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Dialysis (1)

What are the various forms of treatment available for a patient with end-stage kidney failure?

There are 3 methods of renal replacement therapy available: Hemodialysis using the artificial kidney, Peritoneal Dialysis by introducing a special solution into the abdomen, and Renal Transplant from a cadaver or a living related donor.


What is dialysis?

Dialysis is a process which separates solutes dissolved through in water a semipermeable membrane.


What happens in hemodialysis?

In hemodialysis the patient's blood is let out of his body where it is treated with anticoagulant ( heparin ) to prevent it from clotting and passed over a semipermeable membrane in the dialyzer ( artificial kidney ) through which exchange of solutes ( dialysis ) takes place.

The blood returning to the patient after passing through the dialyzer ( artificial kidney ) is almost devoid of toxic substances.

What is vascular access and how is it made possible?

In order to get the patient's blood to flow out and pass through the artificial kidney machine for cleansing, a vascular access is necessary. Put simply, the access is a point for entry into the bloodstream so that the patient can be connected to the machine.

The most common form of vascular access is the arterio-venous (AV) fistula. The other types of access are the AV shunt and the subclavian catheter. The AV fistula takes a few weeks to mature while the AV shunt and the subclavian catheter can be used immediately.

What are the equipment required for hemodialysis?

The patient requires a hemodialysis machine with a built-in system to monitor the various sets of pumps, the dialyzer or artificial kidney, lines for letting out and returning blood to the patient, dialysate or dialysis solution, water treatment unit ( deioniser or reverse osmosis ) and vascular access for the patient ( usually an AV fistula ).


When should a patient be considered for dialysis?

A patient should be considered for dialysis or transplant as soon as it is clear that he or she has chronic renal failure, usually with a serum creatinine level of about 7 to 8 mg. The doctor would usually suggest an operation for an AV fistula at this stage.

Dialysis is started when the serum creatinine level is about 12 to 15 mg though occasionally it is started earlier when the patient has symptoms of renal failure.

How are patients selected for hemodialysis?

Acceptance policies in different countries vary considerably. Some countries accept any patient wishing treatment while many others select patients using age, medical, economic and other factors as the criteria because of financial constraints.


What is home dialysis?

This is the best option for the patient on dialysis. The patient can dialyse himself after office hours at his own convenience with the aid of his spouse or partner. Employers are happier and such patients are more productive, compared to those dependent on the centre or self- dependency dialysis. In Singapore, home dialysis is actually private dialysis unlike the government-supported self-dependency dialysis. The set up for home dialysis includes a dialysis machine and a water treatment unit ( reverse osmosis or deioniser ). Together they cost about $15,000 to $20,000 with a recurrent monthly expenditure of about $800 for disposables like dialysers, dialysate and blood-lines. It is obvious that not many can afford to dialyse at home.


What is the effect of hemodialysis on the patient?

Initially, most patients will experience some after-effects with life on hemodialysis. Some may feel unwell at the end of each dialysis, feeling a bit washed out. During dialysis they may have cramps, vomiting or hypotension. These effects are caused by the changes occurring in the composition of the body fluids. However most patients get over these effects after a few weeks. The majority of patients will have the feeling that they have been given new lives as they no longer suffer from symptoms of end-stage renal failure, such as nausea, vomiting, shortness of breath, giddiness and tiredness. Even food tastes better and everything in their body seems to work well again.


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