How many live on hemodialysis after kidney rejection?

Healthy kidneys are a blood filter. Its entire volume passes through the renal filter per day more than 1000 times. 1 liter of blood is cleared in 1 minute. For a short period of time, the kidneys - our natural filter, removes molecules of substances toxic to the body and excess water from the blood that enter the urinary tract and leave the body. The beneficial substances that circulate in the blood return to the bloodstream.

Unfortunately, for various reasons, the kidneys can be damaged and lose their functions, which leads to the delay 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 many people live on hemodialysis at present depends on the availability of proper equipment, professionalism of the medical staff, concomitant diseases, but to a greater extent on the person himself, his lifestyle and an adequate attitude to his health.

Artificial renal filter

In the mid-18th century, applying the laws of physics, a scientist from Scotland developed a blood purification system. He studied it in dogs devoid of kidneys. The device did not live up to expectations due to the development of many complications.

The first human hemodialysis procedure was performed by a German doctor in the early 19th century. 15 procedures were performed for different people who after that did not live long. This is due to the development of thromboembolism. They used hirudin leeches, a blood-thinning protein that was quickly neutralized by the patient’s immune system and blood clotted to form blood clots. A positive result of the method was achieved in 1927 using a heparin procedure, but the patient died anyway.

In the fall of 1945, the Dutch doctor improved the apparatus used in those days and successfully removed the patient from the uremic state, finally proving the effectiveness of hemodialysis. In 1946, the doctor published a manual for the treatment of patients with uremia with hemodialysis.

The mechanism of the magic filter

Hemodialysis is a blood purification system without involving the kidneys. Access to the vein and arteries is required to complete the procedure. Systems are introduced into these vessels and form shunts that attach 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 come out of the blood. Substances necessary for life enter the capillary from the dialysate and 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 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 in history there is evidence that there were patients who lived 40 years. The Russian book of records describes a woman who spent 30 years on dialysis.

The method of extracorporeal blood purification carries a lot of costs. Over one million rubles are spent per person per year. Currently, there is a state program, thanks to which the costs are paid by the state. Scientists themselves are trying to improve the devices themselves, so in the near future this procedure will become available to everyone suffering from renal failure. Consider what types of hemodialysis machines exist.

By functionality

1. Classic - a device 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.
2. Highly efficient. The area of ​​the semi-permeable membrane is 1.5 - 2.2 sq.m. It accelerates blood flow to 500 ml / min., Which reduces the duration of the procedure to 3 hours. In the opposite direction of the blood, the dialysate moves, the speed is up to 800 ml / min.
3. High flow. Allows you to cleanse the blood of anything, lets even large molecules pass.

By type of dialyzers

- Capillary. Closest to the physiology of a healthy kidney.

- Disc (plate).

Portable devices

There are portable blood purification devices. They are common in Western countries. These devices are used by more than half of patients with chronic renal failure. The equipment is expensive, estimated at 20 thousand dollars. Portable devices have their advantages:

- there is no queue;

- excluded the possibility of contracting blood contact infections (hepatitis, HIV);

- with them you can freely move during the procedure.

The disadvantage of such devices is that an unpredictable reaction may occur and emergency assistance will be required.

Peritoneal dialysis

Liquid (dialysate) is injected into the abdominal cavity through a puncture on the anterior abdominal wall. The volume is about 2 liters. One end of the tube is in the stomach, and the other closes. No dialyzer required. The membrane in this case is the peritoneum, toxic substances pass through it into the dialysate solution. Exposure of the fluid is 4-5 hours, after which the fluid is discharged through the catheter, and the clear solution is again poured in the same volume. There is a risk of inflammation of the peritoneum, which can lead to additional treatment methods, up to an emergency operation. When performing any type of hemodialysis, sterility rules must be observed. This procedure is contraindicated for overweight individuals (abdominal type of obesity) and people who have adhesive disease.

What are the reasons for hemodialysis?

This procedure was the only salvation for thousands of patients whose kidneys could not perform their functions.

Hemodialysis is prescribed to people who have the following health problems:

1. Acute and chronic renal failure (acute renal failure and chronic renal failure). It is characterized by low daily urine output, laboratory-confirmed decrease in glomerular filtration rate (SLE). How many live on kidney hemodialysis depends on the tolerance of the procedure and the patient's recommendations. Dialysis is performed to replace completely lost kidney function and excretion of nitrogenous toxins in chronic renal failure. In acute renal failure, hemodialysis is performed to remove toxic substances from the body that have caused acute renal failure and release excess fluid.

2. Diabetic nephropathy. It is a late vascular complication of diabetes. Renal filter capillaries are sclerosed due to constantly elevated glucose levels. The renal threshold for blood glucose is 10 mmol / L. When the sugar level is above this indicator, glucose begins to filter into the urine. The molecules are large and damage the delicate walls of the capillaries. How much you can live on hemodialysis with diabetes depends on the degree of compensation of the pathology, the level of glycated hemoglobin, the presence of other severe types of complications. For diabetics older than 70 years, hemodialysis is contraindicated.

3. Alcohol poisoning (methyl or ethyl). The metabolites of some alcohols cause the formation of crystals that damage the kidney tissue and cause acute renal failure. How many live on hemodialysis after poisoning depends on the degree of damage to the kidney tissue. There is a chance of restoration of kidney function, and the hemodialysis procedure will no longer be needed.

4. Toxic effects of drugs and poisoning by poisons. There is a direct damaging effect on the kidneys. Hemodialysis is performed to remove the poison and drug metabolites from the body. If the body is able to cope, then hemodialysis is performed before the restoration of renal function. How many live on kidney hemodialysis in this situation depends on the type and amount of the damaging agent.

5. The state of hyperhydration, when the body contains a large amount of water ("water poisoning") and there is a risk of developing edema of the brain and lungs. The aim of the procedure will be to remove excess water, lower blood pressure and reduce edema.

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, in order to compensate or remove them. Carried out to restore electrolyte balance.

7. Kidney transplantation. Until the transplanted kidney starts, it is supported. How many live after kidney rejection on hemodialysis? As many as would live without a transplant. About 20 years.

Indications for the procedure

Certain indicators at which an "artificial kidney" is indicated:

1. Daily urine output of less than 500 ml. Normally - 1.5-2.0 liters.
2. Decreased glomerular filtration rate below 15 ml / min. The normal value is 80-120 ml / min.
3. Creatinine value is above 1 mmol / L.
4. Urea level - 35 mmol / L.
5. Potassium above 6 mmol / L.
6. Bicarbonate below 20 mmol / L is metabolic acidosis.
7. Increasing swelling of the brain, lungs, heart, non-standard therapy.

Contraindications to hemodialysis

1. 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. It is dangerous to develop sepsis.
2. Acute cerebrovascular accident. The procedure can increase blood pressure and exacerbate the situation.
3. Mental disorders and epilepsy. Hemodialysis is stress for the body. A slight change in blood pressure can cause a headache and an attack of mental disorder or convulsive syndrome. For high-quality therapy, it is necessary to calm the patient and fulfill the medical requirements of the dialysis center staff during the procedure.
4. The foci of tuberculosis in the body. This type of patient is a source of infection and cannot visit hemodialysis centers. Even if you create a specialized dialysis department, there is a risk of seeding the body with mycobacterium tuberculosis.
5. Malignant tumors. Dangerous spread of metastases.
6. 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 a violation of the heart rhythm, up to a stop of cardiac activity. In chronic heart disease, blood flows through the vascular bed at a slower rate and there are areas of thickening, and the dialysis procedure can provoke a blood clot and clogging of any artery.
7. Severe arterial hypertension. There is a risk of hypertensive crisis.
8. Age over 80 years. The reason is that the cardiovascular system of age-related patients undergoes involution. The veins and arteries become fragile, making access to the hemodialysate difficult. It is noted that people after 60 years of age live on hemodialysis, as much as their cardiovascular system allows.
9. Blood diseases. Administration of heparin can aggravate blood clotting disorders, and the hemodialysis procedure can destroy part of the red blood cells, which worsens the course of anemia.

Hemodialysis Complications

Local:

• Inflammation and purulent complications at the site of vascular access.
• Muscle pain and 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.
• Violation of blood pressure (decrease or increase).
• Air embolism.
• Sepsis. In case of non-compliance with aseptic rules against the background of weakened immunity in this category of patients.
• Iatrogenia - 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 processing systems is possible. It all depends on the work of medical personnel.

Who performs

The hemodialysis procedure in the hospital should only be performed by health workers. In recent years, the practice of performing hemodialysis at home has spread. For the patient, this is much more convenient, since he remains in the circle of relatives. At home, the procedure can be performed by anyone (not a health worker) who has undergone training. How much on average live on hemodialysis, in this case depends on how well the person performing the procedure respects sterility. If he does not wash his hands thoroughly enough (this must first be done with soap, after disinfecting, for example, Betadine), he will not observe sterility when applying a bandage at the injection site of the fistula into the patient’s body, an infection that has entered the patient’s body can kill him in a matter of months. If everything is done correctly, the patient will live as long as the person who does not have kidney problems.

Diet for hemodialysis

How much you can live on hemodialysis, to a large extent depends on how the patient monitors his health. He should not drink, smoke, eat smoked meats, pickles, marinades, flour sweets, fried. The menu of such a person should consist of fresh, high-quality products containing vitamins and proteins (chicken, rabbit, low-fat beef, boiled eggs). Limit yourself to products such as milk, beans, nuts, cheese.