidney failure, while on dialysis however, they may eat more protein, depending on your doctor’s recommendations.
. Kidney failure prognosis
The prognosis, or outlook, for people with kidney failure depends on several factors. These include the underlying cause, how well that cause is treated, and any complicating factors, like high blood pressure or diabetes.
Proper treatment and healthy lifestyle changes may be able to improve your outlook. Eating a healthy diet, cutting back on kidney-damaging foods, and treating any underlying issues can help extend your health and your life.
How to prevent kidney disease
- Control your blood sugar if you have diabetes.
- Keep a healthy blood pressure.
- Follow a low-salt, low-fat diet.
- Exercise at least 30 minutes on most days of the week.
- Keep a healthy weight.
- Do not smoke or use tobacco.
- Limit alcohol.
Acute Kidney Injury (AKI)
What is acute kidney injury (AKI)?
Acute kidney injury (AKI) is a sudden onset of kidney failure or kidney damage that happens within a few days. AKI causes a build-up of waste products in the blood and makes it hard for the kidneys to keep the right balance of fluid in the body.
AKI can also affect other organs such as the brain, heart, and lungs. Acute kidney injury is common in patients who are in intensive care units, and especially in older adults.
other causes of AKI
Acute kidney injury can have many different causes. AKI can be caused by the following:
Decreased blood flow
Some diseases and conditions can slow blood flow to your kidneys and cause AKI.
These diseases and conditions include:
- Low blood pressure (called “hypotension”) or shock
- Blood or fluid loss (such as bleeding, severe diarrhea)
- Heart attack, heart failure, and other conditions leading to decreased heart function
- Organ failure (e.g., heart, liver)
- Overuse of pain medicines called “NSAIDs”, which are used to reduce swelling or relieve pain from headaches, colds, flu, and other ailments. Examples include ibuprofen, ketoprofen, and naproxen.
- Severe allergic reactions
- Major surgery
Direct Damage to the Kidneys
Some disease and conditions can damage your kidneys and lead to AKI. Some examples include:
- A type of severe, life-threatening infection called “sepsis”
- A type of cancer called “multiple myeloma”
- A rare condition that causes inflammation and scarring to your blood vessels, making them stiff, weak, and narrow (called “vasculitis”)
- An allergic reaction to certain types of drugs (called “interstitial nephritis”)
- A group of diseases (called “scleroderma”) that affect the connective tissue that supports your internal organs
- Conditions that cause inflammation or damage to the kidney tubules, to the small blood vessels in the kidneys, or to the filtering units in the kidneys (such as “tubular necrosis,” “glomerulonephritis, “vasculitis” or “thrombotic microangiopathy”).
Blockage of the urinary tract
In some people, conditions or diseases can block the passage of urine out of the body and can lead to AKI.
Blockage can be caused by:
- Bladder, prostate, or cervical cancer
- Enlarged prostate
- Problems with the nervous system that affect the bladder and urination
- Kidney stones
- Blood clots in urinary bladder
How is AKI evaluated
Depending on the cause of the acute kidney injury, AKI is evaluated with blood , urine tests, ultrasound scanning & xray of the abdomen,24 hr urine protein, kidney biopsy in some cases. AKI can lead to chronic kidney disease, or even chronic kidney failure. It may also lead to heart disease or death.
What is the treatment for acute kidney injury?
Treatment depends on the cause of your AKI and how quickly kidneys recover. In more serious cases dialysis may be needed to help replace kidney function until your kidneys recover. This is done as alife saving measure.The main goal is to treat what is causing the acute kidney injury. And to treat all of the symptoms and complications until the kidneys recover.
After having AKI, the chances are higher for other health problems (such as kidney disease, stroke, heart disease) or having AKI again in the future. The chances for developing kidney disease and chronic kidney failure increase every time AKI occurs.
Facts on Kidney Stones
- The kidney acts as a filter for blood, removing waste products from the body and making urine.
- It also helps regulate electrolyte levels that are important for body function. Urine drains from the kidney through a narrow tube called the ureter into the bladder. When the bladder fills and there is an urge to urinate, the bladder empties to the outside through the urethra, a much wider tube than the ureter.
- In some people, chemicals crystallize in the urine and may form a kidneystone in suitable environment. These stones are very tiny when they form, smaller than a grain of sand, but gradually can grow over time to an inch or larger.
- Urolithiasis is the term that refers to the presence of stones in the urinary tract, while nephrolithiasis (nephro = kidney + lithiasis = stone) refers to kidney stones and ureterolithiasis refers to stones lodged in the ureter.
- The treatment of kidney stone depends on size of the stone , but where it is located and whether it obstructs or prevents urine from draining can be just as important.
- When the stone sits in the kidney, it rarely causes pain, but when it falls into the ureter, it acts like a dam. As the kidney continues to function and make urine, pressure builds up behind the stone and causes the kidney to swell.( Hydronephrosis or hydroureteronephrosis)
- This pressure is what causes the pain of a kidney stone, but it also helps push the stone along the course of the ureter. When the stone enters the bladder, the obstruction in the ureter is relieved and the symptoms of a kidney stone are resolved.
What Are the Symptoms and Signs of Kidney Stones?
When a tubular structure is blocked in the body, waves of pain occur as the body tries to unblock the obstruction. These waves of pain are called colic pain.
- Renal colic (renal is the medical term for things related to the kidney) has a classic presentation when a kidney stone is being passed.
- The pain is intense and comes on suddenly. It may wax and wane, but there is usually a significant underlying ache between the acute spasms of pain.
- It is usually located in the flank or the side of the mid back and may radiate to the groin. Males may complain of pain in the testicle or scrotum.
- The patient cannot find a comfortable position
- Sweating , nausea, and vomiting are common.
- Blood may or may not be visible in the urine because the stone has irritated the kidney or ureter, hematuria and urine infections.
- If an infection is present along with a kidney stone, fever, and chills may occur.
What Causes Kidney Stones?
There is no consensus as to why kidney stones form.
- Heredity: Some people are more susceptible to forming kidney stones, and heredity may play a role. The majority of kidney stones are made of calcium, and hypercalciuria (high levels of calcium in the urine) is one risk factor. The predisposition to high levels of calcium in the urine may be passed on hereditary. Some hereditary diseases also predispose some people to form kidney stones. Examples include people with renal tubular acidosis and people with problems metabolizing a variety of chemicals including cystine (an amino acid), oxalate, (a salt of an organic acid), and uric acid.
- Geographical location: There may be a geographic predisposition to forming kidney stones,
- There are regional “stone belts,” with people living in the hot climate combined with inadequate fluid intake may cause people to be relatively dehydrated, with their urine becoming more concentrated and allowing chemicals to cristalize to form the nidus, or beginning of a stone.
- Diet: Diet may or may not be an issue,in susceptible people to form stones, then foods high in animal proteins and salt may increase the risk; however, if a person isn’t susceptible to forming stones, diet probably will not change that risk.
- Medications: People taking diuretics and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and potentially increase their risk of forming stones. Taking excess amounts of vitamins A and D are also associated with higher levels of calcium in the urine. Patients with HIV who take the medication indinavir may form indinavir stones. Other commonly prescribed medications associated with stone formation include phenytoin
- Underlying illnesses: Some chronic illnesses are associated with kidney stone formation, including cystic fibrosis, renal tubular acidosis and inflammatory bowel disease.
What Are Staghorn Calculi?
- Some stones grow very large and fill the entire kidney collecting system. They are called staghorn calculi.
- While most kidney stones are made up of calcium oxalate crystals, this type of stone is a composite of struvite, carbonate, and apatite.
- They are usually the result of recurrent urine tract infections, in which the bacteria produce ammonia, allowing chemicals in the urine to form the nidus for stone formation
How Are Kidney Stones Diagnosed?
The classic presentation of renal colic associated with blood in the urine suggests the diagnosis of kidney stone. Many other conditions can mimic this disease,
Symptom control is very important, and medication for pain and nausea may be provided before the confirmation of the diagnosis occurs.
A urinalysis may detect blood in the urine. It is also done to look for evidence of infection, a complication of kidney stone disease. Sometimes, crystals may be seen in the urine and can give a clue as to what type of stone might be present.
CTscanning of the abdomen without oral or intravenous contrast dye is the most commonly used diagnostic test. The scan will demonstrate the anatomy of the kidneys, ureter, and bladder and can detect a stone, its location, its size, and whether it is causing dilation of the ureter and inflammation of the kidney.
ultrasound is another way of looking for kidney stones and obstruction
In those patients who already have the diagnosis of a kidney stone, plain abdominal X-rays may be used to track its movement down the ureter toward the bladder.
- Prevention is always the preferable way to treat kidney stones. Remaining well hydrated keeps the urine dilute and helps prevent kidney stones from forming. Maintaining dilute urine is the most important intervention for stone prevention.
- Those who have never passed a kidney stone may not appreciate the severity of the symptoms. There is little a person can do at home to control the debilitating pain and vomiting that can occur with a kidney stone other than to seek emergency care.It is important to be seen by a physician to confirm the diagnosis and a urologist for treatment. Urinary tract infections associated with a kidney stone often require urgent assessment and may need intervention by a urologist to remove or bypass the stone.
What Is the Treatment for Kidney Stones?
- In the emergency department, intravenous fluids may be provided to help with hydration and to allow the administration of medications to control pain and nausea. .
- If the pain is intractable (hard to control) or if vomiting persists, then admission to the hospital may be necessary. Also, if an infection is associated with the stone, then admission to the hospital will be considered.
- Because of their size or location, some stones may not be able to be passed without help. If the stone does not pass, then a urologist may need to consider using lithotripsy, or ESWL to break the stone up into smaller fragments to allow those small pieces to pass more easily into the bladder.
- If the stone is located in a place where lithotripsy cannot be used, or if there is a need to relieve the obstruction emergently (an example would include the presence of an infection), the urologist may perform ureteroscopy, in which instruments are threaded into the ureter and can allow the physician to use a laser to fragment the stone. Occasionally, the urologist may be able to use instruments to grab the stone and remove it.
What Are Possible Complications of Kidney Stones?
- Since most patients have two kidneys, a temporary obstruction of one is not of great significance. For those patients with only one kidney, an obstructing stone can be a true emergency, and the need to relieve the obstruction becomes greater. A kidney that remains completely obstructed for a prolonged period of time may stop working permanently.
- Infection associated with an obstructing stone is another emergent situation. When urine is infected and cannot drain, the situation is an emergency, that can spread the infection throughout the body sepsis. Fever with chills and rigors is a major sign of this complication, but urinalysis may show an infection and cause the urologist to consider placing a stent, nephrostomy tube, or removing the stone to relieve the obstruction. Antibiotics use may be considered.
How to Prevent Kidney Stones
- While kidney stones and renal colic cannot always be prevented, the risk of forming a stone can be minimized by avoiding frequent dehydration. Keeping the urine dilute will not allow the crystalyzation and form the beginning nidus of a stone.
- Medication may be prescribed for certain types of stones, and compliance with taking the medication is a must to reduce the risk of future episodes.
- Stay hydrated. Drinking more water is the best way to prevent kidney stones. …
- Eat more calcium-rich foods. …
- Eat less sodium. …
- Eat fewer oxalate-rich foods. …
- Eat less animal protein. …
- Avoid vitamin C supplements.
- drink at least twelve glasses of water daily
- drink citrus juices, such as orange juice
- eat a calcium-rich food at each meal, at least three times a day
- limit your intake of animal protein
- eat less salt, added sugar, and products containing high fructose corn syrup
- avoid foods and drinks high in oxalates and phosphates
- avoid eating or drinking anything which dehydrates you, such as alcohol.