KIDNEY DISEASE

Kidney Disease

Kidney Disease

Introduction

Hemodialysis is the most common method used to treat advanced and permanent kidney failure. Since the 1960's, when hemodialysis first became practical treatment of renal failure, we learned a lot about how to make hemodialysis treatments more effective and minimize side effects. In recent years, more compact and simpler dialysis machines have made home dialysis more attractive. But even with better procedures and equipment, hemodialysis is still a complicated and inconvenient therapy that requires a coordinated effort from your whole team of health care, including your nephrologist, dialysis nurse, dialysis technician, dietitian and social worker. The most important members of your team of health care you and your family. Studying your treatment, you can work with your team of health care to secure the best results, and you can live a full, active life.

Risk Factors

The patient is usually systemically anticoagulant during hemodialysis to prevent clotting in the dialysis machine. However, the hemodialysis treatment can be done with regional anticoagulation of the dialysis circuit (using heparin or sodium citrate) or saline flush, in which 50 to 100 ml of saline every 15 to 30 minutes of dialysis cleans the chain of any blood clots.

The immediate objectives are hemodialysis to correct fluid and electrolyte imbalances and remove toxins. Long-term goals for patients with renal insufficiency should

* Optimization of the functional state of the patient's comfort, and BP

* Prevention of uremia and its complications

* Improvement of survival

Optimal "dose" of hemodialysis is uncertain, but most patients do well with 3 to 5 h dialysis three times a week. One way to assess the adequacy of each session is a measurement of urea before and after each session. = 65% reduction in the roll of the predialysis level ([predialysis BUN - postdialysis BUN] / predialysis BUN × 100% = 65%) indicates adequate session. Specialists can use other, more intensive calculation formulas can be used, for example, KT / V = 1.2 (where K is dialyzer urea clearance in ml / min, T dialysis time in minutes and V is urea distribution volume [body of water] per ml ). Dialysis dose can be increased by increasing time on dialysis, blood flow, the surface area of membrane, membrane porosity, but the benefits are unproven. Nocturnal hemodialysis session (6 to 8 hours, from 5 to 6 days a week) and short (1,5 to 2,5 h) in the day session explored as ways to increase efficiency and reduce complications.

Vascular access: Hemodialysis is usually done through a surgical created arteriovenous fistula. However, dialysis can be done through a central venous catheter, if the arteriovenous fistula has not yet been created or is not ready for use, or if the creation of an arteriovenous fistula is impossible. The main disadvantages of central venous catheters are relatively narrow gauge, which makes the blood flow is high enough to achieve the optimum design and a high risk of catheter site infection and thrombosis. Central venous catheters for hemodialysis is best done through the right internal ...