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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.

Peritoneal Dialysis Solution Recalled

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A recent upset of peritoneal dialysis solution has caused Baxter International Inc to issue a recall of a single lot of the solution. DIANEAL PD-2 is a peritoneal dialysis solution made of 1.5% Dextrose. It is being recalled after patients and others have made complaints of particulate matter, which has been identified as mold, in the solution. It is supposed that the affected lot was distributed to customers between May 2013 and January 2014.

DIANEAL PD-2 is a peritoneal dialysis solution used for chronic renal failure patients that have been prescribed peritoneal dialysis therapy. The one affected lot of the solution has been identified as lot number C903799, expiration 05/15 (product code L5B9710), NDC 00941-0411-11. The product affected by this recall was distributed to dialysis facilities, centers, distributors and patients.

What is Peritoneal Dialysis?

Baxter Peritoneal Dialysis Solution RecallPeritoneal dialysis is a home-based dialysis treatment that is a popular alternative to the use of a dialysis machine. It allows the patient to “flush” out toxins in the blood using a peritoneal dialysis solution that is introduced into the abdomen using a catheter.  There is a membrane in the wall of the abdomen called the peritoneal. Waste products pass through the peritoneal and are absorbed by the peritoneal dialysis solution. The patient can then drain the fluid and any waste material it contains to complete the dialysis process. This process takes only 30-40 minutes and can be conducted in the comfort of home.

Many patients who are able to use the peritoneal dialysis treatment prefer it over the cumbersome trips to dialysis centers where they are attached to large dialysis machines for several hours. In some cases a dialysis technician will assist with the process to monitor progress and ensure the treatment is being administered appropriately.

Possible Cause of the Mold

One of the main ingredients that makes peritoneal dialysis solution so effective is dextrose. Dextrose is a sugar that is found in many food products and is also used to induce fermentation in the brewing process of beer and other alcoholic beverages. The peritoneal dialysis solution was stored in flexible plastic bags, making it prone to punctures. If yeasts, mold or bacteria gain access to the solution it could easily cause the solution to become contaminated as the dextrose could act as a food supply for the microorganisms to quickly reproduce.

What makes the contamination of the solution so dangerous is the introduction of these microorganisms directly into the abdomen. This could result in a life-threatening fungal peritoneal infection. It is important that patients and facilities that carry the product check to ensure they do not utilize product affected by the recall.

Consumers with questions should contact Baxter Home Care Services directly at 1-800-284-4060. For more information on the product recall, read the official Baxter press release here.

Peritoneal Dialysis

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There are two main types of renal dialysis: dialysis that uses a dialysis machine and peritoneal dialysis. Peritoneal dialysis is the process of using the peritoneal membrane, the membrane that lines the human abdomen, to filter and clean the blood. If a patient experiences kidney failure or kidney damage, the body can begin to build up with harmful wastes, minerals, and excess fluid. If the blood is not properly filtered with dialysis, this build up can be life threatening.

How does Peritoneal Dialysis Work?

The basic process for peritoneal dialysis consists of:

  1. Introduce a cleansing liquid called dialysis solution into the abdomen via catheter. This solution contains dextrose, a sugar that pulls wastes and extra fluids into the abdominal cavity.
  2. Allow the cleansing solution to reside in the abdomen, usually for 4-6 hours (dwell time). The membrane on the walls of the abdomen, called the peritoneum, allows waste products to pass from the blood to the dialysis solution.
  3. Drain the dialysis solution after the prescribed dwell time. This normally takes 30-40 minutes.

Why Patients Choose Peritoneal Dialysis

One of the major benefits of peritoneal dialysis is that you don’t need to make an appointment at a healthcare or medical center. The dialysis can be administered by yourself at home. This gives you more control over your treatment plan but requires the patient to be much more knowledgeable of treatment procedures, safety precautions, etc. It is important for a patient undergoing a peritoneal dialysis treatment program to work very closely with the physicians, dialysis technician, dialysis nurse, dietician, and other healthcare staff involved in the treatment plan.

Dialysis Technician Duties

Even though peritoneal dialysis is normally administered at home, the dialysis technician plays an important role in assisting patients with their dialysis treatment. A dialysis technician helps the patient identify treatment frequency, monitor patient health, and track progress. The dialysis technician plays an important role in any kind of dialysis treatment.