What is kidney dialysis and how is it performed? Method of kidney dialysis: possible complications How to live on dialysis for a long time

Kidneys are one of the most important organs, without which the human body would “suffocate” from toxins and harmful substances. When the kidneys stop functioning, doctors prescribe kidney dialysis to maintain the body's performance, this method is quite common in modern medical practice.

What is dialysis

Kidney dialysis is a procedure that helps cleanse the human body of harmful substances, waste, and toxins, that is, it performs the same role as the kidneys. The procedure consists of injecting a person with a special solution to cleanse his body using a special apparatus.

The solution is passed through semi-permeable membranes with pores; it is through these membranes that various unnecessary substances are removed from the blood. The specifics of the procedure and the membranes used depend on the type of dialysis.

Cleansing the body requires quite a lot of time - from several days to several weeks, but there are solutions that speed up this process. Depending on how damaged the kidneys are, people live on dialysis either for a short period or for the rest of their lives.

Dialysis classification

Depending on the characteristics of the procedure and the devices used, there are different types of dialysis.

Hemodialysis is a procedure that is carried out using a device called “artificial kidney”. The principle of its operation is as follows:

1. Blood that requires purification passes through a filter into a container (dialyzer) with a special solution.
2. The dialyzer purifies the blood.
3. Purified blood goes back into the body.

Hemodialysis is reserved for patients whose veins and arteries are clearly visible, and is performed under the supervision of a doctor who monitors that the machine does not remove too much fluid from the body. This procedure is carried out for 3-4 hours 3 times a week. Under no circumstances should you miss a session even once.

consists in the fact that a special catheter is inserted into the human abdominal cavity. The abdominal cavity in this case is a dialyzer; a solution is injected into it several times a day. Further, the cleansing process is similar to the previous one. Peritoneal dialysis can be constant (the solution is changed every 4-10 hours) or automatic (a special liquid is changed while the patient sleeps). The second option gives better results. Peritoneal dialysis may cause complications in the abdominal cavity.

Intestinal dialysis. The essence of this technique is that instead of a membrane, the intestinal mucosa is used, and the cleansing technique is the same as for kidney disease - toxins pass through the mucosa into the dialysis solution, cleansing must be carried out repeatedly. Before dialysis, an enema is given with an active solution. Intestinal dialysis is prescribed if the two previous types are contraindicated for some reason.

Pros and cons of different types of dialysis

Both hemodialysis and peritoneal dialysis have the following positive effects on the body:

• perfectly remove accumulated waste and toxins;
• prevent the accumulation of excess salts;
• maintain the “purity” of the blood;
• regulate blood pressure.

Peritoneal dialysis also has the following advantages:

• allows you to set a schedule;
• the kidneys remain functional;
• not contraindicated for diabetics;
• requires little time.

The main disadvantages of hemodialysis:

• it can only be carried out in a hospital;
• requires a lot of time;
• cannot be carried out for patients with diabetes;
• high price for the devices needed for the procedure.

Disadvantages of peritoneal dialysis:

• it needs to be done frequently;
• there is a high risk of introducing an infection into the body;
• is not suitable for all patients (this is especially true for those who have abdominal pathologies).

Indications for dialysis

In medicine, this method of treatment is prescribed to patients whose body cannot cleanse itself of unnecessary substances due to any pathologies, the most common of which are:

• renal failure (determined by the results of laboratory blood tests);
• alcohol poisoning (methyl or ethyl);
• damage to the body by poisons;

• drug overdose;
• coma state
• swelling of the brain and lungs due to excessive hydration;
• disturbance of the electrolyte composition of the blood;
• Excessive water content in the kidneys (in case conventional therapy fails and the risk of death increases).

This is a list of those diseases that, without blood purification, threaten a person with death.

What conditions should be observed during dialysis?

Kidney dialysis is a complex procedure that requires special conditions and compliance with mandatory rules:

• the patient must be treated in a hospital setting under the supervision of a physician (especially for hemodialysis);
• in case of chronic renal failure, blood purification is carried out at least 3 times a week;
• a diet based on a large amount of protein and a restriction in the intake of salt, some spices and water (this condition is necessary to prevent the development of thrombosis and anemia due to the procedure);

• swelling signals the need to reduce the amount of fluid consumed;
• the patient must take vitamins prescribed by the doctor, their dosage is also determined by the specialist;
• life on dialysis requires regular testing for the presence of iron in the blood, as it can increase due to frequent blood transfusions;
• the doctor has the right only to recommend this method, and the patient decides whether to do it or not;
• the doctor must notify the patient how long they live on dialysis;
• Before treatment, the psycho-emotional state of a person must be checked;
• often this method of treatment requires supervision by a psychiatrist and neurologist, who help the patient mentally prepare for the procedure and undergo it without harm to the mental state;
• When agreeing to treatment, the patient must remember that this procedure must be carried out according to the schedule; if it is not followed, there will be no result.

An important and monetary issue: the patient must find out how much the procedure costs and be prepared for significant expenses. However, there are hospitals that receive funds from the local budget, and treatment in them can be provided cheaper, and in some cases, free.

Life expectancy on dialysis

People with kidney problems first of all have questions about what are the indications for kidney dialysis and how long they can live with this procedure.

At the first stages of the introduction of this procedure into medicine, the life expectancy of patients was 3-7 years. Today, devices for blood purification, and the process itself, have been improved, and people can live much longer - from 22 to 50 years, this depends on additional factors (the presence of other diseases, the patient’s lifestyle).

Contraindications

There are a number of contraindications for hemodialysis and peritoneal dialysis. The reasons for refusing peritoneal dialysis are:

• adhesions in the abdominal cavity;
• excess weight, due to which blood purification may not be effective;
• skin diseases in the abdominal area, especially if they are accompanied by inflammatory and purulent processes;
• drainage in the abdominal cavity;

• nervous system disorders;
• inflammatory processes in the abdominal cavity.
• serious pathologies of the cardiovascular system.

Hemodialysis is contraindicated in the presence of the following factors:

• diabetes;
• pathologies of the vascular system;
• nervous disorders;
• if it is difficult to “find” veins and arteries;
• heart diseases.

Kidney dialysis is a complex procedure for which a person must be prepared, first of all, mentally. Before agreeing to such treatment, carefully weigh the pros and cons, and also consult a specialist. If you agree, then, if you carefully follow all the specialist’s conditions, you will live for many more years without much discomfort.

Quite often, with various kidney diseases, when they cease to function normally, doctors recommend that patients begin undergoing dialysis. Not all patients understand what this method of therapy is and what it consists of. This information is very important, since it concerns mainly quite complex situations when there is a possibility of a fatal outcome of the disease.

A medical procedure such as dialysis is the process of cleansing a patient’s blood of toxic substances that his kidneys themselves are no longer able to remove from the body. Most often, such treatment is required in cases of acute and chronic dysfunction of the human urinary system.

Dialysis not only cleanses the blood of toxins, but also monitors the level of blood pressure, removes excess fluid, and maintains the correct balance of electrolytes and alkalis. There are several different types of dialysis that you should choose based on the following factors:

• patient's age;
• severity of disease progression;
• functional state of human organs.

Kinds

Today, there are two different types of dialysis that can be used in different situations depending on a person's needs.

Hemodialysis

It is a special procedure in which the artificial kidney apparatus cleanses the patient’s blood as much as possible from various toxic elements. His work is aimed at removing low-molecular and medium-molecular substances from the human body. A distinctive feature of this procedure is that it promotes the unchanged composition of the protein in the blood plasma.

The result of hemodialysis is the following effect:

1. reducing the amount of uremic toxins in the patient’s blood;
2. normalization of electrolyte and acid levels;
3. removing excess fluid, which helps lower blood pressure.

Hemodialysis is a procedure that has certain contraindications. Among them, experts identify the following diseases and conditions:

1. presence of hemorrhage in the brain;
2. insufficiency of the human cardiovascular system;
3. all types of diabetes;
4. bleeding, including internal bleeding.

It consists of introducing a special solution into the abdominal cavity, which is capable of cleansing the human body. Dialysis fluid is delivered into the patient's body through a catheter. Blood enters the location of the solution using intestinal vessels.

Peritoneal dialysis is believed to have more advantages than hemodialysis. The positive aspects of this method of therapy are as follows:

1. the patient can continue to lead the same lifestyle, regardless of his preferences and desires;
2. residual renal function continues to be preserved in the form in which it was at the time of initiation of therapy;
3. the worsening of cardiovascular problems is significantly slowed down;
4. the degree of the patient’s illness with viral diseases decreases;
5. the patient does not necessarily need to adhere to a strict diet;
6. there are no contraindications in the form of diabetes for this type of treatment;
7. After peritoneal dialysis, the patient can undergo a kidney transplant with a high success rate.

The main disadvantages of this type of treatment are the patient's history of surgical intervention in the abdominal cavity, excess body weight, hernias, vision problems, as well as the last degree of kidney damage.

Indications

Dialysis is not performed for any kidney disease. A doctor may recommend this method of therapy only in certain cases. Most often this happens with the following pathologies of the human urinary system:

• acute and chronic renal failure;
• poisoning with certain alcohols;
• problems with electrolyte balances in the blood;
• overdose of certain medications;
• intoxication with certain substances, which are poisons with the properties of penetration through the hemodialysis membrane;
• overhydration (excessive water content in the body), which cannot be treated with conservative methods.

The above pathologies without appropriate treatment can lead to death. Among the reasons that may become the basis for treatment in this way are the following blood indicators:

• creatinine level exceeding 800 - 1000 µmol per liter;
• urea level is in the range of 20 - 40 µmol per liter;
• glomerular filtration rate - less than 5 milliliters per liter;
• bicarbonate content is less than 15 mmol per liter.

When the kidney samples of a sick person with kidney problems are as indicated in the lists, the nephrologist may recommend starting a dialysis procedure. This requires the corresponding desire of the patient. Without it, it is impossible to start such therapy.

How is it carried out?

For the hemodialysis procedure to be effective, it must be carried out accordingly:

1. To do this, a communication should be made between the artery of a sick person and his venous vessel. This is done using a special shunt, to which in the future an “artificial kidney” device will be attached each time to pump blood through its purification system. The duration of this procedure can be from 3 to 5 hours.
2. Hemodialysis should be performed only in specialized medical institutions. They have appropriate rooms with specialized equipment.
3. There is a certain simplified diagram of how the dialyzer works. First, unpurified human blood is fed into this device.
4. After this, it is passed through a mechanism that separates toxic substances from it. They leave the blood product, after which the corresponding dialysate solution is supplied to it.
5. The liquid mixes with each other, becoming safe for humans.
6. After this, it returns from the device to the body in the form of purified blood without toxins, which has an adverse effect.

Peritoneal dialysis is most often carried out not in Russia, but in foreign medical institutions. This procedure is performed in a hospital setting, since it requires surgically creating direct access to the abdominal cavity of a sick person:

1. To do this, an incision is made in the anterior wall of the peritoneum.
2. After access is achieved, the patient is taught the process of filling his body with dialysate solution. This is necessary because the blood purification process in this case occurs at home.
3. Peritoneal dialysis requires the introduction of a solution into the peritoneum, subsequent filtration of the blood in this place and the removal of toxic substances. All this can be easily done by a sick person with kidney problems without the need to constantly come to the hospital.

The above methods of therapy for the human urinary system are carried out at the Volga Center for Kidney Transplantation and Dialysis. This medical institution is a clinic that provides highly specialized care to patients with diseases of the kidneys, liver, pancreas, intestines, lungs and heart using replacement therapy methods followed by organ and tissue transplantation.

Diet

Due to the fact that kidney diseases lead to the accumulation of toxic substances in the patient’s body, doctors recommend that sick people adhere to certain dietary rules. Its main goal is to completely or significantly limit the consumption of salts in food.

• proteins - from 60 to 70 grams per day;
• carbohydrates - up to 300 grams per day;
• animal fats - up to 70 grams per day;
• any liquids - up to 50 grams per day;
• salts - up to 4 grams per day;
• calcium - up to 1 gram per day;
• potassium - up to 3 grams per day;
• phosphorus - up to 1 gram per day.

The following should be completely excluded from the diet when undergoing kidney dialysis:

1. fatty and fried foods;
2. chocolate and cocoa;
3. dried fruits;
4. broths;
5. canned goods;
6. as well as vegetables and fruits rich in potassium and oxalic acid.

How long do people live on dialysis?

It is impossible to predict exactly how long people on dialysis will live. This is due to the fact that this period depends on many factors, among which the most important is the patient’s state of health. However, you should rely on the following facts:

1. If the patient's kidneys have completely failed and stopped functioning, then dialysis is performed several times a week. With residual performance of these organs, the frequency of the procedure is reduced to once a week or somewhat less frequently.
2. Today in Russia there are no official statistics on how long a person can live on dialysis. With properly selected therapy, as well as a kidney transplant, life expectancy, according to some experts, is extended by about 20 years.
3. The cause of death after the start of dialysis is often blood clots or improperly selected cleansing solutions. The second factor, which also affects the mortality of patients, is various viral diseases that affect a person due to a decrease in the level of his immunity. Thus, the body's protective functions often change significantly after dialysis, which is why a common infection, gastrointestinal problems, or influenza can become fatal.

Despite the existing disadvantages of dialysis, this procedure is indispensable in the nephrological field of medicine. It helps save people's lives, extending it even for decades. The main thing is to select the right therapy, implement all the recommendations of the attending physician and carefully monitor your own health. For many people, dialysis represents the only chance for salvation, which makes this procedure very important and significant.

You can also look at the opportunity to get dialysis under compulsory health insurance.

How long do they live after kidney dialysis? This question is of interest to all patients who are faced with organ pathology. Indeed, this procedure is vitally important, and if it is not carried out on time, it can be fatal. Those who are prescribed hemodialysis are well aware that at a certain time they must report to the hospital without delay. Kidneys play an important role in the human body. They cleanse the blood of toxins, excess salts, organic compounds, remove fluid, and ensure the synthesis of substances that control blood pressure. We can safely say that the kidneys are a powerful filter through which 1,700 liters of blood are purified per day.

brief information

The kidneys function in unison: they filter the same amount of fluid every day. If atrophy of one of them occurs, then the second copes with the necessary function alone. People with one kidney can live their entire lives, but the load on the organ increases significantly. Therefore, patients with one kidney are given the necessary recommendations to maintain their health. It happens that both kidneys stop working due to serious pathologies. In such cases, it becomes a salvation.

People who have various kidney diseases need to avoid bad habits, abuse of salt, spicy and smoked foods. Also, with some pathologies of the organ, therefore, patients require constant monitoring.

If a person is indicated for kidney hemodialysis, then first of all it is necessary to carry out psychological work so that the patient is in the right mood for the procedure and understands the importance of its implementation.

Description of the hemodialysis procedure

Hemodialysis began to be practiced almost 40 years ago. The procedure has proven itself well, so it has been improved over time. This allows us to save and prolong the lives of young people. Dialysis is prescribed if the kidneys lose their filtering function. This cleaning method effectively filters the blood, releasing metabolic products from it and safely removing them from the body. Dialysis exists in two types:

• hemodialysis;
• peritoneal.

Each method has its own advantages, contraindications and implementation features. To understand what hemodialysis is and the content of this procedure, it is necessary to recall kidney function. Essentially, its goal is to purify the blood through a device called an “artificial kidney.” Through an artery or vein, the blood enters special equipment containing filters. Thanks to these devices and a sterile solution, the blood is completely cleansed of toxins and poisons, after which it is returned to the patient’s body.

In this procedure, the person is seated in a special chair and connected to a machine, after which the blood is filtered for several hours.

Hemodialysis is required to be carried out 2-3 times a week, taking into account the patient’s age, height, weight, and the presence of underlying diseases. Sometimes they are limited to one procedure.

But most often it is carried out until a kidney transplant is performed.

During hemodialysis, nothing changes in the protein composition of the plasma. This filtration method is indicated for those patients whose arteries and veins are easily accessible. Thanks to the hemodialysis procedure, the following goals can be achieved:

• get rid of uremic toxins and colloidal substances;
• stabilize the electrolyte composition;
• normalize blood pressure by removing fluid.

Many patients believe that they can avoid this procedure by following a strict diet, but by doing so they miss the opportunity to preserve partial kidney function. It is necessary to begin the hemodialysis procedure as soon as doctors report its need. Refusal of medical help can lead to complete loss of the kidney. Timely hemodialysis will prolong life for a significant period.

What is the difference between peritoneal dialysis?

Peritoneal dialysis is also aimed at filtering blood, but the procedure itself differs in the way it is carried out. Cleansing is carried out using a special solution, which is injected into the abdominal cavity through a catheter for several hours. Almost 2 liters of dialysate is poured into the peritoneum, the membrane of which serves as a natural filter. Toxins, wastes, and breakdown products enter the dialysis solution over a period of 4–12 hours. After the “holding time”, all the fluid from the peritoneum is drained along with the “waste”. The procedure is called drainage and takes about 30 minutes. And after that, the sterile solution is poured again, and the process is repeated.

Peritoneal dialysis involves selecting a solution based on a person’s individual disease. This procedure has clear advantages over hemodialysis.

Its superiority is that a person does not have to give up his usual way of life, since he has time for any activity, recreation and hobby.

Partial kidney function is also preserved, the patient has less risk of being exposed to cardiovascular pathologies, and tolerates viral infections more easily. A strict diet is not required, and there is a high chance of a kidney transplant.

Peritoneal dialysis can be performed in patients with diabetes. This procedure is carried out both at home, after appropriate training, and in the hospital. The number of solution changes is 3–5 times a day. To carry out dialysis in this way, you need to purchase a tonometer, scales, a table, and a hook on which you need to attach the solution container. You will need to buy a heating pad for the dialysate, an antiseptic in the form of hydrogen peroxide and a comfortable chair. Another advantage is that the person is not tied to a dialysis center, but at the same time, the procedure at home also has some disadvantages. However, patients can maintain a completely active lifestyle.

Doctors decide which one to choose, but the peritoneal method gives a person more freedom. In severe cases, only hemodialysis is indicated.

How long can you live with dialysis?

Since this procedure is indicated for serious diseases, which in themselves already pose a danger to human existence, the question logically arises of how many years people can live with kidney dialysis. No doctor can answer this question with certainty.

Much is determined by the stage of the disease, the patient’s age, general health, and the presence of other pathologies.

A lot depends on the behavior of the patient himself, on his mood and desire to follow all the doctors’ recommendations. Dialysis is indicated for the following ailments:

• acute or ;
• diabetes mellitus;
• acute poisoning with toxins;
• electrolyte imbalance;
• drug overdose;
• overhydration (when standard treatment is ineffective).

These conditions themselves are complex and can be fatal, so dialysis cannot be delayed. And life expectancy directly depends on whether the patient adheres to a diet, carries out the procedure regularly, and whether he behaves correctly after hemodialysis. In the last century, some people lived more than 25 years. Over half a century, medicine has stepped forward, but for most people this method may be inaccessible due to the high cost of the procedure. Previously, those on hemodialysis died more often due to the fact that the body “without kidneys” was greatly weakened.

Even a common cold could lead to death, but more often patients suffered from intestinal problems or pneumonia. Now doctors provide patients with everything they need to prolong life. The case of a woman who was on hemodialysis for more than 30 years is included in the Russian Guinness Book of Records.

Although there are no exact statistics, the average life expectancy of people on dialysis is 14–20 years.

If a transplant is performed after dialysis, a person can live for about 55 years. How long a patient will live with kidney dialysis also depends on the quality of the drugs that have to be taken.

It is no secret that medicines may be counterfeit and of poor quality, equipment may be cheap, and specialists may be unqualified. All this can lead to a shortened life span due to complications or errors by medical staff. Therefore, it is worth choosing a dialysis center with good reviews and reputation.

How to prolong life after dialysis

To reduce the burden on the body, doctors usually prescribe a strict diet for patients. Protein products are introduced into the diet and those containing a lot of potassium and phosphorus are excluded. During dialysis, it is necessary to constantly monitor the level of potassium in the blood, as its excess leads to heart rhythm disturbances and death. You should limit your consumption of table salt to avoid swelling. If you violate the diet, you must notify your doctor, as you may need to change your hemodialysis regimen. The doctor will explain how long life can be extended if the regimen is followed, but the chances for “obedient” patients are high.

Sometimes dialysis is the only option for kidney failure. But with the right attitude, a person can live normally for another 20–30 years. The main disadvantage is that the patient is tied to the dialysis center. But thanks to modern technologies, you can sleep during the procedure, listen to music on headphones or watch your favorite TV series on your tablet. Over time, patients get used to this lifestyle and try to lead it fully, setting aside time for communication, entertainment and hobbies.

Answer:: Sad topic, but necessary.

1. How do major religions actually view people choosing to stop dialysis?

Many organized religions, such as the Roman Catholic religion, the Eastern Orthodox religion, and most Protestant denominations believe it is acceptable for people to stop dialysis if the suffering involved with dialysis outweighs the benefits. Some religions, such as Orthodox Judaism and Islam, believe it would be acceptable to stop dialysis only if the patient is imminently dying. If patients have concerns about their religion’s views on stopping dialysis, it is suggested that the patient consult with their clergy before making a decision to stop dialysis.

2. How do we know that stopping dialysis is not suicide?

Suicide occurs when a patient takes an action to cause his or her death. Examples of suicide are taking an overdose of medication or killing oneself with a gun. Patients who commit suicide do not die naturally. When a patient stops dialysis, the cause of death is kidney failure. The death is natural. Before a patient makes a decision to stop dialysis, he or she should be evaluated for depression and other treatable disorders. Discussions should also be held between the patient, the patient’s family and loved ones, and members of the treating renal care team. Others, such as the patient’s clergy, the primary care physician, etc., may also be involved in these discussions

3. Does stopping dialysis mean that the patient will simply be “written off”?

The short answer to this question is “No.” Patients usually choose to stop dialysis because they are no longer satisfied with their quality of life. When a patient asks about stopping dialysis, it is important for the renal care team to evaluate the patient to be sure that there are no treatable, reversible causes of the patient's dissatisfaction with dialysis. If after a full evaluation and therapeutic interventions as appropriate, the patient makes an informed decision to stop dialysis, the patient's wishes should be respected. Even after stopping dialysis, medical care should continue and patients' symptoms should be treated . No one has “let the patient down” if a decision has been made to stop dialysis.

4. Is it true that choosing to stop dialysis means that the family and medical staff will get rid of the patient?

The short answer again is “No.” Dialysis staff are like most health care providers: they want to treat people to help them live productive, happy lives free of pain and suffering. Usually when a patient asks to stop dialysis, extensive discussions are held between the patient, his or her loved ones, and members of the dialysis staff to understand why the patient is choosing to stop dialysis. As part of these discussions, the dialysis staff will strive to identify and treat any of the possible symptoms that are contributing to the patient's poor quality of life before simply stopping dialysis. Unfortunately, for some patients, the burdens of their illnesses and the need for dialysis at some point becomes overwhelming and causes more suffering than benefits. If this is the case and no treatments are likely to improve the patient's quality of life, the decision to stop dialysis may be made. In these cases, the dialysis staff is often saddened by the decision to stop dialysis but they remain supportive of the patient's decisions. Usually members of the dialysis staff will continue to visit with and care for patients who have stopped dialysis.

5. Will insurance companies pay relatives if the patient chooses to stop dialysis?

Yes. Stopping dialysis is a natural death so life insurance policies are paid.

6. How long can a person live if he chooses to stop dialysis?

Most patients who stop dialysis die within 8 to 12 days. An occasional patient who has near normal urine output may live several weeks to a month. Patients who have other illnesses may die only a few days after stopping dialysis. Art Buchwald lived almost a year after stopping dialysis

7. Is it painful to die after stopping dialysis?

Not usually. Patients who stop dialysis usually become very sleepy after a few days and then die in their sleep. Dying from stopping dialysis is considered to be one of the less painful ways to die. If a patient has pain, it can be treated with medications.

8. How come some patients don’t die within the predicted time period?

Some patients who are very sick with infections, heart disease, or lung disease do not even live a week after stopping dialysis. Other patients who have some left kidney function may live several weeks to a month.

9. Are there medications a patient can take to help in this period of time of no dialysis?

Yes. Patients can take a medicine to relieve shortness of breath and pain. Patients can also take medicines to relieve muscle jerks that may occur. Patients who are short of breath can also use oxygen. Anti-nausea medications can be helpful too.

10. Can patients finally eat whatever they like when they stop dialysis?

Yes, patients may eat what they want. Some patients will continue to limit their fluid intake to avoid fluid building up in the lungs. These issues will be discussed with the patient who chooses to stop dialysis. Occasionally, some patients do not want to limit their fluid intake and make an agreement with the dialysis unit to have fluid removal without dialysis after they stop their dialysis treatments. This process is called ultrafiltration. Although some patients who stop dialysis want to have ultrafiltration if fluid buids up in the lungs before they die, ultrafiltration is rarely needed in dialysis patients who stop dialysis.

11. Will the patient who stops dialysis swell up like a balloon?

No, not if the patient is careful about liquid intake or receives ultrafiltration. Most patients who are dying are not thirsty and so drinking a lot of fluid after stopping dialysis rarely happens.

12. Do you have to go to a hospice to get treated?

Most hospices actually provide care in your home. Less than 5% of hospices are in hospitals.. The Medicare hospice benefit does allow for patients who are treated at home to go to the hospital to manage pain or other symptoms that cannot be managed well at home.. The Medicare hospice benefit also provides respite care so that caregivers can get rest. This benefit allows patients to get care in a residential facility, nursing home, or a hospital for up to 5 days.

13. Can hospice help families with patients who stop dialysis?

Yes, hospice physicians, nurses, therapists, and social workers are familiar with helping patients and families who have only a short time to live.

14. Are there any special circumstances that hospice needs to be aware of when they receive a referral for a renal patient?

Yes, hospices will need to know the patient’s expected survival after stopping dialysis.

15. What if my doctor does not want to refer me to hospice?

It is important to find out why. Some doctors are not familiar with hospice and might prefer not to become involved. It is important to have a frank discussion with the doctor regarding quality of life and life expectancy. If the doctor does not want to have this discussion or is uncomfortable with hospice, it might be helpful to talk with a doctor who works with hospice patients. If needed, care can be transferred to another doctor who is comfortable with hospice.

16. If the patient feels a whole lot better once he stops dialysis, does this mean that he is getting better and that he should go back on dialysis?

No. Patients who stop dialysis often report feeling better for the first 3 to 4 days after stopping dialysis. Patients often say that just having made the decision takes a burden off their minds, and they feel more relaxed. Also because patients are not going to dialysis treatments 3 times a week, they are less tired from the travel back and forth and do not have the “washed out” feeling that many patients get after dialysis.

17. Because Medicare stops paying the renal team once a patient goes with hospice and stops dialysis does this mean that the team can no longer be contacted?

Most renal care teams want to be involved in the patient’s care after the patient stops dialysis. They are happy to answer questions the patient or family may have and to prescribe medications as needed to be sure that the patient is comfortable.

18. Is it always true that a patient must stop dialysis in order to get hospice?

No. Patients who are dying from some other condition such as cancer or heart disease may continue dialysis while receiving hospice care.

19. Do younger patients have the right to stop dialysis?

Yes. Regardless of age, the reason why dialysis is stopped is because the burdens associated with it are too great. Occasionally even infants and children have dialysis stopped because continued life with dialysis is causing extreme suffering without a likelihood of benefit.

20. If an older person has dementia, is it homicide for the family to stop dialysis?

No. Patients with dementia often do not understand the dialysis process. Sometimes it is even necessary to restrain them (literally tie them down) to keep them from pulling out their dialysis needles during the treatment. Undergoing dialysis can cause severe agitation for patients with dementia. Patients with advanced dementia who do not understand the dialysis treatment and cannot cooperate with it are patients for whom stopping dialysis should be considered. Death from stopping dialysis is due to kidney failure, not homicide. What families (and staff) perceive regarding how a patient is tolerating dialysis, especially in the demented state, is an important consideration when weighing the patient’s quality of life.

21. What does the renal care team recommend for the patient who is thinking about stopping dialysis?

Various organizations such as the National Kidney Foundation, the Renal Physicians Association, and the American Society of Nephrology have published guidelines on how to evaluate the patient who is thinking about stopping dialysis. Patients should be evaluated according to these guidelines before a decision is made. Patients and families can request such an evaluation by the renal care team prior to any decisions being made.

22. Can a patient not tell his family that he is stopping dialysis?

Patients are legally allowed not to tell their family that they are stopping dialysis. However, not telling the family is usually a very, very, very bad idea. Families are unprepared for the patient’s decision, and the unpreparedness causes them severe emotional suffering. Major decisions such as stopping dialysis are best made with the patient’s family. Telling the family and discussing it with the patient and family (even if it takes a little longer) is likely to facilitate reconciliation and peace with the decision and is usually well worth the time and effort.

23. Can a patient who is stopping dialysis donate any body parts?

Patients who are stopping dialysis are not able to donate internal organs such as hearts, lungs, or livers, but they may be able to donate tissues. It is best for a dialysis patient who is stopping dialysis to express their wishes in advance so arrangements could be made at the time of death for an evaluation of the patient for tissue donation.

24. Will the police come to a patient’s home if he stops dialysis and dies? Should they be notified ahead of time?

No, it is not necessary to call the police. It is best for the patient to be taken care of by hospice after the patient stops dialysis. When the patient dies, the hospice should be called, and a hospice nurse will come to the home and assist the family in making necessary arrangements.

25. Can a person stop dialysis and die in the hospital?

In past years, most patients who stopped dialysis died in the hospital. In recent years, there have been changes in insurance coverage. Insurance companies may deny hospitalization coverage for a patient who has stopped dialysis. Hospices can help dialysis patients who have stopped dialysis to die comfortably at home.

26. Will all insurances pay for hospice?

Many, if not most, will pay for in-patient hospice. Patients and families should discuss this matter with the dialysis social worker prior to making the decision to stop dialysis to be sure what type of coverage the patient has with regard to hospice.

27. Would it be okay for little children to visit a patient who has stopped dialysis?

In most cases, it is encouraged to have little children visit beloved family members who have stopped dialysis. The dialysis patient then has an opportunity to say goodbye to the child. The child is also given the opportunity to have a final memory of the patient.

Thanks to the development of medical technologies, today it is possible to maintain the health of seriously ill people with the help of special equipment. One of these is dialysis or artificial kidney. The device saves lives when the kidneys stop working.

Dialysis what is it

Dialysis is a slow process of cleansing the human body of toxins. Lasts from several days to a week. The period depends on the severity of the condition. Speed ​​up the process by replacing the solvent. The essence of the procedure is that a shunt is surgically created between a vein and an artery, to which a blood purification system is attached.

Kidney dialysis

An artificial kidney completely replaces the functioning of an organ that has stopped functioning. The kidneys remove toxins from the blood and maintain normal salt balance. When acute or chronic deficiency develops, toxins begin to accumulate in the plasma. Because of this, all systems and organs suffer. Dialysis allows blood to be purified outside the kidney.

It is sometimes prescribed for a short time to relieve intoxication. But some patients have to undergo the procedure for life.

Thanks to the artificial kidney, harmful metabolic products are removed from the body:

• Creatinine.
• Medicines (barbiturates, sulfonamides, drugs containing boric acid, tranquilizers).
• Excess water.
• Toxins of exogenous origin (arsenic, strontium).
• Urea.
• Inorganic substances.

Types of dialysis

There are three types:

• Intestinal. The membrane of the natural dialyser is the inner surface of the colon.
• . The human circulatory system is connected to the equipment through a set of filters, tubes, and membranes that cleanse the plasma of toxins.
• Peritoneal. Access to the renal vessels and connection to the device is made through an incision in the peritoneum. Carry out for hemodialysis intolerance, low blood pressure, vascular and cardiac disorders.

Indications and contraindications

An artificial kidney is indicated for:

1. Mushroom poisoning.
2. Acute, chronic organ failure.
3. Electrolyte imbalance.
4. Poisoning with heavy drugs.
5. Intoxication caused by toxic chemicals and pesticides.
6. Alcohol poisoning.

The procedure is contraindicated for people:

• With infectious diseases in the acute stage.
• Diagnosed with pulmonary tuberculosis.
• Who have been diagnosed with cancer.
• Suffering from severe hypertension.
• Who recently suffered a heart attack.
• With chronic heart failure.
• Over 80 years old.
• Those with mental disorders.
• Those who have pathologies of the circulatory system.

When the patient is at risk of death, the procedure is performed even if there are contraindications.

How is it carried out?

It is carried out in a medical center or hospital. The doctor selects the duration and number of procedures based on the patient’s condition. During hemodialysis, a person is connected to an artificial kidney machine using a catheter. It is inserted into large veins. Blood from the body enters the device through a tube. After filtration, the purified blood is sent through a second tube back into the body.

Peretonic dialysis is carried out continuously or automatically. In the first case, liquid is injected into the peritoneal cavity for 6-10 hours, and then replaced with a new portion of the solution. In the second case, fluid replacement occurs while the patient is sleeping.

Prognosis and how long they live after it

Today, doctors use modern equipment to purify blood. What allows you to prolong the patient’s life for a period of time from 20 to 50 years. How long a person will live on an artificial kidney depends on the severity of the disease, the presence of concomitant pathologies, the characteristics of the body, and proper nutrition.

Diet and how to eat properly during kidney dialysis

Patients on the artificial kidney machine are prescribed a diet. When compiling it, the degree of organ damage, the general condition of the patient, and his hemodialysis experience are taken into account. It is necessary to remove foods rich in potassium, phosphorus, and salt from the diet. Reduce fluid intake to 1 liter per day. Spicy and salty dishes are prohibited.

Nutrition should be balanced. Allowed:

• Chicken, rabbit.
• Fruits.
• Low-fat fish varieties.
• Vegetables.

Dialysis machine

Devices for blood purification differ in design, but have the same operating scheme. The device consists of a monitor, a dialyzer, a device that ensures blood flow through the dialyzer and a device that prepares and supplies a special solution.

There are devices lamellar And capillary type. In the first case, the system consists of lamellar grooves. An acidic liquid flows through them. The plates are connected by cylindrical channels and covered with a membrane. The solution flows along the plate, and blood flows through the membrane. The device allows you to control filtration and does not require a large volume of plasma.

The capillary device is considered safer and more effective. Consists of parallel tubes that allow blood to pass through. The dialysate flows in the opposite direction. The design provides high quality cleaning.