Dialysis
"New dialysis techniques are being developed to serve as a support treatment for certain diseases while waiting for the efficacy of the definitive treatment".
DR. NURIA GARCÍA FERNÁNDEZ PERSON IN CHARGE. HEMODIALYSIS UNIT
What is dialysis for?
The main function of dialysis will be to "clean" the blood of the toxins generated, excess water and electrolytes, such as sodium and potassium, which are produced by a defect in their elimination by the kidney.
In the Clinica Universidad de Navarra we have a Dialysis Unit composed of a team of multidisciplinary professionals specialized in this treatment: nephrologists, nurses, nutritionists, etc.
Upon your arrival for each session, a nurse and a nursing assistant will receive you and be responsible for your care. In addition, the Unit's nephrologist will be at your disposal for anything you need.
In recent years, important advances have been made in dialysis techniques that allow it to be an aid in the treatment of certain diseases such as heart failure, liver failure, multiple myeloma, etc.
During hemodialysis, the patient will be sitting in a reclining chair. During this time, besides being able to sleep, listen to the radio, read or talk, he or she can connect to the internet via wifi or watch television. You will also have breakfast, lunch or an afternoon snack, depending on the time.
When is dialysis indicated?
The fundamental indication for dialysis is the treatment of chronic renal failure, which should always be integral, that is, with options for changing from one technique to another and the possibility of renal transplant in case there is no contraindication.
The diseases that lead to renal failure are multiple, but the main ones are: glomerulonephritis, pyelonephritis, interstitial nephritis, vascular nephropathies and diabetic nephropathy. Dialysis is also indicated in acute renal failure and in some intoxications.
Most frequent indications for this treatment:
Do you have any of these diseases?
It may be necessary to start dialysis
Special indications
In recent years important advances have been developed in dialysis techniques that allow it to be an aid in the treatment of other diseases.
90% of hospital admissions in patients with heart failure are due to fluid overload that further destabilizes the heart, sometimes compromising other organs such as the lung and kidney, and increasing the risk of mortality.
The pharmacological treatment indicated in these cases may not be sufficient, especially when they do not respond well to diuretic treatment.
In these cases, we have what is known as ultrafiltration, a treatment which, through a venous access, allows the blood to be extracted and a volume of water to be removed from it through an external filter.
This technique offers a series of advantages with respect to pharmacological treatment: controlled and adjustable volume and speed of liquid extraction, it does not have an effective negative effect on the levels of electrolytes in the blood, it has been shown to improve that of heart failure and to achieve more or less prolonged hemodynamic stability in the majority of these patients.
Indications:
- Heart failure with demonstrated resistance to diuretics.
- Acute heart failure with oligoanuric renal dysfunction (reduced urine volume).
- Bridge treatment to heart transplantation.
Liver failure and/or cholestatic itch are two processes that in certain situations become severe or refractory to usual medical treatment.
Liver failure can be acute, due to viruses, drugs or toxins that cause acute damage to the liver, or as a result of acute chronic liver failure in a patient with known liver disease.
When the liver loses its functions, due to failure or major resection in case of tumors, a large amount of toxic substances such as bile acids, conjugated bilirubin, amino acids, etc., accumulate in the body, which can cause a severe generalized toxicity picture compromising life.
In these situations and while waiting for the definitive treatment such as liver transplantation or the regeneration of the residual tissue at resection, we have a liver dialysis system called MARS. Both studies on MARS and the results of our experience show how this system provides clinical stability, with usual hemodynamic and neurological improvement and, as a consequence, it can prolong the survival time while waiting for liver transplantation or tissue regeneration.
Regarding the indications of cholestatic refractory pruritus, they are usually minor, and the aim is to reduce it after several consecutive sessions for a more or less long time. It is postulated that substances responsible for the patient's pruritus are eliminated.
Indications:
- Acute decompensation of chronic liver failure.
- Acute hepatic dysfunction caused by viruses, toxins, drugs, etc.
- Initial hepatic dysfunction of liver transplantation from treatable cause such as hepatotoxicity, etc.
- Liver dysfunction after liver resection surgery.
- Pruritus (itching) that does not respond to treatment in chronic cholestatic syndromes such as primary biliary cirrhosis, sclerosing cholangitis, etc.
Although sufficient data have long been available to state that the use of MARS can stabilize the liver function of patients with acute liver failure or acute chronic liver disease, its final impact on the mortality of these patients is not yet clear.
Multiple myeloma is a tumorous disease of the bone marrow that consists of an atypical proliferation of plasma cells.
Plasma cells come from B lymphocytes and under normal conditions are responsible for the production of immunoglobulins, blood proteins with an important defense function against infection.
These atypical cells produce and secrete an abnormal immunoglobulin into the blood which produces an excess of light chains that the kidney is unable to eliminate effectively and which can cause irreversible damage to kidney function.
The simultaneous application of a chemotherapy treatment to reduce the plasma cells that produce these light chains and another treatment that allows the effective elimination of these very high chains in the blood and toxic to the kidney, increases the possibilities of a better recovery of the renal function.
Renal involvement in multiple myeloma is one of the most frequent complications (50% of cases). Renal failure is the main cause of morbidity and mortality in myeloma patients. Clinical research indicates that reducing the period of exposure of the kidney to light chains to toxic levels reduces the risk of developing permanent kidney failure.
Indication:
- Patients diagnosed with multiple myeloma with excess free light chains and associated renal failure, attributable to that cause, who have been scheduled for chemotherapy treatment for myeloma.
The Nephrology Service, in close collaboration with the Haematology Service, carries out this type of haemodialysis as a coadjuvant treatment in chemotherapy in those patients with multiple myeloma who meet the inclusion criteria.
Radioactive iodine is administered as a complementary treatment to surgery for differentiated thyroid carcinoma.
This iodine is mainly eliminated through the urine so, in those patients with renal failure, hemodialysis is strictly necessary to decrease the radiation to the rest of their body.
Otherwise, the treatment with radioactive iodine could not be carried out since the risk of diminishing blood cells (myelosuppression) and irradiation of other organs such as salivary glands, digestive system, etc., would be very high.
The hemodialysis procedure is carried out in a special isolation room that the patients occupy during the treatment with radioactive iodine. It is performed by means of a conventional hemodialysis monitor reserved for these treatments and with a standard and equivalent guideline to that performed in your usual center.
Before and after each session, radiopharmaceutical levels are taken to determine the duration and number of sessions required. Under all the radioactive protection measures, the nurse connects you to the dialysis and to the monitor for taking constants and then monitors the dialysis from outside the room through a video-camera system.
Every time you see abnormal indicators on the dialysis or constants monitor, you will enter with the protective measures and solve the problem.
How is dialysis performed?
Hemodialysis
When the semi-permeable membrane is artificial. These can be of cellulosic or synthetic nature and by their structure they can be of capillary fiber or flat membrane. They vary by their permeability, surface, thickness, electrical charge and adsorption capacity.
What is required and how is hemodialysis performed?
It is required a permanent access way to the intravascular torrent (preferably an internal arteriovenous fistula, possible a cannula, etc.), an artificial kidney (it consists of a blood extraction pump, a monitor and the dialyzer where the semipermeable membrane is located and where the exchange between the liquid or dialysis bath and the blood takes place).
Usually, the dialysis session in chronic patients is carried out three days a week (Monday, Wednesday and Friday; or Tuesday, Thursday and Saturday), with a duration of 4 hours per session, in morning, afternoon or evening shifts. It can take place in the hospital, in an outpatient dialysis unit or even at the patient's own home.
What complications can occur in hemodialysis?
The main complications are insufficient blood flow (the ideal is over 300 cm./min.), dialyzer breakage with blood loss, hypotension, dizziness, headaches, nausea or vomiting, itching, cramps, etc.
Currently, with modern automatic machines and various variants of bicarbonate dialysis, complications are minimal and largely curable.
Peritoneal Dialysis
When the semi-permeable membrane is natural, as in the case of the patient's peritoneum (layer that covers the internal organs of the abdomen and has multiple capillaries and a large surface area).
What is required for peritoneal dialysis?
Peritoneal dialysis requires the placement of a multi-perforated soft catheter in the abdomen, through which dialysis solution (similar to the liquid part of the blood but without waste products) is infused, of about two liters with refills every 4-6 hours during the day and about 8 hours at night, every day of the year.
This method of dialysis is called continuous ambulatory peritoneal dialysis and is performed by the patient himself after a period of hospital training. It can also be done with a machine or cycler that carries out the refills in a programmed way at night, allowing the patient to be free during the whole day and this is called automated peritoneal dialysis.
What complications can occur in peritoneal dialysis?
The main ones are the loss of fluid through the catheter access tunnel, infection of the tunnel or catheter, catheter obstruction, peritonitis, abdominal hernias, loss of protein, etc. All of them are solved with treatment.
Choice of Dialysis Type
The patient can and should choose, with the help of the nephrologist who treats him/her, the method of dialysis (peritoneal dialysis or hemodialysis and its multiple variants) that best suits him/her due to his/her characteristics (age, work, family circumstances, distance to the dialysis unit, type of renal disease and other concomitant diseases, possibility or not of access to the intravascular torrent, previous abdominal operations, etc.).
The doctor must inform you about all the differences between the different dialysis modalities and the advantages and disadvantages in general and in the specific case of the patient.
Furthermore, as the treatment of chronic end-stage renal failure is integrated, it is always possible to switch from one type of dialysis to another in case of intolerance or unsolvable problems.
Where do we do it?
IN NAVARRA AND MADRID
The Nephrology Service
of the Clínica Universidad de Navarra
The Nephrology Service of the Clínica Universidad de Navarra has more than five decades of experience, both in the diagnosis and treatment of all kidney pathologies and in the transplant of this organ.
Our specialists have completed their training in centers of national and international reference.
We have the best facilities in the Dialysis Unit in order to offer the highest quality care to our patients.
Why at the Clinica?
- National reference in kidney transplantation, pioneer in living donor kidney transplantation.
- Specialized nursing for the care and follow-up of our patients.
- Cardiovascular and renal damage prevention program.
