THE three previous issues dealing with diabetes, kidney diseases and uremia have brought torrents of messages and calls, as voluminous as the amount of rains the habagat has poured mercilessly on Baguio and the Cordilleras, of varied nature mostly inquiry about what’s next when a person is diagnosed to have a longstanding kidney disease almost on the verge of renal failure, thus a lot centered on dialysis, what it really is, what is does, whether it’s really all worth having it and so forth and so on.
Admittedly, dialysis is a complex process and this column, limited in terms of time and space, may not be able to fully provide a complete information about the procedure. However, your columnist, with due respect to nephrologists and other kidney specialists, happily oblige our dear readers for fast facts, basic simple bits and pieces of dialysis.
Dialysis is the process of removing waste products and excess water from the body. Right at the outset, it must be stressed, emphasized and clarified that, dialysis is not only for those whose kidneys are about to fail or at their end-stage of the illness. There is such a thing as acute renal failure, meaning, a healthy normal individual is subjected to circumstances in which all of a sudden, and his/her kidneys fail.
Example is when a person goes into hypovolemic shock, where there is fast fall in blood pressure because of massive blood loss; there are also the so-called nephrotoxic drugs like the antibiotic aminoglycosides. Mind you, and this should not scare our readers, there is such a thing as analgesic-induced nephropathy by common pain-relievers like acetyl salicylic acid (aspirin) and the NSAIDs- non steroidal anti-inflammatory drugs, but these are rare occurrences, considered by doctors either as hypersensitivity reaction or some kind of drug idiosyncrasy.
Be that as it may, the above examples, acute in nature, are potentially and thankfully reversible, meaning one bout of dialysis, with aggressive management of the cause of the sudden kidney shutdown, with proper hydration and strict monitoring of electrolyte levels, particularly potassium and sodium, the kidneys return back to normal.
There are two methods of dialysis. Hemodialysis is a procedure in which the blood of the patient- containing excess amounts of potentially harmful substances- is removed from the body and is circulated to a machine called dialyzer. This procedure requires repeated access to the blood stream, thus an artificial connection between an artery and a vein called arteriovenous fistula (usually at the wrist area) is aseptically surgically made to facilitate the access.
Inside the dialyzer, a porous artificial membrane separates the blood from a fluid- the dialysate- that is similar in composition to normal body fluids. The pressure in the dialysate compartment is lower than the pressure in the blood of the patient, thus allowing toxic waste from the blood to filter into the dialysate. The dialyzed blood- now purified or we may say, cleansed- is returned to the person’ body.
In peritoneal dialysis, the peritoneum, a serous membrane that lines the abdomen and covers most abdominal organs, acts as a permeable filter.
Fluid is infused thru a catheter inserted through the abdominal wall into the peritoneal space. The fluid must remain inside the space for a while to allow waste materials from the blood to filter, pass through the many pores of the peritoneum. Then the fluid is drained out, discarded and replaced with fresh fluid. In this procedure, the word “exchange” means the number of fresh fluid that must be infused, based on the level of waste products in the person’s blood, mostly nitrogenous in nature like ammonia.
That said, your columnist hopes and prays that not one of us, our family and loved ones will undergo either of the two. Amen.