HEALTH CARE TODAY
WITH DIALYSIS
By Dr. J. Peter Singh - American Renal Associates
Kidney disease is a leading health problem in the United States.
According to the National Kidney Foundation, approximately 26 million American adults have chronic kidney disease (CKD), and there are millions of others that are at high risk. It is possible that up to 50 percent of a renal function may be lost without any signs or symptoms. This can happen to anyone at any age. A number of kidney diseases can be successfully treated in the early stages but may be potentially fatal if neglected. Because early detection can help prevent the progression of kidney disease, it is important to know about kidney failure and potential causes.
Kidney failure can have many varied causes. Some are systemic
diseases such as diabetes, hypertension, amyloidosis, polycystic kidney disease or renal cell carcinoma. Others are event-driven such as drug toxicity, urinary system obstruction and shock due to blood loss. There are six major warning signs of kidney disease:
• Gradual swelling of the body (eyelids, hands, ankles, and abdomen)
• Lower back pain just below the rib cage • Increased frequency or changes in the pattern of urination • Burning on urination • Bloody or coffee colored urine • High blood pressure
Hemodialysis treatment floor of the Dialysis Care Center of Palm Coast - courtesy of American Renal Associates
In hemodialysis, the patients’ blood is filtered through an
Dr. J. Peter Singh examining a dialysis patient - courtesy of American Renal Associates
Loss of renal function, due to an event, can occasionally be
recovered. When renal function is not recovered, the patient is said to have chronic kidney disease and requires life sustaining treatments. These treatments, in their varied forms, are referred to as dialysis.
Dialysis treatments remove extra fluid and waste (toxins) from
the patient’s blood, which their kidneys can no longer do. There are several ways to treat patients with kidney failure, either in- center (hemodialysis) or at home (hemodialysis or peritoneal dialysis). All require a significant amount of time to complete the actual procedures needed for the chosen treatment. CKD patients receiving dialysis must also follow the diet plan and medication regimen prescribed by their nephrologist (physician specializing in kidney diseases).
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artificial dialyzer, removing excess waste products from the blood normally processed by functioning kidneys. This process also regulates fluid and electrolytes in the body and helps with blood pressure control. There are several different kinds of dialysis machines, all using the same processes of osmosis (movement of fluids due to solution concentration), diffusion (movement of particles due to solution concentration) and ultrafiltration (movement of fluid due to pressure gradient). The patient must have an access for the blood to be taken from the circulatory system and returned. These can be internal, such as a graft or fistula, or external, through a central venous catheter. Hemodialysis can be done in-center with the assistance of the staff, or at home with a trained helper. In-center treatments are usually 3-4 hours, 3 times a week. Home hemodialysis is often performed daily with less time and lower blood flow rates. In peritoneal dialysis, the patient’s peritoneal membrane, in the abdomen, serves as the filter. A catheter is implanted through the abdominal wall into this area, which stays in place as long as the patient is on a dialysis regimen. This catheter is to allow an infusion and subsequent drain of dialysate, a special normalizing solution. Dextrose in the solution creates an osmotic gradient that causes fluid to be pulled into the peritoneal cavity where electrolytes and uremic toxins are removed through diffusion. Peritoneal exchanges can be done manually throughout the day or overnight with the assistance of a cycling machine. In some circumstances, the treatment is the transplantation of a kidney from a donor to the CKD patient. This can be from a living related donor, living unrelated donor or cadaveric donor. Some patients are not suitable transplant candidates due to comorbidities or age. Patients will be evaluated by the nephrologist to determine if they are candidates for transplantation.
Through a team approach, the staff at a dialysis facility strives,
to provide the best care for a patient in a safe and comfortable setting, with the hope of increasing the patient’s overall well-being and quality of life. Each member of the patient-care team must be as knowledgeable as possible in the care and treatment of the patient with CKD.
The team consists of the patient’s nephrologist, nurse, patient
care technician, dietitian and social worker, among others. The nephrologist is responsible for prescribing the dialysis treatment to meet the needs of the individual patient. This includes the dialyzer size, length of treatment time, dialysate concentration and medications given during treatment. The medical director is the lead physician and head of the clinic responsible for overseeing
2012-2013 The Greater Daytona Healthcare GuideTM
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