Health Articles
Kidney Failure And Haemodialysis
A human being is born with two kidneys, which are commonly known as the excretory organ of the body. The main functions of the kidneys are to remove various waste products form the blood and to excrete them in the urine. Apart from that the kidneys also play a very important role in the regulation of water and salts namely; sodium and potassium. The other functions of the kidneys are the production of an important substance called erythropoietin, which is essential to the production of red blood cells and in the conversion of vitamin D to its active form.|
Kidney failure is the term used when kidneys are unable to perform the above functions. It can occur rapidly (within a few hours or days) when it is called acute renal failure or it may occur gradually over many months or years when the term chronic renal failure is applied. In a patient with chronic renal failure, the term 'end stage renal disease' (ESRD) is used when life cannot be sustained without the help of dialysis or kidney transplant.
Options For Patients With ESRD
End stage renal disease means that the life of the patient cannot be sustained without some form of support in addition to medicines. This additional support is generally termed as renal replacement therapy which can be in the form of dialysis or kidney transplant.
What is Dialysis ?
Dialysis is a process in which waste products are removed from the blood by allowing it to pass through a membrane. Dialysis is of two types:
- Haemodialysis
- Peritoneal dialysis
Haemodialysis is a process in which the blood is continuously carried by special tubes from the patient's body, into a filter called Hollow Fibre Kidney where it is purified and then returned into the patient's body. Each session of haemodialysis lasts for about four hours. Most patients require 2-3 sessions of haemodialysis a week.
There is a general misconception that haemodialysis is a very painful process. However it is not largely true. Pain occurs only at the time of insertion of needles and catheters into the blood vessels. In patients who have an A-V fistula, the pain is limited to only two simple needle pricks at the time of starting the procedure. In patients who do not have an A-V fistula, catheters have to be placed in the groin or neck which is done after giving local anaesthesia. Placement of catheters carries a potential risk and also failure. It is not meant for long term dialysis: an A-V fistula is the only means. Ideally an A-V fistula should be created well in advance in all patients who are approaching ESRD.
A patient on haemodialysis needs to increase his protein intake to about 60 grams per day but he still has to restrict salt, liquids and fruit in his diet. Patients are advised not to gain (2kg) weight during the interval between two sessions of dialysis.
Patients on haemodialysis are at an increased risk of acquiring the Hepatitis-B infection. Hence they must be vaccinated. Vaccination should be initiated as soon as chronic renal failure diagnosis is made. These patients require four doses of 40 microgram ( 2 ml ) each at 0,1,2 and 6 months.
Patients on maintenance haemodialysis can lead useful lives for many years, provided dialysis is initiated at the proper time and they receive adequate dialysis. Adequacy of dialysis is determined from various parameters and the dialysis prescription can be modified regarding the duration and frequency by the Nephrologist.
Dr P. K. Prasher
Consultant - Nephrology,
Fortis Hospital, Mohali.
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