– Doctor’s visit
– Collection of clinical or laboratory documentation from other hospitals or the patient
– Diagnostic examinations
– Diagnostic conclusions and therapy plan
– Programming access to the healthcare facility
– Implementation of the therapy plan
There are three main types of dialysis treatment:
The blood is extracted by a machine and pushed through the dialysis filter, which purifies the blood. The filter comprises two compartments separated by a membrane; the blood flows in one compartment, while the dialysis solution (an aqueous solution enriched with solutes that need to be released into the blood and deficient in those that need to be removed) flows in the other.
To connect the patient to the machine, it is necessary to have vascular access – a blood extraction point that can regularly provide the large volumes required for efficient dialysis. The most common vascular accesses are the arteriovenous fistula (a point of junction surgically created between a vein and an artery, typically at the forearm level) and the central venous catheter (a catheter positioned inside a large calibre venous vessel).
The session usually lasts about four hours and is performed three times a week. The duration of each session and the weekly frequency may vary to the doctor’s discretion, based on the patient’s clinical needs.
Haemodialysis and peritoneal dialysis can be performed at home, with different procedures and set-ups.
Home haemodialysis is mainly suitable for patients with no other severe pathologies. It is a complex therapy that requires proper training and the help and presence of an adequately prepared person (the ‘dialysis partner’) during the sessions. The dialysis partner is often a family member who acquires the necessary knowledge and skills during a few months of training at the dialysis Centre. It is also necessary to install a proper dialysis water preparation system at home.
Home peritoneal dialysis requires the presence of a dialysis partner only if the patient is unable to independently perform the dialysis procedures, which are simple but require a learning period. There are two types of peritoneal dialysis: automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). In CAPD, the presence of the partner is only necessary during the exchange procedure. In APD, it is usually necessary at the beginning and at the end of the session, while during the session it is enough for the partner to be nearby, in order to be able to take action in case of alarms generated by the equipment.
Unlike hemodialysis, with peritoneal dialysis, the blood is filtered inside the patient’s body through a peritoneal membrane covering the inner walls of the abdomen and the abdominal organs. The dialysis solution is introduced into the abdominal cavity and then removed through a small tube called peritoneal catheter. This treatment is done daily and can be performed at home.
Dialysis is a treatment that partially replaces kidney functions. The treatment eliminates from the body the excess liquids and dregs that the kidneys are no longer able to remove and enables the restoration of electrolyte and acid-base equilibrium.
However, dialysis cannot compensate for the lack of hormones produced by the kidneys; a pharmacological replacement therapy is therefore necessary.
Chronic kidney failure can be completely asymptomatic and is often detected accidentally through routine haematochemical tests.
Symptoms such as malaise, asthenia (fatigue), polyuria (increased urine volume during the day), nocturia (urination predominantly at night), pale skin, oedema (especially in the lower limbs, such as swollen feet and ankles), dyspnoea (difficulty breathing), pruritus, appetite reduction, nausea, vomiting, uremic breath (with urine smell), difficulty concentrating, sleep disorders and paraesthesia in the limbs (alteration of sensitivity, generally perceived as tingling) might only appear in the most advanced phases.
Chronic kidney failure can be diagnosed through simple laboratory tests such as urine analysis and evaluation of creatinemia and glomerular filtration.
It is important to rely on a nephrologist, who can look for the cause of kidney failure and possible complications through further laboratory and practical research.
The kidneys perform several functions:
maintaining the salt and water balance by regulating the plasma concentration of electrolytes (sodium, potassium, chlorine, calcium, magnesium and phosphates) and eliminating excess fluid through the urine
regulating the acid-base equilibrium (blood pH control) through the reabsorption of bicarbonates and the excretion of hydrogen ions
eliminating the terminal products of metabolism (urea, uric acid, creatinine etc.) and foreign substances (pharmaceutical drugs)
producing hormones, including erythropoietin, which stimulates the formation of red blood cells, and renin, which regulates blood pressure
regulating calcium metabolism, which is crucial for our bones, by activating vitamin D.
The kidneys are two bean-shaped organs located in the abdominal cavity, just below the diaphragm, one on each side of the spine.
Most people have two kidneys; however, it is possible to lead a normal life with only one kidney, which can compensate the functioning of the missing one.
When the kidneys are unable to perform their functions, excess fluid and dregs accumulate in the blood. This results in water and salt retention, which can lead to an onset of oedema (excess of fluid in the tissues) and higher blood pressure. The excess fluid can also accumulate in the respiratory system, resulting in acute pulmonary oedema (fluid in the lungs); this condition may, in some cases, lead to death.
Other possible complications from kidney failure include:
electrolyte alterations, in particular hyperkalaemia (high potassium concentration in the blood), which may cause an onset of cardiac arrhythmia
metabolic acidosis, characterised by low blood pH and bicarbonate deficiency
anaemia, due to a lower production of erythropoietin
alterations in calcium and phosphorus metabolism, resulting in increased parathyroid hormone, bone lesions and vascular calcifications.
Kidney failure can be:
acute: the kidney functions are compromised very quickly (it can be reversible)
chronic: the deterioration of kidney function is slow, progressive and irreversible.
The main causes of chronic kidney failure are hypertension and diabetes mellitus.
For this reason, patients with one or both conditions should closely follow the therapy indicated by their physician and have periodical blood and urine tests to assess their renal function.