He althy kidneys are the filter of blood. Its entire volume passes through the renal filter more than 1000 times a day. 1 liter of blood is cleared in 1 minute. In a short period of time, the kidneys, our natural filter, take molecules of substances toxic to the body and excess water from the blood that enter the urinary tract and leave the body. Useful substances that circulated in the blood are returned to the bloodstream.
Unfortunately, for various reasons, the kidneys can be damaged and lose their functions, which leads to the retention of toxic substances in the body. If you do not cleanse the blood of toxins, then a person will die from self-poisoning. About 50 years ago, people with kidney failure died at a young age. How long people live on hemodialysis at the present time depends on the availability of proper equipment, the professionalism of the medical staff, concomitant diseases, but to a greater extent on the person himself, his lifestyle and an adequate attitude to his he alth.
Artificial kidneyfilter
In the mid-18th century, applying the laws of physics, a scientist from Scotland developed a blood purification system. He studied it on dogs deprived of kidneys. The device did not live up to expectations due to the development of many complications.
The first human dialysis procedure was performed by a German doctor in the early 19th century. 15 procedures were performed on different people, who did not live long after that. This is due to the development of thromboembolism. They used leech hirudin, a blood-thinning protein, which was quickly neutralized by the immune system of patients and the blood thickened with the formation of blood clots. A positive result was achieved in 1927 with a heparin procedure, but the patient died anyway.
In the autumn of 1945, a Dutch doctor improved the apparatus used at that time and successfully brought the patient out of the uremic state, finally proving the effectiveness of hemodialysis. In 1946, the doctor published a manual on the treatment of uremia patients with hemodialysis.
Magic filter mechanism
Hemodialysis is a blood purification system without involving the kidneys. The procedure requires access to a vein and artery. Systems are introduced into these vessels and form shunts, which are attached to the hemodialyzer. From the arterial shunt, blood enters the apparatus, where there are capillaries with semipermeable membranes. The capillary is surrounded by a cavity with dialysis fluid, where, according to the law of osmosis, harmful molecules leave the blood. Substances necessary for life come from the dialysate into the capillaryand enter the patient's bloodstream. In order to prevent thrombosis, an anticoagulant is introduced into the system. The processed dialysate is removed and the purified blood is returned to the patient. In terms of time, the procedure lasts from 4 to 12 hours and is repeated 3 times a week, and in some cases every day.
How many live on hemodialysis? Statistics show - an average of 15 years, but there is evidence in history that there were patients who lived for 40 years. The Russian book of records describes a woman who spent 30 years on dialysis.
The method of extracorporeal blood purification carries many costs. More than a million rubles are spent per year per person. Currently, there is a state program, thanks to which the costs are paid by the state. Scientists are trying to improve the devices themselves, so that in the near future this procedure will become available to everyone suffering from kidney failure. Consider what types of hemodialysis machines exist.
By functionality
- Classic - apparatus with a small membrane area. Only small molecules pass through the filter. Blood flow rate up to 300 ml/min. The procedure lasts 4 hours.
- Highly efficient. The area of the semi-permeable membrane is 1.5 - 2.2 sq.m. Accelerates the blood flow rate up to 500 ml / min., which reduces the duration of the procedure to 3 hours. Dialysate moves in the opposite direction of blood, speed up to 800 ml/min.
- High flow. Allows you to cleanse the blood of anything, skips evenlarge molecules.
By type of dialyzers
- Capillary. Closest to the physiology of a he althy kidney.
- Disc (lamellar).
Portable devices
There are portable blood purifiers. They are common in Western countries. More than half of CKD patients use these devices. The equipment is expensive, estimated at $20,000. Portable devices have their advantages:
- no queue;
- excluded the possibility of contracting blood-contact infections (hepatitis, HIV);
- you can freely move with them during the procedure.
The disadvantage of such devices is that an unpredictable reaction can occur and emergency assistance is required.
Peritoneal dialysis
Fluid (dialysate) is injected into the abdominal cavity through a puncture in the anterior abdominal wall. The volume is about 2 liters. One end of the tube is in the abdomen, and the other is closed. A dialyzer is not required. The membrane in this case is the peritoneum, through which toxic substances pass into the dialysate solution. The exposure of the liquid is 4-5 hours, after which the liquid is removed through the catheter, and the pure solution is poured again in the same volume. There is a risk of inflammation of the peritoneum, which may lead to additional methods of treatment, up to an emergency operation. When performing any type of hemodialysis, it is necessaryobserve the rules of sterility. This procedure is contraindicated in people who are overweight (abdominal type of obesity) and people who have adhesive disease.
What are the reasons for dialysis
This procedure has become the only salvation for thousands of patients whose kidneys have failed to perform their functions.
Hemodialysis is prescribed for people with the following he alth problems:
1. Acute and chronic renal failure (ARF and CRF). It is characterized by a small daily urine output, a laboratory-confirmed decrease in the glomerular filtration rate (SLE). How long they live on kidney hemodialysis depends on the tolerability of the procedure and compliance with the doctor's recommendations by the patient. Dialysis is carried out in order to replace the completely lost kidney function and remove nitrogenous wastes in chronic renal failure. In acute renal failure, hemodialysis is performed to remove toxic substances from the body that caused acute renal failure and to release excess fluid.
2. diabetic nephropathy. It is a late vascular complication of diabetes mellitus. The capillaries of the renal filters become sclerosed due to persistently elevated glucose levels. The renal threshold for blood glucose is 10 mmol/l. When the sugar level is above this indicator, glucose begins to be filtered into the urine. The molecules are large and damage the delicate walls of the capillaries. How long you can live on hemodialysis with diabetes mellitus depends on the degree of compensation for the pathology, the level of glycated hemoglobin, and the presence of other severe complications. For diabetics over 70 years of age, hemodialysis is contraindicated.
3. Alcohol poisoning (methyl or ethyl). Metabolites of some alcohols cause the formation of crystals that damage kidney tissue and cause acute renal failure. How long they live on hemodialysis after poisoning depends on the degree of damage to the kidney tissue. There is a chance that kidney function will be restored and hemodialysis will no longer be needed.
4. Toxic effects of drugs and poisoning with poisons. There is a direct damaging effect on the kidneys. Hemodialysis is performed to remove poison and drug metabolites from the body. If the body is able to cope, then hemodialysis is carried out until the kidney function is restored. How long they live on kidney hemodialysis in this situation depends on the type and amount of the damaging agent.
5. A state of overhydration, when the body contains a large amount of water ("water poisoning") and there is a risk of developing cerebral and pulmonary edema. The purpose of the procedure will be to remove excess water, lower blood pressure and reduce swelling.
6. Violation of the ratio of electrolytes in the body. Occurs with loss of fluid with frequent vomiting, diarrhea, intestinal obstruction, prolonged fever. Use special dialysates with the necessary electrolytes to replace or remove them. Carry out until the balance of electrolytes is restored.
7. Kidney transplant. Until the transplanted kidney starts, it is supported. How long do they live after kidney rejection on hemodialysis?As much as they would live without a transplant. About 20 years old.
Indications for the procedure
Certain indicators for which an "artificial kidney" is indicated:
- Daily urine output less than 500 ml. Normal - 1.5-2.0 l.
- Reduction of glomerular filtration rate below 15 ml/min. The normal value is 80-120 ml/min.
- The value of creatinine is above 1 mmol/l.
- Urea level - 35 mmol/l.
- Potassium above 6 mmol/l.
- Bicarbonate below 20 mmol/l - metabolic acidosis.
- Increasing swelling of the brain, lungs, heart, resistant to standard therapy.
Contraindications for hemodialysis
- Infectious process. Microorganisms circulate in the bloodstream. The hemodialysis procedure enhances blood flow throughout the body and there is a huge risk of pathogenic flora entering the heart, which can cause inflammation. Dangerous development of sepsis.
- Acute cerebrovascular accident. The procedure can increase blood pressure levels and make the situation worse.
- Mental disorders and epilepsy. Hemodialysis is stressful for the body. A slight change in blood pressure can cause a headache and an attack of mental illness or seizures. For high-quality therapy, it is necessary to calm the patient and fulfill the medical requirements of the working staff of the dialysis center during the procedure.
- Tuberculosis outbreaks inbody. This type of patient is a source of infection and cannot visit hemodialysis centers. Even if you create a specialized dialysis unit, there is a risk of contamination of the body with Mycobacterium tuberculosis.
- Malignant tumors. Dangerous spread of metastases.
- Chronic heart failure, acute myocardial infarction and the first day after it. Hemodialysis affects the electrolyte ratio and any change in it can lead to heart rhythm disturbance, up to cardiac arrest. In chronic heart disease, blood flows through the vascular bed at a slower speed and there are areas of thickening, and the dialysis procedure can provoke the movement of a blood clot and blockage of an artery.
- Severe arterial hypertension. There is a risk of a hypertensive crisis.
- Age over 80 years old. The reason is that the cardiovascular system of aging patients undergoes involution. Veins and arteries become brittle, making it difficult to access hemodialysate. It is noted that people after 60 years of age live on hemodialysis as long as their cardiovascular system allows.
- Blood diseases. The introduction of heparin can aggravate bleeding disorders, and the hemodialysis procedure can destroy some of the red blood cells, which worsens the course of anemia.
Hemodialysis complications
Local:
- Inflammation and purulent complications at the vascular access site.
- Pain and muscle discomfort.
- Contact dermatitis.
System:
- Violation of the general condition in the form of weakness, headache, malaise, nausea, muscle pain.
- Generalized allergic reaction to membrane components.
- Impaired blood pressure levels (decrease or increase).
- Air embolism.
- Sepsis. In case of non-compliance with asepsis rules against the background of weakened immunity in this category of patients.
- Iatrogeny - infection with viral hepatitis and HIV. A high degree of sterilization is required. In conditions of a large flow of patients and a small amount of equipment, an insufficient level of system processing is possible. It all depends on the work of the medical staff.
Who does it
The hemodialysis procedure in the hospital should only be performed by he althcare professionals. In recent years, the practice of performing hemodialysis at home has spread. It is much more convenient for the patient, as he remains in the circle of his relatives. At home, the procedure can be performed by any person (not a he alth worker) who has been trained. How many people live on hemodialysis on average, in this case, depends on how sterile the person performing the procedure is. If he does not wash his hands thoroughly enough (this must be done first with soap, then with a disinfectant solution, for example, Betadine), does not observe sterility when applying a bandage at the site of injection of a fistula into the patient's body, an infection that enters the patient's body can kill him in a matter of months. If everything is done correctly, the patient will live as long as a person who does not have kidney problems.
Dietfor hemodialysis
How long you can live on hemodialysis depends to a large extent on how the patient takes care of his he alth. He should not drink, smoke, eat smoked meats, pickles, marinades, floury sweets, fried foods. The menu of such a person should consist of fresh high-quality products containing vitamins and proteins (chicken, rabbit, lean beef, boiled eggs). Limit yourself in foods such as milk, beans, nuts, cheese.
