How many years can you do hemodialysis. Kidney dialysis: how long do they live on this procedure

It is known that life expectancy directly depends on the condition of the kidneys. But only the chronically ill truly know.

His body works in a mode of ever-increasing poisoning with waste products of its own metabolism, because the organs of purification and excretion cannot cope with their task.

The smell of acetone, vinegar and other poisons in the air he exhales. They are clearly read by others among other unpleasant odors, but they give only a distant idea of ​​​​what is happening inside the body at that time.

Connected to the evacuation of toxins, the skin also exudes a waste of no less strength.

And then extremely clogged biological filters fail. They refuse to serve, causing the patient to despair.

But not for someone who already has experience in hemodialysis. Such a patient does not bring things to a critical point - he knows: it's time to visit the dialysis center.

What is kidney dialysis?

The term “artificial kidney” apparatus is widely known. But for those who have questions about the kidneys, the unit saves lives. Or prolong it for years.

The device "artificial kidney" is a design (machine) that makes possible hemodialysis of the kidneys.

The literal translation of the term "dialysis" means: separation or fractionation. Therefore, the literal answer to the question: kidney dialysis, what is it - means a division into good and bad. Thanks to the machine that takes over the function of failing kidneys, the good things that the body needs return to it, and the obscene things are removed.

Kidney hemodialysis is the purification of blood from toxins, produced artificially. During the procedure, it leaves the body for a short time in order to return to it purified.

"Leaves" does not mean at all that it merges somewhere from the bloodstream - it continues to circulate, driven by the heart.

But some interference is made in its movement - an “artificial kidney” device, or a hemodialyzer, is connected.

Blood enters it from:

  • punctured vein, or
  • direct arteriovenous connections, or
  • transplant- a synthetic tube simulating a saphenous vein.

Leaving it already cleansed, it returns to the bloodstream through punctured vein.

The entire volume of blood is passed through the apparatus repeatedly. The process is carried out either in sessions of 4-5 hours, or proceeds around the clock-constantly. Depending on the variant of the pathology, the needs (and financial capabilities) of the patient, the following structures are used:

  • stationary;
  • portable, worn on the body, weighing 4-7 kg.

All this time, the movement of blood does not stop for a moment - it is promoted by the contractions of the heart, which continues to perform its function of a pump. The procedure exactly repeats the natural process. Only in the middle of the path of blood from heart to heart there is a human-designed kidney.

Brief excursion into chemistry and physics

An illustration of the process is the purification of smoking smoke in a hookah, where it is passed through water and then consumed.

Kidney hemodialysis uses 3 physical and chemical laws, which the diffuser allows to implement - filter apparatus, which is a membrane with selective permeability.

Process diffusion going on through the membrane that stands in the way between the hemodialysis solution and the patient's blood. It allows you to extract compounds with specified molecular weights from the blood.

In accordance with the pore diameter and other clear parameters of the filter membrane, these are electrolyte ions and proteins of the β2-microglobulin category.

But in parallel, the reverse process occurs (possible) - the transition from the solution for hemodialysis into the blood of electrolytes and high-molecular compounds. Considering this fact, the predetermined concentration of electrolytes is maintained in the dialysate solution, which makes it possible to maintain the salt balance in the patient's blood. To prevent the penetration of microbial poisons and other toxins into the patient's blood, a methodical cleaning of the working solution is carried out.

The insufficient perfection of filtering membranes does not yet allow extracting from the blood toxins, chemicalassociated with proteins, as well as their hydrophobic fractions.

The removal of hydrophobic fractions of toxins occurs using the same filter thanks to the process convection, possible due to the presence of osmotic pressure. It arises due to the difference in concentrations of solutions on different sides of the membrane.

The path of blood during hemodialysis lengthens and becomes more difficult. Therefore, to facilitate filtration through the membrane, the hemodialyzer operates its own pump. Due to its work, pressure is created by the blood on the surface of the membrane, and the process starts ultrafiltration - removal of excess water from the body.

The rest of the design is:

  • pipeline for passing blood;
  • dialysate solution propulsion system and
  • control system for many parameters of both environments.

Used to prevent blood clotting anticoagulant(usually heparin).

Summary: since each chemical compound has a certain electrical charge, specific gravity, chemical and spatial structure, kidney hemodialysis is electrochemical sorting into useful and harmful for the body with regular removal of harmful by means of the apparatus.

As a result of using a hemodialyzer, the following occurs:

  • extraction from the blood of the majority of nitrogenous compounds that are not chemically bonded with proteins;
  • ridding the body of edematous fluid.

When and to whom is hemodialysis of the kidneys indicated?

If very recently intravenous injection was equated to surgery, then hemodialysis of the kidneys is an operation in fact.

Therefore, before starting hemodialysis, not only the indication for the procedure is taken into account, but also factors that can complicate (make it impossible) the course of the operation - contraindications.

Main testimony options for the hemodialysis procedure are:

  • acute renal failure;
  • chronic renal failure;
  • poisoning with drugs or poisons (subject to their ability to pass through the membrane of the hemodialyzer);
  • severe disorders of the electrolyte balance of the blood;
  • alcohol intoxication;
  • life-threatening hyperhydration (categories of pulmonary edema, cerebral edema), which cannot be eliminated by other (conservative) methods. In the latter version, to improve the state, we apply the method isolated ultrafiltration.

foundation data are used to prescribe a hemodialysis procedure laboratory and instrumental diagnostics:

  • indicators of the level of urea in the blood;
  • Ultrasound, MRI of the kidneys.

Contraindications

Kidney hemodialysis has contraindications both relative and absolute.

  • conditions with the possibility of massive bleeding (and,).

The second is the options:

  • mental deviations and pathologies (epilepsy, schizophrenia, psychosis);
  • malignant neoplasms in an incurable stage (for example: throat cancer at stage 4);
  • blood diseases ( , );
  • severe neurological pathologies;
  • in patients older than 70 years or senile (over 80 years) age;
  • combinations of two (or more) significant pathologies, such as advanced atherosclerosis, diseases with respiratory failure;
  • drug addiction and alcoholism without the likelihood of rehabilitation.

About security guarantees

In addition to the emergence of a number of social and financial issues for the patient (the cost of one course reaches 1.5 million rubles, because 1 session requires a volume of dialysate of the order of 120 liters), one should not discount the possibility for him complications during this mini-operation.

Because the kidneys not only participate in cleansing the internal environment of the body, but also are complex hormone-producing formations, likely risk of complications as:

  • arterial hyper- or hypotension;
  • hyper- or hyponatremia;
  • convulsive syndrome or seizure of epilepsy;
  • air embolism or thrombosis;
  • weakness, dizziness, nausea, vomiting, or heart rhythm disturbances due to changes in intracranial pressure;
  • an allergic response to the components of the dialysis solution.

In the age of disposable catheters and syringes, a natural question arises: is it dangerous to use a device that simulates the work of the kidneys? Will any hepatitis or HIV-AIDS category of infection be transmitted through the device?

Unintentional infection the patient during the preparation of the procedure is unlikely, but also not excluded - it all depends on the state of immunity and the general status of the body. Indeed, with the loss of kidney function up to 85% (which is the basis for treatment), the state of the internal "climate" often changes irreversibly.

"Artificial kidney" - the only method of blood purification?

After receiving an answer to the question: kidney dialysis, what is it - it would be unfair not to get acquainted with alternative methods of blood purification.

In addition to cleansing with an artificially constructed kidney, there are other methods based on the same principle of a limitedly permeable membrane.


Peritoneal dialysis

At peritoneal dialysis the role of the filter is performed by its own peritoneum the patient being cleaned, intestinal dialysis performs the same function the wall of the large intestine.

Although both methods are less effective, they make it possible to achieve a satisfactory result in the variant when hemodialysis is contraindicated.

In addition, they are less expensive ingredients and equipment.

The method of detoxification hemosorption is somewhat different. He offers purification of the patient's blood by its perfusion through a detoxifier - a special filter column made of activated carbon or another type of sorbent.

Used in a specialized hospital, the technique, also being cheaper compared to hemodialysis, has its own scope for removing a number of toxic substances from the body.

After solving a number of technical issues (such as replacing a sorbent of a simple composition with ion-exchange resins), this method promises great prospects.

In the case when all options for detoxification have been exhausted, the patient has the last chance to survive - kidney transplantation.

About the need for a regimen and diet for hemodialysis

In view of the load on the body, which increases both with all options, and in the process of its hardware treatment, there is a need for therapeutic nutrition.

  • Due to the forced circulation of blood and aggressive intervention in the existing balance of metabolism, a loss of part amino acids, minerals and vitamins, the supply of which should be replenished by the consumption of high-grade protein foods, mainly of animal origin.
  • In the presence of arterial hypertension, it is prescribed completely salt-free diet.
  • Due to a sharp decrease in the volume of diuresis (oliguria of any origin: with heart, kidney, liver failure), consumption water also severely limited.
  • Due to urinary excretion disorder potassium It is necessary to reduce the consumption of foods rich in this substance in order to avoid its overabundance in the body.
  • Due to imbalance phosphorus and calcium minerals that work in close conjunction with potassium, there is a need for a forced correction of their content in the blood.
  • Renal insufficiency leads to greater caution regarding compounds aluminum. This trace element, which gets inside when using aluminum dishes or is part of multivitamin complexes, becomes very toxic under the changed new conditions. Therefore, rash behavior and non-compliance with the diet can become, damage to bone tissue and neurological pathology.

For drug correction of the level of all these microelements, repeated laboratory diagnostics are required.

Forecast and conclusion

Making a decision on certain measures on the diet and lifestyle of the patient remains the prerogative of the attending physician or medical consultation, while the patient is obliged to coordinate all his actions with a doctor - a specialized specialist (nephrologist or urologist).

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

General information

In the normal state, the kidneys of each person tend to function normally. However, sometimes these organs fail to filter a sufficient amount of both slags and liquids. As a result, the amount of these components reaches a dangerously high level, which leads to their accumulation in the human body. This phenomenon is called by specialists renal failure, i.e. a condition in which the ability of these organs to process and / or excrete urine is partially or completely lost, which in turn provokes the development of disorders of both acid-base and water-salt, as well as osmotic homeostasis. Leaving this condition without due attention is extremely dangerous, since a long absence of treatment can cause the death of the patient.
Hemodialysis- one of the methods of therapy, which is widely used in both acute and chronic renal failure. It is about this method of treatment that we will talk with you right now.

Hemodialysis - what is it?

The term hemodialysis comes from the two words " haemo" And " dialysis", which in Greek means " blood" And " decomposition, separation". This term refers to an efferent method of blood purification in acute and chronic renal failure. Such purification is carried out using a special apparatus "artificial kidney". During its implementation, it is possible to extract from the body all the toxic components resulting from metabolism. In addition, this method allows you to restore various disorders of both water and electrolyte balance. Immediately, we note that specialists often use such a method of therapy as peritoneal dialysis, which has its own important features. So, for example, during hemodialysis, blood is purified using an “artificial kidney” apparatus, but during peritoneal dialysis, blood is purified by changing special solutions in the abdominal cavity. There is also such a thing as intestinal dialysis, which involves washing the intestinal mucosa with special hypertonic solutions.

Information from history

For the first time, problems related to blood purification began to be discussed in ancient times. In those days, experts were of the opinion that almost all diseases are the result of mixing various bodily fluids. In the fight against them, they used a variety of decoctions and infusions prepared from medicinal plants and minerals. This approach did not give the desired result. In some cases, patients got even worse. The problem of blood purification reached a completely new level only at the beginning of the 19th century. This is not surprising, since it was during this period that scientists managed to understand the numerous rather complex processes that take place in the human body. The first foundations of dialysis were laid by a Scottish scientist Thomas Graham. It happened in 1854. Already 50 years later, the first apparatus was created, with the help of which it was possible to extract dissolved substances from the blood. The first efferent method of human blood purification was carried out by a doctor Georg Haas. It happened in 1924 in Germany. The procedure took about half an hour.

Device "artificial kidney"

As we have already said, this method of blood purification involves the use of an “artificial kidney” apparatus. His work is based on dialysis methods, which allow the extraction of components with a low molecular weight from the patient's blood plasma. The list of these components can include both products of nitrogen metabolism in the form of uric acid and urea, and electrolytes in the form of calcium, sodium, potassium, etc. An important role is played by some of the principles of ultrafiltration, which in turn help to remove water and toxic components with a higher molecular weight. To date, there is a huge number of different designs of this device. Despite this, they all have the same circuit and similar constituent components. They mainly consist of a dialyzer, a perfusion device, which tends to ensure the movement of blood through the dialyzer, a monitor, as well as a device for preparing and supplying a special dialysis solution to the dialyzer. As for the dialyzer, it is considered to be the basis of the entire apparatus, the most important element of which is a semi-permeable dialysis membrane. It is this membrane that allows you to divide the internal space of the dialyzer into 2 parts, one of which is for blood, and the other is for solution. If we talk about dialysate solution, then its composition resembles the ultrafiltrate of blood plasma. It is used exclusively to restore uremic disorders of the acid-base and salt composition of the blood.

Procedure - how is it carried out?

During the procedure, the specialist uses access to conduct blood through the device itself. To create such access allows a small surgical intervention. There are 2 types of access. In the first case, we are talking about a fistula, namely the connection of an artery with a vein. In the second case, a stent is inserted, i.e. an artificial tube used to connect an artery to a vein. As early as 7 days after surgery, a kind of maturation of the fistula is noted. Its size increases, as a result of which its appearance begins to resemble a cord under the skin. The duration of the process varies from 3 to 6 months. As soon as the maturation of the fistula comes to an end, dialysis needles are immediately inserted into it. If we talk about a stent, then it is allowed to use it already 2 to 6 weeks after its engraftment. As for blood supply, it is carried out through tubes using a roller pump. Devices are also connected to the system, with the help of which it is possible to track the speed of blood flow, as well as pressure. The optimal speed is considered to be from 300 to 450 ml/min. It is also important to note the fact that the use of both a stent and a fistula can significantly increase the amount of blood flow through a vein. As a result, the vein becomes elastic and easily stretched, which significantly increases the effectiveness of this procedure.

Who performs?

This procedure is best performed in a medical facility under the supervision of medical staff, but it can also be performed at home with the help of a partner who has previously received special training. The most important thing is to thoroughly rinse and sterilize the device before carrying out hemodialysis. The procedure lasts from 5 to 6 hours. All this time, it is necessary to carefully monitor the patient's pulse, his blood pressure, as well as the state of vascular access. Immediately after the procedure, a sterile dressing must be applied to the area.

How does it work?

For the procedure, a dialyzer is used, as well as a special filter designed to purify the blood. At first, the blood enters the dialyzer, where it is cleansed of existing toxins, after which the already purified blood is returned back to the body. By the way, it comes back through other tubes.

How often is this procedure allowed?

This procedure in most cases is carried out 3 times a week. During its implementation, the patient can both sleep and talk, read, watch TV or write.

Materials and equipment

Here is a list of materials needed for one such procedure:
  • pumping station;
  • reverse osmosis for water purification;
  • hemodialyzer ( the device itself);
  • Consumables;
  • a sterile set in the face of tampons, wipes, as well as auxiliary tools;
  • disposable syringes;
  • medical scales;
  • drugs and emergency aid;
  • chair for the location of the patient;
  • dialyzer ( functional unit of dialysis, which includes a semi-permeable membrane);
  • saline;
  • antiseptic and aseptic preparations;
  • a line for carrying the patient's blood from the bloodstream to the dialyzer and back;
  • heparin or low molecular weight heparins;
  • 2 translucent needles for puncture of an arteriovenous vascular prosthesis;
  • temporary central venous catheters;
  • bicarbonate and acetate concentrate in a special container.

Indications

The list of main indications for this procedure can include:
  • acute renal failure;
  • chronic renal failure;
  • alcohol intoxication;
  • serious violations of the electrolyte composition of the blood;
  • drug overdose;
  • poisoning with poisons that tend to penetrate the hemodialysis membrane;
  • hyperhydration, which threatens the patient's life and is not treated with conservative methods.

It is worth noting that renal failure is considered to be the main indication for dialysis, since in this case this procedure can prolong the life of the patient. Moreover, hemodialysis in this case is considered to be a method of maintenance therapy.

Contraindications

Modern experts identify absolute and relative contraindications to this procedure.


Absolute contraindications include:

  • various lesions of cerebral vessels;
  • damage to the blood system in the form of leukemia or anemia;
  • serious damage to the central nervous system;
  • age over 80;
  • age over 70 with diabetes mellitus;
  • malignant neoplasms;
  • pathology of the lungs in the stage of obstruction;
  • chronic hepatitis;
  • pathology of peripheral vessels in the stage of decompensation;
  • mental illness such as epilepsy, psychosis or schizophrenia;
  • the presence of inclinations to drug addiction, vagrancy or alcoholism;
  • coronary heart disease with previous myocardial infarction;
The list of relative contraindications is presented:
  • diseases in which there is an increased risk of massive bleeding with the introduction of anticoagulants ( gastric or duodenal ulcer, uterine fibroids);
  • active forms of pulmonary tuberculosis and other vital organs.

Possible Complications

The kidneys take an integral part in the functioning of numerous systems of the human body. Given this fact, a violation of their work causes the failure of the functions of many other systems and organs.
As for the directly possible complications of dialysis, these are:
  • arterial hypertension;
  • anemia;
  • damage to the nervous system;
  • bone diseases;
  • pericarditis;
  • an increase in the total amount of potassium in the blood.
And now, more about each of these complications:

1. arterial hypertension: characterized by a persistent increase in blood pressure. If this condition is noted along with one of the pathologies of the kidneys, then experts recommend minimizing the use of both liquid and table salt. Prolonged lack of treatment for this condition can cause the development of both heart attack and stroke;

2. Anemia: accompanied by a significant decrease in the total level of erythrocytes ( red blood cells) in blood. But it is these cells that, with the help of hemoglobin, tend to carry oxygen to tissues. The main reason that provokes the development of anemia during hemodialysis is considered to be the lack of erythropoietin, namely the hormone that is synthesized by healthy kidneys in order to stimulate the formation of red blood cells in the bone marrow. Anemia in this period can also develop against the background of large blood loss or due to insufficient intake of iron and vitamins by the patient;

3. Damage to the nervous system: in medicine, this phenomenon is called peripheral neuropathy, which is accompanied by a violation of sensitivity in the area of ​​\u200b\u200bboth the feet and legs, as well as the hands. There are plenty of reasons for this, namely diabetes mellitus, the accumulation of a large number of waste products in the body, a lack of vitamin AT 12 etc.;

4. Bone diseases: in patients with an advanced stage of renal failure, there are serious malabsorption of both phosphorus and calcium, as well as various vitamins, which causes the development of renal osteodystrophy. This condition refers to increased bone fragility. As a result, all these changes lead to the destruction of bone tissue and all because the kidneys can no longer transform the vitamin D in a form that facilitates the absorption of calcium. A clear imbalance of both phosphorus and calcium causes their deposition in the joints, lungs, blood vessels, heart and skin. The deposition of these substances in the skin provokes the development of inflammatory reactions and painful ulcers;

5. Pericarditis: characterized by inflammation of the pericardium, i.e. the membrane that covers the heart. This phenomenon occurs due to the accumulation of a large amount of fluid around the heart, which provokes a significant decrease in the release of blood and heart contractions;

6. An increase in the total amount of potassium in the blood: this condition is called hyperkalemia. Patients on dialysis should follow a low potassium diet. Regular increases in the level of this component can provoke cardiac arrest.

Side effects

Most often, side effects such as:
  • heart rhythm disturbances;
  • muscle cramps;
  • bronchospasm;
  • pain in the back;
  • allergic reactions;
  • confusion;
  • hearing impairment.

Measures to prevent the development of complications

In order to prevent the development of certain complications, experts recommend:
  • strictly follow the prescribed diet;
  • observe all hygiene rules;
  • consume the allowable amount of liquid;
  • regularly take prescribed pharmaceuticals;
  • immediately inform the doctor about the development of any symptoms of complications;
  • undergo preventive examinations with a doctor and take all the necessary tests.

Diet in dialysis therapy

In the fight against acute and chronic renal failure, both hemodialysis and special dietary nutrition are important, which is prescribed to all patients without exception. A properly selected diet can significantly reduce the waste accumulated in the blood due to the vital activity of the body.
Nutritionists advise such patients, in the very first place, to carefully monitor the level of potassium in the body. It's no secret that potassium is a mineral found in both milk and nuts, some vegetables and fruits, and chocolate. Its excessive amount or lack can have a detrimental effect on the heart. In the treatment of hemodialysis, it is necessary to consume a large amount of protein. Your choice should be chicken, lean beef, turkey and rabbit meat, as animal proteins are much better than vegetable proteins. Both butter and vegetable oil can be added to food in an amount of no more than 20 g per day. The amount of liquid consumed should also be reduced to a minimum, since any liquid tends to accumulate in the body in large quantities, and especially in case of any violations of the kidneys. Too much fluid can cause a variety of heart problems, swelling, and high blood pressure. It will not be superfluous to limit yourself in such products as nuts, milk, dried beans and cheese. The composition of all these products includes phosphorus, a large amount of which provokes the removal of calcium from the bones. Without enough calcium, bones will never be strong and healthy. Salt should also be consumed in minimal quantities, after which you are very thirsty. The calorie content of the daily diet should not exceed 35 kcal per 1 kg of body weight.

Medications

Patients undergoing hemodialysis therapy require both special dietary nutrition and medications. So, for example, they are often prescribed multivitamins and iron preparations that help replenish the components that were lost during this procedure. In order to enhance the synthesis of red blood cells, they are often prescribed special hormones such as testosterone or erythropoietin. To remove excessive amounts of phosphates from the body, medications such as calcium acetate And carbonate. Low levels of calcium in the blood can be increased with the help of special forms of vitamin IN , as well as calcium preparations. Often, medications are also used to lower blood pressure, which is observed in 90% of cases out of 100.

Problems that arise

Regular dialysis procedures can save patients' lives, but long sessions often cause the development of stressful conditions in any life situations. Such patients are especially worried about the threat of loss of independence. The thing is that all these patients are almost completely dependent on the medical staff or their household members. Often they have to give up work or study just because they have to devote time to this procedure at least 3 times a week. As a result, their rhythm of life changes completely. Now they need to follow a certain schedule, which in no case can be avoided. It is also important to note the fact that regular procedures very often change the appearance of the patient, which also does not go unnoticed. Children under such treatment are very often retarded in development, which distinguishes them from their peers. In adolescents, due to such treatment, self-esteem is significantly reduced. Elderly people cannot remain alone at all and move to live with their relatives. In general, psychological difficulties arise all the time. Given all this information, it is very important that both the patient and his relatives regularly consult a psychologist. This is especially necessary for obvious behavioral disorders, prolonged depression, as well as problems that are directly related to physical limitations or adaptation to such a rhythm of life.

Dialysis chairs

The chairs designed for this procedure are being improved more and more every year. This is not surprising, since they should provide patients with convenience and comfort. Note that all segments of such chairs are movable relative to each other, so it will not be difficult to take a comfortable position before the procedure.
The latest models are generally equipped with a control panel, so that the position of the chair can be easily changed during the procedure. Armchairs are characterized by both stability and ease of movement. The height of the footrest is also adjustable. Practically, all models are equipped with a hanging table, on which you can put a book or your favorite magazine. The attached light bulb allows you to significantly improve the conditions for reading, as it illuminates the entire manipulation field. There is also a special foot pedal used in emergency cases to move the chair to a horizontal position. To turn off the power supply of the chair, you do not need to reach for the outlet. It is enough to press the existing switch, which is located under the seat.

Home hemodialysis can replace kidney transplant

Canadian scientists conducted studies during which they came to the conclusion that home dialysis performed for various kidney pathologies can replace the transplantation of this organ, which was received from a deceased donor. The main feature of such treatment is considered to be that the patient undergoes the procedure from 6 to 8 hours, which significantly exceeds the duration of the same procedure in a hospital. Moreover, at home, such procedures can be carried out almost every night. For 12 years, specialists have been monitoring their patients. All of them suffered from various pathologies of the kidneys. Some of them were treated at home, but the other part underwent surgery for a kidney transplant. After that, scientists compared mortality in the 2 groups. Their surprise knew no bounds, as it turned out that home dialysis is more effective than a standard transplant procedure. Scientists are confident that this particular procedure can become an excellent alternative to transplantation for all those patients for whom kidney transplantation is categorically contraindicated for one reason or another.

How to prevent the development of kidney pathologies?

In order to prevent the development of this kind of disease, experts recommend:
  • do not sit on stones and cold ground;
  • do not abuse alcohol, especially beer;
  • after swimming in a cold pond, it is good to dry yourself with a dry towel and take off your wet underwear;
  • pay special attention to the medications taken, many of which tend to have a detrimental effect on the kidneys;
  • in no case should you carry colds and flu on your feet;
  • dress exclusively for the weather and cover your lower back at all times;
  • avoid hypothermia, which can cause vasospasm of the kidneys.
Before use, you should consult with a specialist.

The hemodialysis procedure allows prolonging the life of a patient with a disorder, being an alternative. At the same time, it is difficult to unambiguously answer the question of how long you can live on this procedure. However, you can consider a number of points regarding hemodialysis - indications and contraindications, possible side effects, the required diet. Then it will be possible to say about the duration and quality of life at least in the first approximation.

Dialysis (hemodialysis) of the kidneys - what is it

This procedure consists in purifying human blood from harmful waste products of the body and stabilizing the water and electrolyte balance by artificial means.

Dialysis is not able to heal the kidneys or slow down the inflammatory or regressive processes in the kidney tissues. Its goal is to maintain the performance of all body systems until the moment when this task can again be performed by the patient's excretory organs or until a transplant is performed.
Very often, in the presence of a number of indications and / or if transplantation is impossible, the procedure has to be performed for life.

Dialysis is a general concept, based on the method of conducting, there are hemodialysis and intestinal dialysis. However, the last two types are less effective and are used, as a rule, in the presence of contraindications to hemodialysis, or as a temporary measure.

It is not obvious, but the procedure requires psychological preparation. The question here is not so much how long they live on kidney dialysis, but how ready a person is for this procedure and possible restrictions in everyday life after it (diet, medication).

Indications for hemodialysis

Hemodialysis sessions, as a necessary life-sustaining measure, are prescribed for acute and chronic renal failure to cleanse the kidneys of endotoxins, but can also be recommended for the following pathological conditions:

  • poisoning with products containing alcohols;
  • the presence in the body of poisons of plant or chemical origin;
  • hyperhydration (fluid excess), not amenable to medical treatment and life-threatening (pulmonary or cerebral edema);
  • violation of water and electrolyte balance in the body;
  • state of overdose as a result of a violation of the regimen of medication.

It is worth noting that the attending physician can only recommend hemodialysis, the decision is made by the patient himself, who must be provided with comprehensive information about possible side effects.

How many live on such a procedure

Not so long ago, the diagnosis of "chronic renal failure" left no chance of survival. , appointed for life, allows you to support the body of such patients. For how long? But here everything is not so simple.

Each patient asks the question, how long do they live on hemodialysis according to modern statistics? The most frequently cited time frame is 15 years. The psychological attitude of the patient is very important here - you need to show a little will, without this the process of adaptation to the procedure may be delayed, someone may need the help of loved ones - and this is also not forbidden.

Also, one should not forget that quite recently we could only talk about 3 or 7 years of life, however, the equipment is being improved, the procedure itself is becoming more streamlined, and during the life on hemodialysis, the patient may have the opportunity to undergo transplantation - after it, the need on dialysis it just disappears.

Do not forget that medicine does not stand still and can provide patients with drugs that compensate for some "weakness" of the body after the dialysis procedure.

So there is no need to despair and remember that earlier (and now even more so) there were cases when people lived on this procedure for decades.

Complications of dialysis affecting life

The human body is not always able to adequately respond to this not quite natural procedure. It is important to distinguish between unwanted symptoms associated with adaptation to dialysis and systemic problems.

The first is a temporary phenomenon, they may require only symptomatic correction, and, as a rule, fade away as you get used to the procedure.

More serious side effects of sessions include:

  • pressure surges and heart rhythm disturbances;
  • anemia;
  • epileptic seizures;
  • diseases associated with the spread of microbial flora in the body - sepsis, endocarditis, osteomyelitis;
  • large-scale disturbance of water and electrolyte balance.

In these cases, the following measures will help:

  • constant monitoring and correction of a number of indicators;
  • adequate drug therapy;
  • dieting and.

Also, the cause of complications can be sessions in the presence of contraindications:

  • mental disorders or predisposition to them;
  • tuberculosis;
  • oncological diseases accompanied by metastases;
  • arterial hypertension and pre-stroke condition;
  • a number of blood diseases (anemia with a violation of the formation of red blood cells, cancer, clotting abnormalities);
  • diabetes.

At the same time, if the probability of death is high, the procedure can be performed even if there are contraindications.

Unfortunately, the intervention of human and technical factors in the procedure cannot be ruled out. As a result, the following undesirable phenomena may occur:

  • equipment malfunctions;
  • incorrectly selected composition of dialysate;
  • the entry of air particles into the bloodstream;
  • obstruction of the hardware catheter;
  • infection in the blood during dialysis or preparation for it.

At the same time, subject to the rules for operating the equipment and the proper level of qualification of the personnel, the probability of such cases is very small.

Factors that help prolong life

Undoubtedly, the severity of the underlying disease and the general condition of the body play an important role. But the following points can affect the duration of life:

  1. In order to start applying this technique, you should not wait for the full. If there are indications with the procedures, it is better not to delay.
  2. You should adhere to the regimen of sessions prescribed by the doctor.
  3. You need to be careful about the choice of medicines used, and, if possible, the clinic in which the sessions are held.
  4. Do not be silent about eating disorders or emerging ailments - this information may be important for correcting the regimen of procedures.
  5. You will need to make changes to your daily diet - food should be rich in proteins and contain a limited amount of salt, some spices and water. It is advisable to avoid canned food, smoked meats and foods rich in potassium. Diet is a necessary condition, especially relevant for lifelong dialysis.

It is important to know! Under such a condition as lifelong renal hemodialysis, the role of diet is so great that life expectancy can directly depend on it.

Simply put, you need to understand that hemodialysis, while cleansing the body and working “instead of the kidneys”, is still not a natural process. Therefore, it is important to monitor your health in general and listen to your doctor in all matters relating to maintenance therapy. Then there is the opportunity to live a full life for several decades.

In medicine, hemodialysis is the process of extracorporeal (outside the body) purification of blood from toxic metabolic products, as well as excess volumes of water in the blood plasma. Similar tasks in the body are performed by the kidneys, however, in some cases, for example, in various forms of renal failure, hemodialysis is vital.

Indications for hemodialysis

Indications for hemodialysis can be any processes, the result of which was the saturation of the blood with toxic products of its own metabolism or substances that entered the blood from the outside.

In what situations is hemodialysis used most often?

  • In acute or chronic renal failure, when the kidneys do not cope with their tasks of cleaning the blood and removing excess water from the body. The most common autotoxic breakdown product is urea. accumulated in blood plasma as a result of the breakdown of complex proteins, and creatinine- a residual product of energy metabolism in muscle tissue.
  • In case of drug poisoning, mainly from the groups of barbiturates, salicylates, tranquilizers, antipsychotics, as well as containing salts of bromine, iodine and sulfanilamide drugs.
  • In case of poisoning with large doses of ethyl alcohol when the fastest blood purification is vital even with healthy kidneys.
  • With methylate poisoning- a frequent occurrence among patients with chronic alcoholism, drinking by chance or ignorance of a certain amount of methyl alcohol.
  • Some pathologies, the pathogenesis of which leads to excessive accumulation of toxic products in tissues and blood plasma. The classic example of such a disease is long-term compression syndrome in which hemodialysis is carried out regularly due to acute renal failure.
  • In diseases whose symptoms include active accumulation of fluid in vital cavities and organs. This is pulmonary edema, cerebral edema, acute heart failure, leading to the accumulation of large volumes of water in the pleural cavity.

It is not a method that is necessary for the pathogenesis of any complexity of the above reasons. His use only in the presence of such strict indications:

  • amount of urine secreted during the day in a physiological way, less than 500 ml;
  • kidney functionality remains at the level no more than 15%, which is equal to cleaning 200 ml of blood per minute;
  • urea concentration in blood plasma more than 35 mmol/l;
  • concentration creatinine - more than 1 mmol / l;
  • hyperkalemia - more than 6 mmol / l;
  • concentration blood bicarbonates below 20 mmol/l;
  • bright symptoms edema of the brain, pericardium, lungs, not amenable to the methods of conservative therapy;
  • Clinical signs acute poisoning large volumes ethyl alcohol;
  • use any quantity methyl alcohol in history.

Contraindications for hemodialysis

As already mentioned, hemodialysis is a procedure that should be used only when necessary.

However, there are some contraindications that limit or completely exclude hemodialysis, regardless of the strict indications.

  • Acute or chronic infectious diseases, including focal.
    In the process of hemodialysis, blood pressure rises and the blood flow speed increases, which can contribute to the spread of microorganisms through the bloodstream and cause a general infection of the blood - sepsis or inflammation in the area of ​​​​the inner lining of the heart cavities, that is endocarditis. The lungs can also be a prime target for colonization by pathogenic microflora.
  • Psychopathological disorders and diseases of the schizo-like, epileptic and psychotic series.
    The hemodialysis procedure causes a slight cerebral edema in the patient, which is almost always provokes an epileptic seizure or the manifestation of acute symptoms of schizophrenia. In addition, twilight states and the absence of any intellectual activity make the hemodialysis procedure impossible.
  • At .
    In any phase of the pathological condition, hemodialysis is completely excluded due to the same cerebral edema.
  • Any form of tuberculosis.
    It interferes with hemodialysis active spread of Koch's bacillus throughout the body and possible infection of other patients.
  • Malignant oncological pathologies.
    Increased blood flow can contribute to the spread of metastases throughout the body.
  • Arterial hypertension.
    If it is characterized by an increase in indicators up to 300 ml of mercury in systole and 160 mm in diastole. During hemodialysis, as is known, blood pressure rises, and this process is practically uncontrollable by drugs. If the procedure coincides with an attack of hypertension, the risk of heart attack or stroke due to rupture of blood vessels.
  • Age over 70 years.
    There are many objective contraindications for hemodialysis - age-related organic disorders in the heart muscle and walls of blood vessels diabetes as a risk factor for vascular weakness, reduced immunity, contributing to infection.
  • Some pathologies of the blood.
    This, for example, decreased clotting, blood cancer, aplastic anemia. In the process of hemodialysis, in any case, blood cells, in particular erythrocytes, are damaged, which further enhances anemia, which is the main symptom of the above diseases.

It is worth noting that, regardless of any contraindications, if there is a serious danger to the patient's life, hemodialysis is carried out in any case. After all, there is a chance for salvation.

What is the hemodialysis procedure and equipment used

The hemodialysis procedure is based on the physical phenomena of diffusion and convection - the ability of the membrane to pass some chemicals and retain others. To remove excess water, a so-called ultrafiltration process is used.

Artificial membrane installed in a hemodialyzer with selectivity to chemicals, replaceable structure — depending on the need to filter certain structures, install the appropriate membrane. The main physical criterion of a membrane is the diameter of pores and their number located on its area, porosity. In this way, the quality of the filtration is regulated.

On one side of the membrane, the patient's blood is passed, on the other side there is a dialysis solution that has the ability to "attract" certain chemicals. The composition of the dialysis solution also depends on the indications for a particular pathological condition.

In addition to the function of purifying the blood, a hemodialyzer or “artificial kidney” has the ability to saturate the blood with various chemicals, so this opportunity is often used during hemodialysis. For example, in order to restore the electrolyte composition of blood plasma. A prerequisite for hemodialysis is additional blood purification from infectious agents.

Ultrafiltration is provided by increasing the pressure of the blood mass on the membrane intended for this purpose, and dialysis solution contains hydrophilic elements that attract water. Thus, the concentration of water in the plasma decreases.

Always taken for hemodialysis only venous blood, as the most saturated with decay products. Blood from a venous catheter circulates through a hemodialyzer and returns to the body upstream through a vein or through an artery.

Depending on the indications and the severity of pathological processes, hemodialysis can be performed under different conditions.

  • at home, using a portable hemodialyzer. It is more often carried out in cases of acute renal failure, when the filtering ability of the kidneys is reduced.
  • In an outpatient setting on fixed equipment often in acute renal failure or in the terminal stage of chronic.
  • In stationary conditions in especially severe cases of renal failure or acute poisoning.

Given the weak capabilities of portable devices, hemodialysis at home is more often prescribed daily, for 2-4 hours. Stationary equipment is characterized by the best quality of filtration, so the process is carried out 2-3 times a week. The quality of hemodialysis is determined by the amount of urea in the blood, as well as by the general clinical condition of the patient.

Complications during hemodialysis and quality of life of patients

One of the most common reasons for the use of hemodialysis is an increased content of water in the blood plasma when ultrafiltration is indicated. Side effects caused by a sharp decrease in the liquid part of the blood - plasma loss, often manifest themselves in different ways.

  • Active lowering of blood pressure.
  • Manifestation of fatigue.
  • Drowsiness.
  • The appearance of pain in the legs.
  • Skeletal muscle spasms, usually in the lower extremities
  • Nausea.
  • Excruciating headaches.

The severity of these symptoms is highly dependent on the volume and speed of fluid being removed.

With the massive use of hemodialyzers, infection with infectious diseases, in particular tuberculosis and hepatitis B, is possible.

Increased blood flow during hemodialysis can provoke the spread of pathogenic microflora throughout the body, which can lead to:

  • sepsis;
  • endocarditis;
  • osteomyelitis.

The first use of a hemodialyzer can provoke allergic reactions in a patient, due to the ingress of allergens into the blood from the surface of the membrane, which is due to its chemical structure and the use of aseptic measures for its purification. However, in order to reduce allergic manifestations, modern nephrology uses gamma irradiation to sterilize membranes.

Long term complications with frequent use of hemodialyzers may be:

  • liver amyloidosis;
  • neuropathy of various trunks;
  • The latter are caused by an increase in the left side of the heart due to increased blood pressure and blood flow during hemodialysis.

The main functions of the kidneys: cleansing the blood of harmful substances, regulating the volume of biological fluids, producing enzymes and hormones. If their work is severely disrupted, a person is prescribed hemodialysis. What it is, how it is carried out and what contraindications it has - the attending physician will explain in detail, since there are different dialyzers and each has its own recommendations and application features.

Importance of hemodialysis

In some diseases, the kidneys cannot cope with the cleansing of the blood and the release of waste substances from the body. In such a situation, hemodialysis is needed. This name, translated from Greek, means the division of blood into components (haemo [blood] + dialysis [decomposition]).

Hemodialysis is carried out with an "artificial kidney" device and allows you to increase life expectancy in diseases accompanied by severe impairment of the kidneys.

With the help of hemodialysis, they also restore the acid-base and electrolyte balance, normalize blood pressure.

Using the device, the following unwanted components are separated from the blood:

  • metabolic end products (urea, creatinine);
  • electrolytes contained in excess of the norm (calcium, sodium, potassium);
  • excess liquid;
  • alcohol;
  • medicines;
  • drugs;
  • other toxic substances.

There are medical programs under which the procedure in the dialysis center is carried out at the expense of the state. But they do not apply to commercial blades. In these medical institutions, one procedure without medication and dialysate costs from 1,700 rubles.

Fundamentals of hemodialysis:

  • sterilization of the device and all its complementary parts;
  • detoxification of the body through blood dialysis;
  • removal of excess fluid by ultrafiltration;
  • control of blood composition, the rate of separation of substances, the level of pressure, the capacity of the equipment, the permeability of membranes and other indicators.

Clinical statistics in medicine have made it possible to establish that 50 people for every million patients of urology and nephrology need a procedure for kidney diseases every year. In fact, hemodialysis allows a person to live from 4 to 40 years, depending on the severity of comorbidities and age. This gives him a chance to wait for an organ transplant.

Who needs hemodialysis

Renal replacement therapy is prescribed only if there are vital indications for the procedures. In other cases, other methods of detoxification are used.

Indications for hemodialysis:

  • oligoanuria (less than 500 ml of urine is excreted per day);
  • drug poisoning;
  • renal failure of chronic or acute form;
  • blockage of the ureters;
  • poisoning with harmful substances (arsenic, strontium, others);
  • hyperhydration (excess water, in which the internal organs and the brain swell);
  • water-electrolyte imbalance;
  • mushroom poisoning (pale toadstool and other poisonous species);
  • overdose of narcotic substances (heroin, morphine, other opium derivatives);
  • alcohol poisoning, ethylene glycol, methyl alcohol;
  • critical blood parameters (plasma levels of urea, creatinine, bicarbonate and potassium do not meet the standards).

With pathologies and metabolic disorders, people undergo hemodialysis for as long as they live, until they transplant a kidney. To remove toxic, narcotic or medicinal substances from the body, it is often necessary to carry out at least 3 procedures.

Who is hemodialysis contraindicated for?

Extrarenal cleansing can not be carried out with infectious diseases. A temporary refusal of the procedure is needed to prevent complications in which bacteria are spread by hematogenous route (sepsis, bacteremia).

Other contraindications for hemodialysis:


In emergency cases, extrarenal cleansing is carried out, despite indirect contraindications, in order to save a person's life.

Varieties of hemodialysis

There is a program, urgent and chronic blood detoxification. Program hemodialysis is a planned procedure for a long period. This method is often prescribed to prepare the patient for organ transplantation. About the cost of the operation in Russia, you can

Urgent blood detoxification is used for poisoning and other emergency situations.

Chronic hemodialysis is prescribed when there is a need for systematic non-renal cleansing throughout life, until an organ is transplanted. Other differences lie in the functionality of the equipment used and the location of the procedure.

Types of hemodialysis:

  • stationary (in intensive care units);
  • home;
  • outpatient (in dialysis centers).

Companies produce dialyzers of several types and they are equipped with disc or capillary filters. In this regard, hemodialysis is traditional, highly effective, high- and low-flow. The differences come down to the capacity of the apparatus, the speed of blood flow and the type of membranes.

Features of hemodialysis

During chronic and program cleansing in a medical institution, an artery is first connected to a vein in order to subsequently less traumatize the bloodstream. Doctors form an AVF () or insert a special tube - a stent. After healing (after 5–14 days), blood purification begins. In emergency cases, this is not done, and the session is carried out immediately through catheters.

How is the hemodialysis procedure performed?

  1. They measure the patient's pressure, pulse, heart rate, body temperature, ask about the presence of symptoms of complications and other complaints.
  2. The device is connected to the bloodstream through a fistula, stent or catheter.
  3. The specialist monitors the processes of blood purification and the indicators of the sensors, checks the patient's condition. If necessary, the doctor provides emergency assistance.
  4. After the procedure is completed, a sterile dressing is applied to the access site.

It is not uncommon for people to buy portable dialyzers, learn how to use them, and do hemodialysis at home. In these cases, the blood is cleaned once a day, but at first the procedure is carried out under the supervision of a nurse. Regular monitoring of potassium and urea is also required.

At home, apply and. First, doctors make a hole in the patient's abdominal wall. After tissue healing, a catheter is inserted through it. With the help of this tube, a person pours dialysate into the abdominal cavity, closes the valve, and after 5-6 hours the liquid is drained. In peritoneal dialysis, people performing the procedure must ensure that their hands and materials are sterile so as not to bring infection into the body.

Possible Complications

Hardware blood purification does not always 100% compensate for lost kidney function, and the procedure itself has side effects. During hemodialysis, people most often experience heart pain, their rhythm of myocardial contractions is disturbed, vomiting, convulsions begin, confusion and allergy to drugs are possible. Therefore, during the procedure, there are always medicines for emergency care next to the patient, so that, if necessary, the doctor can stabilize his condition in a timely manner.

Complications of hemodialysis:

  • anemia;
  • arterial hypertension;
  • peripheral neuropathy;
  • bone pathologies;
  • hyperkalemia;
  • pericarditis.

To avoid their development, carry out prevention. Be sure to follow a diet, drinking regimen, take antihypertensive pills and vitamins in a timely manner, undergo an examination, and also inform the doctor about the deterioration of health.

How often does a person need hemodialysis

In case of poisoning of all types and acute renal failure, hardware blood purification is carried out at intervals of up to 3 procedures per day. In these cases, the duration of each session does not exceed 6 hours. Sometimes 1 procedure is prescribed lasting 14-16 hours. Hemodialysis is carried out until the person's condition stabilizes.

Hemodialysis is shown both with and with hyperhydration. The procedure is carried out throughout life every 2-4 days or daily. In the case of water-electrolyte imbalance and other critical blood parameters, the frequency of sessions is changed - the duration and frequency of hemodialysis depends on the concentration of ions. Usually the procedure lasts up to 6 hours, and is carried out 2 ─ 3 times within 7 days.

How long do people live on hemodialysis

According to the average indications, blood purification increases life expectancy by 15 ─ 20 years. But hemodialysis of the kidneys should not be postponed for the next day, sessions should not be skipped, and it is also forbidden to break the diet, stop taking antihypertensive pills and other prescribed medications. Failure to comply with these rules often leads to sudden death.

How long patients live depends on the work of the kidneys. If a person has a kidney transplant, then he can live another 10 ─ 55 years, depending on the age at which the operation was performed.

diet for hemodialysis

Therapeutic nutrition is prescribed to prepare the patient for blood purification and speed up his recovery at the end of the session. A person on hemodialysis needs to control the amount of potassium-rich foods consumed. You also need to eat more animal protein. Smoking, drinking alcohol or drugs is strictly prohibited.

What types of foods must be included in the diet:

  • dietary meat (chicken, turkey, rabbit, beef);
  • vegetable and butter;
  • fresh vegetables, fruits and berries rich in B vitamins.

The energy value of food should be 35 kilocalories per kilogram of human weight. On average, you need to eat 100 g of fat, 400 g of carbohydrates, 2 g of potassium, 100 g of protein.

What types of products are restricted in use:

  • salt and salty foods;
  • hard cheese;
  • nuts;
  • chocolate;
  • legumes;
  • cocoa;
  • foods rich in phosphorus.

A person needs to observe the drinking regimen and drink up to 700 ml per day. But in each individual case, the doctor sets the rate of water consumed for the patient.

Medicines for hemodialysis

With regular extrarenal blood purification, medications are prescribed to help replenish useful substances, as well as maintain a person's condition between sessions and during the procedure.

What medications do people on hemodialysis take?

  • multivitamin complexes;
  • iron preparations (Ferrogradomet);
  • hormonal drugs (Epogen);
  • Carbonate;
  • Theozol;
  • antiallergic tablets;
  • antihypertensive drugs (Cozaar, Kapoten);
  • anticoagulants (Warfarin, Heparin);
  • laxative medications (Bisacodyl).

During intensive care, detoxification drugs, sedatives, diuretics and other medications are used.

Conclusion

Hemodialysis is prescribed for kidney diseases with a loss of their functions of at least 70%, unless there is a direct contraindication. If you feel unwell, or in cases of violation of the diet and treatment, you should inform your doctor. Then he selects dialyzers and filters or changes the methods of cleansing, which will help to avoid complications and reduce the side effects of the procedure. The effectiveness of hemodialysis depends not only on the qualifications of specialists, but also on the conscientious attitude of the patient to therapy.