Dialysis how long they live with him. What is hemodialysis for which diseases is it indicated. Types of hemodialysis depending on the functionality of the devices

Every day, doctors diagnose chronic renal failure in thousands of people. Treatment of such a disease is limited by the number of methods. One such treatment is hemodialysis. The procedure allows you to cleanse the blood of toxic impurities and substances harmful to the body. Although an effective method of treatment, the method still has its drawbacks. It is necessary to find out how long they live on hemodialysis, how often they need to undergo treatment, and what patients should know.

How many live on hemodialysis after kidney rejection

The kidneys in the human body act as a blood filter. During the day, the entire volume of human blood passes through the kidneys more than 1000 times. During this time, a huge amount of harmful substances and excess fluid are removed from the blood. The secretions are excreted from the body through the genitourinary system. Substances necessary for the functioning of the body after filtration, again enter the human blood.

In some cases, the kidneys lose their function, which contributes to the poor removal of harmful substances from the body. If purification does not occur, then the person will die from poisoning. More than half a century ago, people who did not even reach maturity died from kidney diseases. How long you can live today largely depends on modern equipment, the qualifications of doctors and the disease itself. Undoubtedly, the lifestyle of the patient and his own attitude to health play an important role.

The blood purification system was invented by a Scottish scientist in the 18th century. He conducted experiments on dogs that did not have kidneys. The device did not meet the requirements, as it caused a large number of complications. At the beginning of the 19th century, a German doctor for the first time in history performed hemodialysis on a living person. In total, 15 procedures were carried out, but people did not live after that for a long time. Complications arose in connection with the development of thromboembolism. The use of leeches to thin the blood also did not have a positive result. A successful result was achieved only in 1927. The procedure was carried out using Heparin, but soon the patient died.

Proof of the viability of the hemodialysis procedure was the successful removal from the uremic state of a woman using a dialysis machine by a Dutch doctor in 1945. A year later, the doctor published a book on treating uremia patients with hemodialysis.

Magic filter mechanism

Kidney hemodialysis is a blood filtration system without the participation of the kidneys. During the procedure, the hemodialyzer is attached through the shunts to the artery and vein.

Through a shunt attached to the artery, the blood flow is directed to the device, where capillaries with special cellulose membranes are located. The capillary is in the cavity with dialysate. Molecules of toxic substances get into it. Substances useful for the patient's blood move from the dialysis solution into the capillary, which then enter the circulatory system. To prevent complications, an anticoagulant is introduced into the dialysate. The duration of the process can take from 3 to 12 hours. The regularity of sessions is up to 3 times in seven days, and in difficult cases - daily. What is the life expectancy with hemodialysis? Statistics say that people can live up to 15 years, but there are facts that say that it is possible to live up to 40 years.

This method is undoubtedly costly. More than one million rubles is spent per patient per year. To date, public funds have been allocated to cover such costs. Modern science is working to improve the cleaning mechanism so that the process becomes available to all segments of the population.

According to their functional affiliation, the devices can be divided into three types: classic with a small membrane area, a blood flow rate of 300 ml and a process duration of up to 4 hours; highly efficient with increased blood flow up to 500 ml and high flow at 800 ml and a membrane capable of passing large molecules.

Dialyzers are divided into three groups - disk, portable and capillary.

Peritoneal dialysis

A puncture is made in the abdominal wall, and up to 2000 ml of dialysate is poured into the peritoneal cavity. The end of the tube is placed in the peritoneum, and the second is blocked. A hemodialysis device is not required in such cases. The membrane is the peritoneal cavity through which harmful molecules pass into the dialysate. After 5 hours of exposure to dialysate, it is removed through the tube and again the peritoneum is filled with clean dialysate with a volume of 2 liters. This type of dialysis is dangerous for the occurrence of peritonitis. The sterility of the procedure plays an important role. If it is broken, it can lead to the occurrence of inflammation processes. This procedure cannot be performed on people who are obese.

The reasons

The only way to maintain the life of a patient with impaired renal function is hemodialysis. The reasons for using the procedure are:

Contraindications

There are a number of contraindications in which dialysis is strictly prohibited:

• infectious diseases;
• violation of cerebral circulation;
• mental illness;
• tuberculosis;
• acute heart failure;
• arterial hypertension;
• age;
• blood diseases.

Complications

The dialysis procedure does not always go smoothly and easily, often after the session there are various complications of varying severity. Lighter ones include inflammation at the junctions of the hemodialyzer with the patient's body, muscle pain, or allergic reactions. More serious include increased blood pressure, the appearance of weakness, vomiting. Serious complications include blood poisoning, infection with the hepatitis virus or the human immunodeficiency virus. The brand of the dialysis device and the quality of sterilization play a huge role.

diet for hemodialysis

How long a patient undergoing hemodialysis will live depends largely on the patient's diet. Such a patient is prohibited from drinking alcohol and smoking. Fatty foods, sweet pastries, fried goodies and salty foods should be excluded. The use of simple proteins and vitamin complexes is recommended. Do not lean on dairy products and nuts.

How to prolong life after dialysis

For a more comfortable existence, you should adhere to a strict diet. It is necessary to increase the intake of protein, and reduce the intake of foods with a high content of potassium. An increase in the level of potassium in the patient's blood can lead to disruption of the heart muscle and, subsequently, to death. Salt must be completely eliminated. In case of violation of the diet, it is imperative to notify the doctor about this.

Dialysis for chronic renal failure is the only acceptable treatment. Subject to all medical recommendations, a person may well live another 30 years or more. The only negative is the attachment to the place during dialysis. But the process may not be so tedious if there is an opportunity to watch a movie or listen to music. Over time, patients get used to the procedures and bring them into the natural course of their lives.

Kidney hemodialysis is a blood purification procedure that is performed using a special medical device called an “artificial kidney”.

Kidney hemodialysis

The practice of hemodialysis has been going on for more than forty years. Thanks to this procedure, many patients suffering from kidney failure manage to maintain the functioning of the kidneys, respectively, and life.

The kidneys are a powerful natural human filter. When they cannot perform their functional tasks, they carry out hemodialysis, which allows the purification of blood from electrolytes and nitrogenous slags.

Hemodialysis is carried out using a medical unit that has a simple structure. "Artificial kidney" is equipped with a special membrane, it contains dialysate solution and the patient's blood on both sides.

Between them, a hydrostatic pressure gradient is created, due to this, excess fluid and toxic substances are removed from the patient's body.

An "artificial kidney" has three main parts: a block for the unhindered supply of blood and dialysate, and a dialyzer. In addition, the device is equipped with a pump that constantly supplies blood to the dialyzer.

The pump has a special device that allows you to control the rate of blood flow. In the same way, a dialysis solution passes through a special dispenser, which in its composition resembles blood plasma.

Patients diagnosed with renal insufficiency try to follow a strict diet in an effort to delay hemodialysis.

However, patients cannot completely refuse hemodialysis, since it not only filters the blood, but also helps to remove excess water, thereby preserving the remaining kidney functions.

As soon as there is an urgent need for hemodialysis, the procedure should be carried out immediately, since any delay can provoke kidney loss, which is fraught with death for the patient.

Doctors determine the timing of hemodialysis by measuring the glomerular filtration rate of the kidneys.

The frequency of the procedure depends on many circumstances, including the patient's state of health, the presence of concomitant diseases, individual parameters (height, weight, age).

Timely hemodialysis prolongs life expectancy.

Indications and contraindications

Hemodialysis is prescribed when the kidneys cannot cope with the task of cleaning the blood on their own.

The need for an “artificial kidney” arises in case of acute and chronic kidney failure, severe drug overdose, poisoning with any poisons.

Conservative treatment

If hyperhydration is detected, conservative treatment is carried out, but when it is not accompanied by positive results, patients are also prescribed kidney hemodialysis.

All of these situations are quite dangerous for human life, since a delay in the implementation of hemodialysis can cause death.

Hemodialysis allows patients to live their usual lives, work in almost any field. Unfortunately, not all patients can be prescribed hemodialysis, since there are contraindications that prevent the implementation of such a procedure.

Contraindications

Patients suffering from additional pulmonary tuberculosis, or whose body is characterized by severe bleeding, are denied hemodialysis.

Absolute contraindications for the procedure include:

• mental illness;
• malignant tumors;
• pathology of the circulatory system;
• CNS diseases.

Patients who are characterized by an asocial lifestyle (drug addicts, substance abusers, alcoholics) are denied hemodialysis.

If kidney failure is accompanied by heart failure, hepatitis or cirrhosis, artificial blood purification also becomes impossible.

Kidney hemodialysis is denied to patients over eighty years of age, especially those who have diabetes mellitus.

Carrying out the procedure

For each patient with renal insufficiency, an individual hemodialysis plan is developed. In most cases, this procedure is carried out once every two days.

The session is quite long, since it takes from 4 to 6 hours of time.

The device for hemodialysis is equipped with membranes that differ in different surface sizes.

Apparatus for hemodialysis

This allows you to consider different programs for using the device, including daily two-hour hemodialysis and a three-day procedure.

If the kidneys do not completely lose their functionality, the doctor reduces the amount of hemodialysis to stimulate the kidneys.

Kidney hemodialysis is carried out in a hospital. If there is an urgent need to carry out such a procedure at home, special portable devices are used.

Kidney hemodialysis

Of course, conducting kidney hemodialysis at home contributes to a more comfortable implementation of the procedure, moreover, the procedure is carried out immediately, as soon as it becomes necessary.

The portable device "artificial kidney" allows you to live a normal life, work, travel, because it is easy to carry, take with you everywhere.

However, at the initial stages, without medical intervention, the patient will not be able to carry out hemodialysis even if a portable device is used.

It is important to provide access to the patient's veins and arteries. This problem is solved with the help of a catheter, fistula and graft.

The catheter is installed during a single hemodialysis or in cases where other access is not possible due to lack of time.

Needles are inserted into the catheter to allow free circulation of blood.

Help with chronic renal failure

A vein and an artery can be connected using a fistula located in the forearm. The blood flow in the vein increases, due to which it also increases in size.

Given that the walls of the vein have good strength, the needle can be inserted into them repeatedly. In this case, nothing prevents frequent renal hemodialysis.

The graft, which is a synthetic tube, also connects an artery and a vein.

Carrying out hemodialysis is quite simple and fast, but along with such positive characteristics, this type of access to the circulatory system sometimes provokes complications.

Diet

Any pathology needs complex treatment, one of the points of which is diet. It is a suitable diet, based on permitted products, that helps to increase the effectiveness of other therapeutic measures.

If kidney pathologies are detected, which are accompanied by hemodialysis, patients are also recommended to follow a strict diet.

Diet

The purpose of such a diet is to ensure that fewer harmful substances and toxins enter the human blood.

A diet that is suitable for patients requiring continuous hemodialysis must be accompanied by strict adherence to certain rules.

First of all, the patient must consume a sufficient amount of protein food. An ideal option for this is chicken meat, fish, eggs.

The amount of salt is reduced to a minimum, if there is the slightest possibility of completely abandoning it, then this is best done. Salt not only provokes water retention in the body, provokes swelling, but also causes severe thirst.

Drinking regime

Excess water increases the load on weakened kidneys, provokes heart problems, and increases blood pressure.

In the case when the patient could not resist and consumed prohibited foods, it is necessary to tell the attending physician about this, who, based on these data, will be able to provide a new program for kidney hemodialysis.

Complications

Unfortunately, complications can occur during hemodialysis, so it is impossible to call such a procedure simple and painless.

The patient may become very nauseous, followed by vomiting. Often this procedure is accompanied by the occurrence of muscle cramps.

Due to technical failures in the operation of the “artificial kidney” unit, as well as violations of the rules for its use, an air embolism may occur, leading to death.

Serious consequences arise as a result of organizing access to the circulatory system. The use of a fistula sometimes provokes infection of the blood, graft and catheter - the formation of blood clots.

And in the first case, and in the second, such problems can be fatal.

With a sharp decrease in the level of potassium, sodium and calcium, the heart rhythm is disturbed. For some patients, the procedure threatens with serious allergic consequences, the cause of which is the reaction of the body to the components of the membranes.

The dialysis syndrome, which provokes problems with consciousness, is a serious danger. Dialysis syndrome occurs due to a sharp decrease in plasma pressure.

If discomfort occurs during hemodialysis, the patient should tell the doctor about it, who, by adjusting the rate of blood supply, adjusting the composition of the dialysis solution, normalizes the patient's condition.

In the event of serious consequences, the doctor develops a new hemodialysis program.

Kidney hemodialysis is a method of cleansing the blood of toxins in acute or chronic renal failure, helping to normalize the acid-base balance and electrolyte balance of the blood, remove toxins and excess fluid.

The use of the "artificial kidney" device can significantly increase the life span of patients with renal insufficiency and prevent damage to internal organs in case of blood intoxication.
There are 2 types of method:

• Direct hemodialysis ("artificial kidney").
• Peritoneal dialysis - cleansing is carried out due to the change of solutions in the abdominal cavity, and the membrane is the human peritoneum.
• Intestinal dialysis is the cleansing of the mucous membrane of the gastrointestinal tract with special hypertonic agents.

In hemodialysis, blood purification is carried out by using the "artificial kidney" apparatus, which includes a set of filters and a porous membrane.

When blood passes through these barriers, large molecular proteins and toxins are removed.

The equipment replaces the natural kidney in case of insufficiency and allows for high-quality detoxification. The device filters toxins from the blood, removes urea, excess fluid, restores acid-base balance, and normalizes the electrolyte level.

Peritoneal dialysis is an alternative procedure that is performed in the following cases:

1. With contraindications for hemodialysis.
2. There is no possibility to visit the hemodialysis center.
3. There is no place to connect hemodialysis equipment.

For the procedure, you need to make a special hole in the abdominal wall through which a catheter will be inserted inside.

The procedure does not require any special equipment.

The manipulation is simple - 2 liters of dialysate are poured into the abdominal cavity 4 times a day.

The catheter is blocked, so a person can lead a normal life for 6 hours. Then the old solution is drained, and a new dialysate is poured into the abdominal cavity.

The essence of the procedure is that urea and toxins are filtered through the capillaries in the peritoneum. Small vessels play the role of a natural filter.

The main advantage of the procedure is the ability to perform at home. The load on the heart is reduced by the slow release of fluid. The disadvantage of the procedure is the likelihood of pathogenic bacteria entering the abdominal cavity and the development of peritonitis. True, peritoneal dialysis should not be performed on patients suffering from intestinal adhesions and obesity.

Still have questions about hemodialysis? Read more about, as well as the cost of the procedure. All about peritoneal hemodialysis and its principles.

Read about the name of the violation of the outflow of urine.

And here is all about the external and secondary symptoms of kidney failure. What is the difference between the acute form and the chronic form and what are the prognosis for recovery.

Indications for carrying out

There are indications for hemodialysis:

1. Chronic and acute renal failure.
2. Poisoning drugs and poisons.
3. Severe electrolyte disturbances.
4. Alcohol intoxication.
5. Pulmonary edema and hyperhydration (excess water in the tissues).

What substances are removed from the blood by hemodialysis:

• Creatinine (the end product of protein metabolism).
• Urea is a residual substance from the energy breakdown of protein in muscle tissue.
• Medications - barbiturates, bromine compounds, boric acid derivatives, salicylates, sulfonamides, iodine.
• Ethyl and methyl alcohol.
• Excess water.
• Calcium, potassium and sodium electrolytes.
• Poisons - pale grebe, strontium and arsenic.

An indication for the use of hemodialysis is also severe blood intoxication against the background of diseases of the internal organs.

Contraindications

Contraindications for hemodialysis:

1. Tuberculosis of the internal organs and lungs is accompanied by impaired microcirculation and prevents the spread of mycobacteria throughout the body. The danger of the disease is that patients with tuberculosis cannot be patients in TB centers, so as not to become a source of infection for other people.
2. Bacterial diseases with the development of sepsis and endocarditis against the background of hemodialysis will be exacerbated, as the bacteria will be carried with the blood through the internal organs.
3. Mental illnesses (psychosis, schizophrenia, epilepsy) and stroke are a contraindication to blood purification. During the procedure, a slight swelling of the brain occurs, which in mental patients will provoke an exacerbation of the disease.
4. Cells of malignant tumors during hemodialysis can spread throughout the body, which leads to the appearance of metastases in the internal organs.
5. Chronic heart failure is exacerbated by dialysis, as there is an imbalance of magnesium, calcium and potassium. Electrolyte disturbances cause cardiac arrest and pathological changes in the heart rhythm. The appearance of congestive changes in the blood causes the formation of blood clots (varicose veins, thrombophlebitis of the cerebral sinuses).
6. The age of the patient over 70 years of age on the background of diabetes is a contraindication to the procedure. If the tone of the venous wall is disturbed, then hemodialysis causes a high risk of vascular atrophy.
7. Malignant hypertension (pressure over 250/130 mmHg) provokes rupture of capillaries and arteries in the kidneys, fundus, heart and other vessels.
8. Blood diseases (aplastic anemia, leukemia and blood clotting disorders) during the blood purification procedure can provoke internal bleeding.

All of the above procedures can be carried out if there is a threat to human life.

Classification

Classification of hemodialysis by location:

1. Home.
2. Outpatient.
3. Stationary.

Home hemodialysis is carried out using portable equipment. With its help, doctors have the opportunity to conduct daily blood purification for 2-3 hours a day. The equipment is widespread in Western Europe and the USA and is an excellent alternative to kidney transplantation, which is not available to every patient due to high cost. In the UK, approximately 60% of patients with kidney failure receive home hemodialysis.

WAK - a prototype wearable artificial kidney

The advantage of the procedure is simplicity, mobility and safety. The patient can lead a normal life, and the medical institution does not spend money for his stay in a hospital.

The disadvantage is the high cost of equipment (about 20 thousand dollars). Health care workers must be trained to operate specialized equipment.

Outpatient hemodialysis is performed in patients with terminal chronic renal failure and allows for extrarenal blood purification in patients.

The procedure lasts 4 hours 3 times a week on the equipment installed in the clinic. It is being carried out as planned.

The advantage is the dynamic control over the procedure based on the results of laboratory studies, which allows for the correction of treatment during dynamic monitoring of a person.

The disadvantage of manipulation is planning with the need to wait in line.

Stationary hemodialysis is carried out using devices called "artificial kidney". They are used to purify the blood in acute and chronic renal failure. The advantage of the procedure is the possibility of dynamic control by medical personnel over the state of human health. The disadvantage of manipulation is the high financial costs of the patient's stay in the hospital and the possibility of infection with hepatitis B.

Types of kidney hemodialysis depending on the functional features of the equipment:

• ordinary;
• highly efficient;
• high flow;
• low flow.

Traditional hemodialysis of the kidneys is carried out using devices with a membrane area of ​​0.8 to 1.5 square meters.

This type of filter is characterized by low permeability, as small molecules pass through it. When passing blood through the equipment, a slow blood flow is provided at a rate of 200-300 ml/min with a procedure duration of up to 5 hours.

Highly effective dialysis is carried out on dialyzers with a membrane area of ​​1.5-2.2 square meters. In them, the blood flow rate is higher than 350-500 ml/min. In the opposite direction, the blood moves at a speed of 700-800 ml / min. The duration of the procedure is about 4 hours;

High flux dialysis is performed using a high permeability membrane. Such equipment differs from previous types in the special structure of membranes through which large molecules penetrate. The use of this type of equipment allows you to avoid complications: amyloidosis, anemia, carpal tunnel syndrome.

Apparatus for hemodialysis

When using low-flow equipment, the speed of blood movement is low, which allows for a thorough cleaning of toxins and poisons.

Types of "artificial kidney" according to the structure of dialyzers:

1. Lamellar.
2. Capillary.

Lamellar varieties consist of lamellar membranes arranged in parallel. The dialysate is located in the inner part of the disk, and the blood stream washes the outer side.

Advantages of disk (plate) dialyzers:

• Filtration control.
• Low flow resistance to blood flow.
• Low risk of venous thrombosis.
• A small volume of blood to fill the dialyzer.

Disc dialyzers are common in inpatient and outpatient settings.

Capillary hemodialysis is carried out on special equipment, thousands of small capillaries through which blood flows are used as a filtration barrier. When moving in the opposite direction, it passes through the dialysis solution. This filtration method, in comparison with the lamellar analogue, has significant advantages:

1. A clean hemodialysis solution reduces the risk of contracting hepatitis viruses.
2. High filtration efficiency.

In Russia, the choice of the type and type of hemodialysis depends not so much on the goals and purpose, but on the financial capabilities of the hemodialysis department or center.

Procedure: essence and methodology

The essence of the hemodialysis procedure is to purify the blood by convection and diffusion through membranes with certain pore sizes. Removal of excess liquid is carried out by ultrafiltration.

Methodology

1. Before performing, you should measure the pressure, temperature, pulse, examine the patient.
2. At the second stage, vascular access is connected (veno-venous and arteriovenous) with subsequent connection of the patient to the "artificial kidney". The procedure requires constant monitoring of the patient.
3. At the end of the manipulation, an aseptic dressing is placed on the area where the catheter is installed. The duration and duration of the session is determined individually for each patient individually.
4. Diffusion of substances through a special membrane, on one side of which there is a cleaning solution (dialysate), and on the other - blood. The quality and degree of removal of toxins, as well as other substances, depends on the pore size and characteristics of the membrane.
5. Trace elements and protein can pass into the blood and a person from the dialysis solution, therefore, before performing hemodialysis, the electrolyte composition of the blood should be assessed.
6. Diffusion does not remove toxic substances that can dissolve in water.
7. Convection allows the elimination of toxins from the blood due to the difference in pressure on both sides of the membrane.
8. Ultrafiltration is carried out by roller mechanisms controlled by electronic units. The process allows you to remove excess fluid from the body.

To fully understand the essence of the hemodialysis procedure, we present the structural features of the "artificial kidney":

1. Blood processing system.
2. Dialysate preparation unit.
3. Complex of filters (from synthetics and cellulose).

The dialysis fluid unit includes the following components:

• Complexes for mixing concentrate and water.
• Temperature control unit.
• Blood leak sensors.
• Filtration control mechanism.
• Air removal system.

The blood processing unit consists of the following components:

• Heparin transfer pump.
• Mechanism of blood pumping.
• Air removal device.
• Venous and arterial pressure detectors.

Depending on the purpose, synthetic or cellulose membranes of disk or capillary type are installed in the equipment.

The use of low-flow hemodialysis is effective for restoring the acid-base state and regulating water-electrolyte metabolism.

The high-flux analog also allows restoring the water-electrolyte composition and acid-base balance in patients with end-stage renal disease, but complications are less common when using it.

The choice between these hemodialysis options should be made on the basis of secondary outcomes. So in the presence of impaired lung function, high-flux dialysis is the preferred option.

Find out how it manifests itself - what a urinalysis shows and doctors' forecasts for the course of the disease.

Read about how to improve the quality of life in chronic renal failure. The causes of the disease, the principles of treatment and the basics of proper nutrition.

Diet for kidney hemodialysis

The effectiveness of the patient's condition before and after the hemodialysis procedure depends on the quality of the diet.

At the pre-dialysis stage, a person with kidney failure should limit protein intake to 0.8 grams per kilogram per day. It is also necessary to reduce the intake of potassium, phosphates and other electrolytes.

In patients with renal insufficiency, a decrease in the concentration of amino acids is observed. Pathology worsens against the background of restriction of protein intake. As a result, the intake of keto acids is prescribed before dialysis. Some hemodialysis centers recommend ketosteril for patients with renal insufficiency.

Restriction of fluid intake during hemodialysis is necessary for patients with arterial hypertension and heart failure against the background of kidney failure. In other cases, water restriction can lead to a violation of urine output. Danger is also an increase in the concentration of nitrogenous compounds in the blood. Against the background of water intake, the concentration of these toxins is diluted, therefore, during hemodialysis, fluid drinking is limited only according to indications.

Another feature of the dialysis diet is the restriction of potassium intake.

The body is sensitive to this trace element.

With an increase in its concentration in the blood, a violation of the rhythm of heart contractions and muscle tremors are observed. You need to limit dried fruits and animal products.

Correction of phosphorus-calcium metabolism during hemodialysis is carried out after the determination of these trace elements in the blood. To restore the level of minerals, special preparations are prescribed (vitamin D3, calcium preparations, phosphate binders). Against this background, it is required to limit products containing phosphorus and calcium - milk.

Another important point in hemodialysis of renal failure is the rejection of drugs with aluminum (phosphalugel, almagel).

They lead to dementia and neurological disorders. With kidney failure, you can not even take food from aluminum dishes.

Approximate diet for kidney hemodialysis(7G):

• 100 grams of fat;
• 60 grams of proteins;
• 400 grams of carbohydrates;
• 2 grams of potassium;
• 0.7 liters of liquid.

The calorie content of the diet is less than 3000 kcal.

Complications of hemodialysis and peritoneal dialysis

Hemodialysis is a technical procedure that is carried out on automated equipment. It is characterized by complications:

1. Lowering blood pressure due to vasoconstriction, a rapid decrease in the level of circulating fluid, cardiac pathology.
2. Hyperkalemia due to hemolysis of red blood cells and bleeding.
3. Adverse reactions to dialysis are heaviness in the chest, pruritus, respiratory failure, back pain, and abdominal pain.
4. Syndrome of pathology of osmotic balance (disequilibrium syndrome).
5. Hemolysis of blood cells (destruction) due to traumatization of cells when passing through the tubes of the apparatus.

A rare number of patients experience other adverse reactions during hemodialysis:

• increase in creatinine at the beginning of the procedure;
• Heart arythmy;
• endocarditis;
• hyperparathyroidism;
• uremic neuropathy;
• convulsions;
• acute violation of cerebral blood supply;
• anemia;
• intoxication;
• pericarditis (inflammation of the lining of the heart (pericardium)).

The hemodialysis procedure is quite complicated, therefore, it is carried out only after a thorough examination of the patient's health. Only a doctor who has been qualified to work with an "artificial kidney" can prescribe the duration and frequency of the blood purification procedure.

Related video

Hemodialysis is a procedure for extrarenal blood purification from various toxins, metabolic products, excess water. In addition, during the procedure, it is possible to correct the electrolyte balance. The procedure is carried out using the device "Artificial kidney". The method is based on the use of special membranes with selective permeability. On one side of the membrane flows blood, on the other - a dialysis solution that can absorb endo- and exotoxins.

The membranes used may differ in their selectivity. Some of them are able to skip even some proteins. Also, the dialysis solutions used may differ in their properties, which are able not only to absorb toxins and metabolic products, but also to compensate for the lack of minerals in the patient's blood.

Indications for hemodialysis:

• poisoning;
• drug overdose;
• pronounced deviations of the electrolyte composition of the blood;
• pronounced excess fluid in the body, not eliminated by conservative therapy: pulmonary edema, cerebral edema.

Complications:

• lowering blood pressure;
• convulsions;
• infectious complications;
• nausea, vomiting;
• air embolism;
• dialysis syndrome - develops under the condition of a rapid decrease in the osmotic pressure of the blood and is manifested by a violation of consciousness by the type of stunning, convulsive seizures;
• cardiac arrhythmia - develops with rapid, calcium and sodium in the blood;
• allergic reactions to the components of the membrane used in the device.

Contraindications:

• absolute:
• schizophrenia;
• epilepsy;
• advanced oncological processes;
• age over 80 years (if the patient has diabetes - over 70 years);
• severe diseases of the nervous system;
• the presence of 2 or more severe concomitant diseases: malignant tumors, coronary heart disease with a history of infarction, heart failure; severe atherosclerosis with decompensated peripheral vascular occlusion, liver cirrhosis, COPD;
• alcoholism, drug addiction, vagrancy.
• relative:
• pulmonary tuberculosis in an active form;
• risk of bleeding: peptic ulcer of the stomach and duodenum, Melory Weiss syndrome, uterine fibroids ...

diet for hemodialysis

The main goal of dieting is to reduce the intake of products, the metabolism of which leads to a rapid increase in endotoxins. Let's look at the basic rules that should be followed by patients on permanent hemodialysis:

• Limitation of fluid intake. Usually the amount of fluid consumed per day should fluctuate within the following limits: daily diuresis + 500-800 ml. At the same time, the total weight gain between hemodialysis sessions should not exceed 2-2.5 kg. It should be borne in mind that with an increase in fluid loss through the skin and breathing (hot summer, high body temperature), the amount of fluid consumed can be increased.
• Restriction of salt intake (6-8 g of salt per day) or a completely salt-free diet.
• Limiting the use of foods containing a large amount of potassium: bananas, citrus fruits, dried fruits, some vegetables (especially potatoes), natural juices, herbs, bran, oatmeal, nuts, chocolate, cocoa. On average, the amount of potassium consumed per day should not exceed 2000 mg.
• Limited consumption of foods rich in phosphorus (fish, cheeses…);
• It is advisable to eat food with sufficient content of animal protein and energy (calories).

The listed rules are general, but individual characteristics should be taken into account and the recommendations of the attending physician should be carefully followed.

How is hemodialysis performed?

• Creation of conditions for normal blood flow to the "Artificial Kidney" apparatus. This requires a direct communication between an artery and a vein:
• A fistula is a surgical connection between a vein and an artery, usually in the forearm.
• The use of a transplant - in this case, the communication between the artery and the vein is realized through a synthetic tube. Usually, the graft placement is carried out at the initial stages of hemodialysis, when the fistula has not yet formed. The downside is a higher chance of complications.
• Catheterization of large veins of the neck, chest or thigh. Usually this method is used for urgent hemodialysis when there is no time to create a full fistula.
• The doctor calculates which membrane and dialysate to use. This is determined by the disease, the degree of preservation of the functioning of the kidneys, as well as the severity of intoxication and electrolyte imbalance.
• The doctor also determines the necessary frequency and duration of the procedures, which also depends on the residual kidney function.

Usually the procedure is carried out 3 times a week, and the average duration is 4-5 hours. Most often, the procedures are performed on an outpatient basis, i.e. in a hemodialysis unit. However, there are portable (home) dialyzers that allow for shorter but daily treatments. Such devices significantly improve the patient's quality of life, reduce the likelihood of contracting viral hepatitis, and allow them to change their place of residence and even travel more freely.

Hemodialysis- a procedure for purifying blood through a semi-permeable porous membrane using the "artificial kidney" apparatus. Hemodialysis is necessary for people with acute renal failure, poisoning with drugs, alcohols, poisons. But most of all people with chronic renal failure need hemodialysis. The device takes over the functions of non-functioning kidneys, which allows prolonging the life of such patients by 15-25 years.

The device for hemodialysis filters out toxins, urea from the blood, eliminates excess fluid, normalizes electrolyte balance, blood pressure and restores acid-base balance.

According to statistics, in 2013 there were 20,000 people on hemodialysis in Russia. But doctors say that 1000 people for every million of the population need blood purification. Thus, the number of people who need an "artificial kidney" is 144,000 people. Today, there is an acute shortage of dialysis centers in the regions, and many patients with chronic renal failure have to wait months for their turn.

The cost of procedures per person per year is about 1.5 million rubles. This includes the cost of a disposable blood filter (dialyzer), dialysis fluid (about 120 liters per 1 procedure) and the operation of an artificial kidney machine. But if there is a place in the dialysis center, then the treatment of the patient should be paid through special state programs.

What is hemodialysis

Purpose of hemodialysis- cleanse the blood of harmful substances:

• urea - a product of protein breakdown in the body;
• creatinine - the end product of energy metabolism in muscles;
• poisons - arsenic, strontium, toadstool poison;
• drugs - salicylates, barbiturates, hypnotic tranquilizers, boric acid derivatives, bromine and iodine compounds, sulfonamides;
• alcohol - methyl and ethyl;
• electrolytes - sodium, potassium, calcium;
• excess water.

1. Blood processing system:
   • blood pump;
   • heparin pump;
   • device for removing air bubbles;
   • blood and venous pressure sensors.
2. System for the preparation of dialysis solution (dialysate):
   • air removal system;
   • system for mixing water and concentrate;
   • dialysate temperature control system;
   • detector for monitoring blood leakage into the solution;
   • filtration control system.
3. Dialyzer (filter) with a hemodialysis membrane made of cellulose or synthetics.

The principle of operation of the device for hemodialysis.

• Removing exchange products. In the blood of a person with renal insufficiency, a high concentration of various substances: urea, toxins, metabolic products, proteins. They are not present in dialysate. According to the laws of diffusion, these substances from a liquid with a high concentration, through the pores in the membrane, penetrate into a liquid with a lower concentration. Thus the blood is cleansed.
• Normalization of electrolyte levels. In order not to remove the elements necessary for life from the blood, the dialysis solution contains sodium, potassium, calcium, magnesium and chlorine ions in the same concentration as the blood plasma of a healthy person. Therefore, excess electrolytes, according to the laws of diffusion, passes into dialysate, and the required amount remains in the blood.
• Maintaining acid-base balance. In order to maintain a normal acid-base balance, a buffer is present in the solution - sodium bicarbonate. Bicarbonate passes from solution into plasma and then into erythrocytes, providing blood with bases. Thus, the pH of the blood increases and returns to normal.
• Removal of excess water by ultrafiltration. The blood flows through the filter under pressure due to the operation of the pump. The pressure in the dialysate bottle is low. Due to the pressure difference, excess fluid passes into the dialysate. This helps eliminate swelling of the lungs, joints, brain, remove fluid that accumulates around the heart.
• Prevention of blood clots. Heparin, which prevents blood clotting, helps prevent blood clots. It is gradually added to the blood using a special pump.
• Air embolism prevention. An “air trap” is installed on the tube that returns blood to the vein, where a negative pressure of 500-600 mm Hg is created. The purpose of this device is to trap air bubbles and foam and prevent them from entering the bloodstream.

Types of hemodialysis

Types of hemodialysis depending on the location

1. Hemodialysis at home.

   For this, specially designed portable devices Aksys Ltd. "s PHD System and Nxstage Medical" s Portable System One are used. After a course of study, they can be used to cleanse the blood at home. The procedure is done daily (nightly) for 2-4 hours. The devices are quite common in the US and Western Europe and are considered a good alternative to a kidney transplant. So in the UK, more than 60% of dialysis patients use home "artificial kidneys".

   Advantages: the method is safe, easy to use, there is no need to wait in line, it allows you to lead an active lifestyle, the blood cleansing schedule meets the needs of the body, there is no danger of contracting hepatitis B.

   Flaws: the high cost of equipment 15-20 thousand dollars, the need to take a course, at first, the help of a medical worker is needed.

2. Hemodialysis on an outpatient basis.

   Outpatient hemodialysis centers perform extrarenal blood purification for patients with acute renal failure and with end-stage chronic renal failure, when kidney function cannot be restored. Patients are served on a first come, first served basis. In most cases, the procedure is carried out 3 times a week for 4 hours. For this, devices of the Swedish concern "Gambro" AK-95, "Dialog Advanced" and "Dialog +" by B / Braun, INNOVA by GAMBRA are used.

   Advantages: the procedure is carried out by qualified specialists, sterility is observed in the center, the constant control of doctors over the results of analyzes (creatine, urea, hemoglobin) allows you to adjust the treatment in a timely manner. If possible, patients are taken to dialysis and after the procedure they are taken home by special transport or by ambulance.

   Flaws: the need to wait in line and visit the dialysis center 3 times a week, there is a possibility of contracting hepatitis B and C.

3. Hemodialysis in stationary conditions.

   Hospitals have departments equipped with "artificial kidney" devices. They are used to treat poisoning and acute renal failure. Here, patients can stay around the clock or on a day hospital.

   Technically, the procedure of hemodialysis in a hospital is not much different from blood purification in hemodialysis centers. Similar devices are used for blood filtration: VAKHTER-1550, NIPRO SURDIAL, FREZENIUS 4008S.

   Advantages: constant monitoring by medical staff.

   Flaws: the need to stay in a hospital, the possibility of infection with hepatitis B.

Types of hemodialysis depending on the functionality of the devices

1. Conventional (traditional) dialysis.

   Use devices with a cellulose membrane with an area of ​​0.8 - 1.5 sq.m. Such a filter is characterized by low permeability, only small molecules pass through it. At the same time, the blood flow is low from 200 to 300 ml / min, the duration of the procedure is 4-5 hours.

2. High performance dialysis.

   The procedure is carried out on dialyzers with a membrane surface area of ​​1.5 - 2.2 sq.m. In them, blood moves at a speed of 350 - 500 ml / min. In the opposite direction, the dialysate moves 600 - 800 ml / min. Due to the high efficiency of the membrane, it was possible to increase the blood flow rate and reduce the procedure time to 3-4 hours.

3. High-flux hemodialysis using high-permeability membranes.

   These devices differ from the previous type of "artificial kidney" by special membranes through which substances with a high molecular weight (large molecules) can pass. Thanks to this, it is possible to expand the list of substances that are removed from the blood during hemodialysis. Such blood purification avoids a number of complications: amyloidosis, carpal tunnel syndrome, reduces anemia and increases survival. However, the highly permeable membrane allows substances from the dialysate to pass into the blood, so the solution must be sterile.

Devices "artificial kidney" differ in the structure of dialyzers

Peritoneal dialysis is an alternative to hemodialysis.

• there are no places for hemodialysis;
• there is no way to get to the hemodialysis center;
• contraindications for hemodialysis.

Through the capillaries in the peritoneum, slags, urea, excess fluid pass into the solution and the blood is cleansed. In this case, the peritoneum acts as a natural membrane.

Advantages: blood purification can be performed at home, no heparin is required, the release of fluid is slow, which reduces the load on the heart.

Flaws: long sessions, the need to maintain sterility, otherwise there is a high risk of bacteria entering the abdominal cavity and developing peritonitis, it is not recommended for patients suffering from obesity or intestinal adhesions.

Indications for hemodialysis

• the amount of urine excreted is less than 500 ml per day (oligoanuria);
• kidney function is preserved by 10-15%, the kidneys purify less than 200 ml of blood per minute;
• the level of urea in the blood plasma is more than 35 mmol / l;
• the level of creatinine in blood plasma is more than 1 mmol / l;
• the level of potassium in the blood plasma is more than 6 mmol / l;
• the level of standard blood bicarbonate is below 20 mmol/l;
• signs of increasing swelling of the brain, heart, lungs, which cannot be removed with drugs.

Contraindications for hemodialysis

• Infectious diseases, which can provoke the entry of microorganisms into the blood and the development of endocarditis (inflammation of the heart) or sepsis (blood poisoning). The hemodialysis procedure promotes increased blood flow and the spread of pathogens.
• Stroke and mental illness: epilepsy, psychosis, schizophrenia. The procedure is stressful and can exacerbate changes in the nervous system that have occurred before. When cleaning the blood, a slight swelling of the brain occurs, which causes a headache and can provoke an attack of mental disorder. Low intelligence and inability to follow the instructions of doctors and nurses make the hemodialysis procedure impossible.
• Active tuberculosis of the lungs and other internal organs. Increased blood circulation causes the spread of Mycobacterium tuberculosis throughout the body. Another difficulty is that TB patients cannot visit hemodialysis centers so as not to infect other patients.
• Malignant tumors. Hemodialysis can promote the appearance of metastases of cancerous tumors, since increased blood flow carries malignant cells throughout the body.
• Chronic heart failure, the first months after myocardial infarction. During hemodialysis, an imbalance of potassium, calcium and magnesium and other changes in the chemical composition of the blood can occur. This can result in irregular heartbeat and cardiac arrest. And stagnation of blood in heart failure is associated with the risk of blood clots and their separation during hemodialysis.
• Malignant arterial hypertension. Severe form of hypertension, when the pressure rises to values ​​of 300-250 / 160-130 mm Hg. st at the same time the vessels, heart, fundus and kidneys are affected. In such patients, the procedure can provoke a short-term increase in pressure associated with vasospasm. The result can be a stroke or myocardial infarction.
• Age over 80. In people with diabetes, hemodialysis is contraindicated after 70 years. This is due to age-related disorders of the heart and blood vessels. The veins do not provide sufficient blood flow for dialysis and may not be able to handle the extra stress. In addition, in such patients, due to vascular atrophy, it is almost impossible to isolate a section of the vein for regular procedures, and reduced immunity increases the likelihood of infectious complications.
• Blood diseases- bleeding disorders, leukemia, aplastic anemia. When blood passes through the dialyzer, its cells can be damaged, which increases anemia. The introduction of heparin reduces blood clotting and increases the risk of internal bleeding.

Extrarenal blood purification is a very urgent problem. In different countries, developments are constantly underway to create a small and effective "artificial kidney". Already today there are devices that can be carried with you and blocks that are transplanted into the human body instead of non-functioning kidneys. It is hoped that in the coming decades such developments will become available to all patients with chronic renal failure.