Tag Archives: hemodialysis

When Does a Person Need Dialysis?

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Dialysis is the process of removing waste and excess fluid from the blood.  This process is typically handled by the kidney.  Patients who have suffered kidney damage or kidney failure lose some of this functionality.  A patient will typically need dialysis when waste products in the body become too high and they start to cause damage.  These waste products build up slowly and dialysis can help maintain safe levels.  There are several chemical levels in the blood that doctors measure to determine if you need dialysis.  Two of these are the blood urea nitrogen (BUN) level and the creatinine level.  When these levels rise, they indicate decreased functionality of the kidneys to clean waste products from the body.

Creatinine Clearance Test Shows When You Need Dialysis

Some doctors use a urine test called the “creatinine clearance” to measure kidney function.  A patient saves their urine in a container for a full day.  The waste products in the blood and urine are estimated by measuring the creatinine.  They are then compared to see how well the kidney is removing the wastes and depositing them into the urine.  Through this comparison doctors have a good idea of how well the kidneys are working.  The result is called the creatinine clearance.  When creatinine clearance falls below 10-12 cc/minute, the patient is not doing well and may need dialysis.

Calculating creatine clearance to see if patients need dialysis

The doctor uses other indicators of the patient’s status to decide about the need for dialysis. If the patient is experiencing a major inability to rid the body of excess water, or is complaining of problems with the heart, lungs, or stomach, or difficulties with taste or sensation in their legs, dialysis may be indicated even though the creatinine clearance has not fallen to the 10-12 cc/minute level.

What types of dialysis are there?

There are two main types of dialysis: “hemodialysis” and “peritoneal dialysis.” Hemodialysis uses a special type of filter to remove excess waste products and water from the body. Peritoneal dialysis uses a fluid that is placed into the patient’s stomach cavity through a special plastic tube to remove excess waste products and fluid from the body.

In Home Peritoneal Dialysis Treatment

In Home Peritoneal Dialysis Treatment
Photo by BAXTER CZECH

Peritoneal Dialysis

Peritoneal dialysis uses the patients own body tissues inside of the belly (abdominal cavity) to act as the filter. The intestines lie in the abdominal cavity, the space between the abdominal wall and the spine. A plastic tube called a “dialysis catheter” is placed through the abdominal wall into the abdominal cavity. A special fluid is then flushed into the abdominal cavity and washes around the intestines. The intestinal walls act as a filter between this fluid and the blood stream. By using different types of solutions, waste products and excess water can be removed from the body through this process.

Hemodialysis

During hemodialysis, blood passes from the patient’s body through a filter in the dialysis machine, called a “dialysis membrane.” For this procedure, the patient has a specialized plastic tube placed between an artery and a vein in the arm or leg (called a “gortex graft”). Sometimes, a direct connection is made between an artery and a vein in the arm. This procedure is called a “Cimino fistula.” Needles are then placed in the graft or fistula, and blood passes to the dialysis machine, through the filter, and back to the patient. In the dialysis machine, a solution on the other side of the filter receives the waste products from the patient.

Atrial Fibrillation Patients At Risk During Dialysis

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A recent study published in the medical journal Heart found that atrial fibrillation (AF) patients who receive regular dialysis treatment have more episodes of irregular heartbeat on dialysis days. The study also shows that irregular heartbeats for AF patients occur more often during the dialysis treatment.

Dialysis and Atrial Fibrillation

Irregular heartbeat of Atrial Fibrillation patient.

Several hospitals in the Netherlands studied 40 dialysis patients enrolled in the implantable cardioverter defibrillator-2 (ICD-2) trial. An ICD is an electronic device implanted inside the chest that constantly monitors heart rate and rhythm. Whenever the heart begins to beat irregularly, the ICD delivers energy to the heart muscle, bringing it back into a normal rhythm. Because all 40 dialysis patients had such devices, researchers were able to look at heart rhythm data during dialysis.

During a 28-month follow up period, the ICD-2 devices detected a total of 428 AF episodes in 14 different patients. Analysis found that AF occurred more frequently on days when the patient was receiving hemodialysis, especially during the dialysis procedure. Dialysis technicians are often required to monitor the vital signs of a patient before, during, and after dialysis. They attend dialysis technician school to learn how to do this.

The authors of the study wrote, “This study provides insight in the exact timing of AF onset in relation to the dialysis procedure itself. Researchers hope to use the study results to identify further areas of investigation. One key factor is how poor kidney function causes the need for hemodialysis and is also an independent factor in AF. “These findings might help to elucidate some aspects of the pathophysiology of AF in dialysis patients and could facilitate early detection of AF in these high-risk patients.”

DaVita Launches Hemodiafiltration Trial in Colorado

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COLORADO SPRINGS, CO – For the first time hemodiafiltration will be delivered to dialysis patients in the United States. DaVita Kidney Care, one of the leading kidney care providers, announced it will be delivering hemodiafiltration treatment to select patients in a Colorado Springs clinic. The trial is expected to last six months.

The most common treatment for patients suffering from kidney damage, disease, or failure is hemodialysis. Hemodiafiltration differs from dialysis in that it incorporates the existing dialysis processes, but includes additional steps to filter even larger toxin particles from the patient’s blood. European dialysis centers often practice hemodiafiltration, but this is the first time the treatment will be offered in the U.S.

Shaun Collard, Vice President of Clinical Operations at DaVita, commented, “At DaVita, we are always evaluating ways to improve patient outcomes and experience during dialysis treatments. We are excited to have the opportunity to be the first U.S. provider to evaluate this treatment.”

The main purpose of the six-month trial is to determine if hemodiafiltration provides better outcomes over traditional dialysis methods. Another important factor of the trial is to measure the impact on the patient’s quality of life with the new treatment.

While the benefits of hemodiafiltration are still unclear, this new study will be the first to shed light on any potential benefits. “We are constantly evaluating the efficacy of kidney care treatments and hemodiafiltration has shown potential benefits internationally,” said Dr. Robert Provenzano, M.D., FACP, and Vice President in DaVita’s Office of the Chief Medical Officer.

Tiny Wrist-Worn Dialysis Machines a Real Possibility

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Hemodialysis is one of the most effective ways of treating a patient with kidney failure or kidney damage. Once the kidney is no longer able to function properly, artificial methods must be employed to do the job. Dialysis machines are usually quite large, expensive, and requires constant maintenance. But that could all change with a new technology being developed.

A recent paper published in the Biomaterials Science online journal outlines a new technology that may make wrist-worn dialysis machines a real possibility in the near future. Dialysis machines are used to remove excess toxins and fluid from the blood. Current technology requires patients to essentially allow their blood to flow outside of their body into the equipment. Once inside the machine, the blood is filtered and then returned back into the body. This process requires the patient to visit a dialysis center which provides access to the expensive equipment. Researchers at the National Institute for Materials Science in Japan have developed a new technology that could potentially minimize the need for dialysis equipment.

How the Technology Works

The Japanese researches have developed a microfiber that could replace the significantly larger filtration systems found in current dialysis machines. The abstract of the paper states:

There is a need to develop a simple, cheap, and accessible method of treating patients with kidney failure, especially in resource-limited environments such as disaster areas and the developing world due to the inaccessibility of conventional hemodialysis treatments. In this study, we develop a zeolite–polymer composite nanofiber mesh to remove uremic toxins for blood purification. The nanofiber is composed of blood compatible poly(ethylene-co-vinyl alcohol) (EVOH) as the primary matrix polymer and zeolites which are capable of selectively adsorbing uremic toxins such as creatinine. The composite fiber meshes were produced by a cost-effective electrospinning method: electrospinning composite solutions of EVOH and zeolites. Scanning electron microscope (SEM) images revealed that the 7 w/v% EVOH solution produced non-woven fibers with a continuous and smooth morphology. The SEM also showed that over 90% of zeolites in the solution were successfully incorporated into the EVOH nanofibers. Although the barrier properties of the EVOH matrix lowered the creatinine adsorption capacity of the zeolites in the fiber when compared with adsorption to free zeolites, their adsorption capacity was still 67% of the free zeolites. The proposed composite fibers have the potential to be utilized as a new approach to removing nitrogenous waste products from the bloodstream without the requirement of specialized equipment.