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, a number of points regarding hemodialysis can be considered - indications and contraindications, possible side effects, desired power mode. 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 general concept, based on the method of conducting, distinguish between 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.
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 (excess fluid), not amenable to drug 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 also following points can affect life expectancy
- 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.
- You should adhere to the regimen of sessions prescribed by the doctor.
- You need to be careful about the choice of medicines used, and, if possible, the clinic in which the sessions are held.
- Do not be silent about eating disorders or emerging ailments - this information may be important for correcting the regimen of procedures.
- 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 - 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,” nevertheless natural process is not. 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.
Like other vascular diseases, it is often a complication of chronic renal failure. This study confirms the prevalence of ED in 80% of patients undergoing hemodialysis, a blood purification procedure using an "artificial kidney" machine. This device filters out toxins, urea from the blood, normalizes electrolyte balance and blood pressure, and eliminates excess fluid.
The authors of the study noticed the effect of hemodialysis on erectile function. Among patients undergoing hemodialysis, 79.1% experienced a change in erectile function. Kidney transplantation in the early stages of chronic renal failure exacerbated erectile dysfunction. A large number of factors play a role in this: chronic fatigue from hemodialysis, psychiatric and depressive diseases in patients, the influence of age and hemodialysis itself.
The scientists came to an important conclusion: nephrologists should pay attention to ED, especially in patients on hemodialysis. A proper treatment kidney disease without loss of diuresis can prevent erectile dysfunction.
This once again shows how closely the systems and organs in our body are connected. Serious kidney diseases, as well as methods of their therapy, can give complications to the reproductive system, lead to erectile dysfunction. "Eromax" gently and effectively solves this problem, because it contains only natural herbs (ginseng root, leuzea root, bitter gourd extract), as well as drone brood, which is a testosterone donator, zinc citrate, vitamin B6 and other amino acids and vitamins. "Eromax" increases sexual desire, increases testosterone levels, improves erectile function, improves quality of life and does not cause side effects from the urinary system, which is especially important for patients with renal insufficiency.
"Saudi Journal: Kidney Diseases and Transplant", 2016.
Saudi Journal of Kidney Diseases and Transplantation 2016; 27(1): 23-28.
© 2016, Saudi Organ Transplant Center
Erectile dysfunction in hemodialysis patients
Imen Gorsan, Nadia Amri, Fathi Yunsi, Imed Helal, Adel Kheder.
(Department of Medicine A (M8), Charles Nicolas Hospital; Faculty of Medicine
University of Tunis El-Manar, Tunis, Tunisia)
Summary
Erectile dysfunction (ED) is a common problem among patients on hemodialysis, but still remains a taboo topic in our country. The attention paid to this sexual problem remains insufficient, and the prevalence of ED among these patients has not been sufficiently studied. We conducted this study to determine the prevalence and severity of ED in hemodialysis patients. We performed a descriptive cross-sectional study in our hemodialysis unit in March 2013. ED was assessed using the International Index of Erectile Function. Thirty patients with an average age of 49.1 years were selected for this study. The main causes of chronic renal failure were hypertension (62.5%) and diabetes (41.6%). The prevalence of ED was 80%, including 33.3% of patients with severe ED. Plasma gonadotropins were as follows: luteinizing hormone (LH), follicle stimulating hormone (FSH) were at standard levels, except for one patient who had an elevated LH level. Four cases had elevated prolactin levels. 8.4% of patients had ED before the discovery of chronic renal failure, and with the start of hemodialysis - in 91.6%. In 19 patients (79.1%), ED developed during hemodialysis sessions. A significant number of our hemodialysis patients had ED of varying severity. Nephrologists should pay attention to the problem of ED in order to improve the quality of life of patients.
Introduction
Erectile dysfunction (ED) is a common complication of chronic renal failure. It is defined as a persistent inability to achieve and/or maintain an erection sufficient for satisfactory intercourse. There are either a decrease in the number of erections, a decrease in libido, or a decrease in the frequency of erections. Because the subject is still taboo, the attention given to sexual issues is still low; often these problems are considered secondary in our country. The prevalence of ED in patients on hemodialysis is not well documented in our country. ED should be taken into account in the general treatment of patients on hemodialysis, which significantly improves their quality of life.
Some epidemiological studies have shown that ED affects more than 80% of hemodialysis patients and is directly related to the severity of renal failure. The aim of this study was to describe the epidemiological profile of our hemodialysis patients with ED and to determine the prevalence and severity of ED in hemodialysis patients.
Patients and Methods
Patients
A descriptive cross-sectional study was conducted on 72 patients in the hemodialysis unit of the Department of Medicine, Charles Nicolas Hospital, El Manar University of Tunis, Tunis, Tunisia, during March 2013 using the International Index of Erectile Function (IIEF). Inclusion criteria for the study were chronic hemodialysis three times a week, male gender, and complete data on ED.
Patients on chronic dialysis who underwent hemodialysis only once or twice a week, patients on dialysis for acute renal failure, and female patients were excluded from the study.
Finally, based on these criteria, 30 patients were included in this study.
Methods
The following epidemiological and clinical data were collected by interview and from medical records for each patient: age, lifestyle, initial nephrotherapy, dialysis start date, and start of various medications. Routine blood tests were performed, including urea, creatinine, calcium, phosphorus, parathyroid hormone (PTH), albumin, C-reactive protein, and blood work. Blood samples were also collected for testosterone, FSH, LH and prolactin.
The prevalence of erectile dysfunction was assessed using the International Index of Erectile Function (IIEF) questionnaire. The IIEF is a five-part questionnaire, each consisting of five questions, numbered 1 to 5, to measure the quality of sex, sexual desire, and overall satisfaction with sex. The interpretation of the answers depends on the scores set: severe erectile dysfunction (5-10 points), moderate (11-15 points), mild (16-20 points), normal erectile function (21-25 points). Related sexual dysfunctions have also been investigated.
Statistical analysis
The analysis was carried out using the Statistical Package for the Social Sciences (SPSS) program. A chi-square (χ2) test was used to determine the association of ED with the cause of kidney failure and diabetes. Student's t-test was used to determine the association of ED with age, duration of renal replacement therapy, creatinine, Kt/v during hemodialysis, hemoglobin, PTH, and other parameters of the International Index of Erectile Function (IIEF). A P value of 0.05 or more was considered significant.
results
The study included 30 patients, average age which was 49.1 years (41 - 62 years). The prevalence of ED was 80% (24 out of 30 people). For patients older than 56 years, the prevalence of ED reached 33.3%, lower in the age groups 46-55 years and 25-45 years, each of which had seven patients (29.2%).
In most cases, mild ED was observed (37.5%). Severe ED was observed in 33.33% of patients, moderate - in 29.2% of patients.
Five patients of those who had severe ED had gynecomastia. In four cases, there was an elevated prolactin level in the range of 176-1087 mU/ml. The mean testosterone level was 12.66 mmol/l. Plasma gonadotropins (LH and FSH) were within normal limits, with the exception of one patient with an elevated LH level.
The most common condition was hypertension; 62.5% of patients suffered from it. In second place were diabetes (41.6%) and heart disease (33.3%). (Picture 1).
Picture 1. Distribution of patients with ED according to the presence of hypertension, diabetes and/or cardiovascular disease.
Vertical: number of patients
Horizontally:
Severe ED / Moderate ED / Mild ED
Hypertension
Cardiovascular diseases
Before the discovery of renal failure, ED was present in 8.4% of patients, and after the start of dialysis - in 91.6% of patients. In 19 patients, ED worsened during hemodialysis courses.
A decrease in hemoglobin (less than 10 g/dl) was observed in 40% of patients, and thrombocytopenia in 30% of patients. Hyperglycemia was found in 30% of patients. The mean serum cholesterol level was 3.98 ± 1.01 mmol/l; the average level of triglyceride is 1.29 ± 0.9 mmol/l; the average level of calcium in blood serum is 2.1 ± 0.4 mmol/l; the average level of phosphorus in the blood serum is 1.46 ± 0.5 mmol/l; mean PTH level – 848.07 ± 490 mmol/l; the average level of albumin is 29 ± 4.2 g/l.
ED was not significantly associated with duration of renal replacement therapy, hemoglobin, PTH, and cause of renal failure, with P values of 0.765, 0.441, and 0.674, respectively. Premature ejaculation was the main sexual disorder in 42% of patients. Decreased libido was the second most common sexual disorder found in 29% of patients. In third place were delayed ejaculation (in 17% of cases), anorgasmia (in 8% of cases), and no ejaculation (in 4% of cases).
Also, other autonomic neuropathies were found in these patients, such as orthostatic hypotension (in 30% of patients) and gastroparesis (in 6.66% of patients). Some additional etiological factors in terms of ED were found, such as tobacco use (42%), alcoholism (21%), use of beta-blockers (atenolol, 6.66%), and antidepressant treatment (paroxetine, 3.33%) .
Univariate analysis showed no association between older age and ED (P = 0.451), but there was a significant effect of age (over 45 years) and hemodialysis (Kt/v) on erectile function (EF). (Table 1).
Table 1. The relationship of age and Kt / v during hemodialysis with the value of erectile function (EF).
More than half of patients with ED (66.6%) hoped to take medications for this disorder, which affected the quality of their sexuality and therefore their quality of life. Five patients (20.8%) were indifferent to this, three patients (12.5%) refused treatment.
Ultimately, 20.8% of patients began to take medication. Two patients underwent an intracavernous injection of linsidomine, three others were self-administered sildenafil (Viagra), and one patient showed significant improvement. In addition, two patients reportedly resorted to traditional products.
Discussion
ED is a common complication of chronic renal failure, and some studies support the prevalence of ED among men with end-stage renal disease undergoing hemodialysis. The results of our study are consistent with most studies: 80% of male patients in the hemodialysis unit have ED. Other studies report even higher prevalence rates for ED in this group, up to 90%.
The origin of sexual dysfunction in hemodialysis is a complex and multifactorial phenomenon. The metabolic origin of ED is a malfunction of the hypothalamus-pituitary-adrenal axis, and this remains main reason development of these disorders. There are violations of spermatogenesis, changes in the level of gonadotropins, testosterone, prolactin and zinc in plasma. Other hypotheses have been proposed, such as secondary hyperparathyroidism, anemia, and other organic and psychological factors.
The prevalence of ED increases with age. However, this was not observed in our study due to the small number of subjects. Diabetes is the disease most predisposing to ED. Neuropathy, endocrinopathy, vasculopathy may explain the underlying etiology of diabetic ED. Alcoholism and tobacco abuse are risk factors that may exacerbate the effects of chronic renal failure and contribute to the development of endothelial dysfunction. This was noted in 21% and 42% of our patients, respectively. Some medications used by patients on hemodialysis, such as beta-blockers, antidepressants, and some anticonvulsants, are also responsible for ED.
Proper hemodialysis can help prevent ED. Our study examined the significant impact of hemodialysis on the value of erectile function (EF). Patients on hemodialysis without loss of diuresis maintained EF better. The relationship between residual kidney function and ED was not evaluated in our study.
Endothelial insufficiency associated with an underlying vascular pathology that explains the antecedent ED worsens with dialysis, as do other vascular pathologies. These results have been identified in other sources. In our study, 79.1% of patients reported a gradual change in ED with hemodialysis. The exact timing of the effect of hemodialysis on ED has not been determined. In these patients, a permanent increase in ED was found after a year of dialysis. This hypothesis is supported by the results of kidney transplantation on early stages chronic renal failure, which seemed to exacerbate ED.
Patients on hemodialysis suffer from chronic fatigue, which may play a role in ED, especially when dialysis is performed three times a week. Other studies conclude that this period of dialysis was not associated with the presence of ED.
Hemodialysis patients have a significant number of psychiatric and depressive illnesses, which also play a significant role in the development of ED. Psychological impact primary disease, loss of sexual interest, feeling of difficulty and physical lack of interest in this area were additional factors due to which this problem was not sufficiently disclosed or completely ignored.
Anemia may also contribute to the etiology of ED in men with end-stage renal disease, as it worsens an already poor general condition and causes asthenia in these patients. It has been noted in the literature that low level hemoglobin is also significantly associated with ED. Treatment of anemia with recombinant erythropoietin has been reported to improve sexual performance. Unfortunately, this treatment is not available in our center.
Disorders of the hypothalamic-pituitary-adrenal axis, which act as decreased free testosterone, elevated LH and FSH, and elevated prolactin, are well known in uraemic patients. However, androgen treatment has its own contradictions, as it allows you to restore libido, but has almost no effect on ED. Normalization of plasma testosterone concentration is associated with a sense of "well-being" that promotes sexual life. It has been shown that the correction of zinc deficiency in patients with renal insufficiency can lead to improved sexual life and erection. Biologically, this correction leads to an increase in testosterone levels and a decrease in LH, FSH and prolactin levels.
Treatment of ED with sildenafil or vardenafil has been shown to be beneficial in improving comorbid depression in hemodialysis patients. Sildenafil was well tolerated by patients undergoing hemodialysis. Phosphodiesterase-5 inhibitors and zinc represent a promising intervention in the treatment of ED. In order to provide comprehensive assistance to these patients, it is necessary to provide consultations of andrologists and nephrologists.
A significant number of our hemodialysis patients had ED of varying severity. The etiology of this ED in men with end-stage renal disease is multifactorial. We found a significant effect of age and hemodialysis itself. However, our study population was small as not all patients were on dialysis three times a week due to lack of resources. Only the passage of dialysis could explain the occurrence of ED. This is why we chose to include only patients who received dialysis three times a week in the study.
In addition, we did not conduct a comparative study with the control group, since the purpose of this work was only to describe our cohort of patients on dialysis. Our results may provide baseline data for further research in this area.
Nephrologists should pay attention to ED and include it in their routine evaluation of hemodialysis patients in order to improve their quality of life. Collaboration between nephrologists and andrologists will ensure that appropriate medical treatment is prescribed.
Hemodialysis is a method that allows you to purify the blood of waste products (toxins, toxins, urea, protein decay waste, your own spent cells), normalize the level of electrolytes, and remove excess water using the device. With organ dysfunction, it is the only way to survive until transplantation, to prevent intoxication of the body and death due to kidney failure. You can live on hemodialysis if you follow the recommendations of doctors.
Hemodialysis is prescribed to the patient, after diagnosis and when the condition is not corrected by diet, medications. The procedure involves filtering your own blood with an artificial kidney machine. It is used to cleanse the waste products of the body and remove excess fluid, which the body cannot naturally remove after kidney failure. Normally, the kidneys filter 1700 liters of blood per day, if one fails, the load on the second increases. When the second organ fails, the excretory system is blocked, the body tries to remove toxins skin and mucous membranes that cannot cope with the task, resulting in death due to intoxication of the body.
An unpleasant moment is attachment to the hemodialysis center.
The procedure must be carried out several times a week, the duration is several hours. Hemodialysis at home is possible thanks to portable devices (common in Europe and America). After preparatory courses on working with the device, it becomes possible to carry out the procedure at home.
Indications for the procedure:
- acute or chronic renal failure;
- acute intoxication of the body due to the use of surrogate alcohol, medicines, poisons;
- hyperhydration (excessive water content in the body, resulting in swelling of the lungs, brain);
- nephropathy in diabetes mellitus;
- when transplanting a donor kidney, before the organ takes root;
- disturbed electrolyte balance (burns, cystic fibrosis);
- pathological changes in the composition of blood plasma.
Contraindications:
- active tuberculosis.
- The likelihood of hemorrhage.
- CHF (chronic heart failure).
- Malignant hypertension (pheochromocytoma).
- Cirrhosis of the liver.
- Infectious diseases (will lead to sepsis, endocarditis)
- Leukemia, DVZ, hemophilia.
Relative contraindications are: cancer, pregnancy, mental disorders (schizophrenia, epilepsy), age over 75 years.
Rules and frequency of the procedure
The blood purification process looks like this: the patient is injected into a vein with two cannulas connected to a hemodialyzer. The first supplies the body with a medical solution - a dialyzer, the second supplies blood to the device. Both containers have different density, which leads to liquid filtration and volume reduction. The purified blood is returned to the patient.
The second method of hemodialysis is indicated for diabetics, it consists of the procedure of introducing a dialysis solution into the abdominal cavity, which is drained after a certain period. The solution is changed up to 5 times per day. The procedure is called peritoneal dialysis, requires some preparation, but can be carried out at home after training and acquiring tools: a tonometer, a heating pad for a solution, scales, and a dropper support. The advantages of this procedure: a person is not tied to the hospital, the possibility of organ transplantation remains, there is less likelihood of heart pathologies and immunity from viral infections, kidney functions are partially preserved, and there are indulgences in the diet. The type of hemodialysis is selected by the doctor on an individual basis.
Cons - the occurrence of side effects from the procedure. There is nausea, vomiting, drops in blood pressure, convulsions and dizziness. If hemodialysis is not suitable for the patient, the body will react in the first session. The procedure is carried out in medical conditions under the supervision of doctors. If in the 20th century every fourth patient died from hemodialysis, then in the 21st century death is an exception to the rule.
Side effects:
- the development of anemia due to a decrease in the number of red blood cells - erythrocytes;
- pericarditis - an inflammatory process in the heart muscle;
- dizziness;
- body weakness.
Side effects adversely affect the process of blood purification, reduce the years of the patient's life. With an organ transplant, side effects indicate an unsuccessful transplant of a donor kidney.
The frequency of the procedure depends on: the age of the patient, the state of health, the presence of other chronic and infectious diseases, weight, lifestyle, diet. At least once a week, the patient will have to visit the hemodialysis center, but still happens 2-3 times a week.
Life expectancy with kidney hemodialysis
In Russia, life expectancy on hemodialysis is listed in the Guinness Book of Records and is over 30 years. In the world, cases of life expectancy with an artificial kidney apparatus are over 40 years. But it is impossible to answer exactly how long people live on hemodialysis. With strict adherence to the doctor's instructions, diet, regular procedures, accurately prescribed drugs, the patient's chances of prolonging life are great.
People rarely die from kidney failure, the main cause of death is diseases and infections that attack the body, weakened subsequently by kidney disease.
When asked what kidney hemodialysis is, how long they live with it, doctors give a positive prognosis. On average, patients under the age of 14 have a chance of surviving to 40 years or more, and older patients with organ transplants average 55 years of age.
How to increase life expectancy
The process of hemodialysis in the second decade of the 21st century is different from its conduct in the second half of the 20th century. Comfortable chairs, regulating the position of the patient, allow them to take a nap, listen to pleasant music, watch an interesting movie. The procedure is comfortable, apart from the hours spent in the hospital, otherwise the patient lives a normal life. Medicine does not stand still, there are effective medicines and technology.
In general, in order to prolong life, it is worth adhering to the following restrictions and recommendations:
- avoid violations in the diet;
- follow the daily routine;
- visit the hemodialysis center regularly;
- take prescribed medications, follow the treatment schedule, undergo additional examinations on time;
- avoid contact with infectious patients.
In case of errors in nutrition, the patient must notify the attending physician about this for correction of therapy. The doctor forbids drinking more than 1 liter of water per day and prescribes diet number 7. Statistics say that in the absence of the possibility of a kidney transplant or the transplanted organ is rejected by the body, the patient will live as long as he visits the hemodialysis center.
How long do you live with kidney dialysis? This question is of interest to all patients who are faced with the pathology of the organ. Indeed, this procedure is vital, and if it is not carried out on time, then a fatal outcome is possible. Those who are prescribed hemodialysis are well aware that at a certain time they must come to the hospital without delay. The kidneys perform important role in the human body. They purify the blood of toxins, excess salts, organic compounds, remove fluid, provide the synthesis of substances that control blood pressure. We can safely say that the kidneys are a powerful filter through which 1700 liters of blood are cleansed per day.
brief information
The kidneys function in unison: they filter the same amount of fluid every day. If atrophy of one of them occurs, then the second copes with the necessary function alone. People with one kidney can live a lifetime, but the load on the organ increases significantly. Therefore, patients with one kidney are given necessary recommendations to maintain your health. It happens that both kidneys stop working due to serious pathologies. In such cases, salvation becomes.
People who have various diseases kidneys, it is necessary to avoid bad habits, abuse of salt, spicy and smoked dishes. Also, with some pathologies of the organ, therefore, patients require constant monitoring.
If a person is shown hemodialysis of the kidneys, then first of all it is necessary to carry out psychological work so that the patient is set up in the right way for the procedure and understands the importance of its implementation.
Description of the hemodialysis procedure
Hemodialysis began to practice almost 40 years ago. The procedure proved to be excellent, so over time it has been improved. This allows you to save and prolong the lives of young people. Dialysis is prescribed if the kidneys lose their filtering function. This purification method effectively filters the blood, releasing metabolic products from it and safely removing them from the body. Dialysis comes in two forms:
- hemodialysis;
- peritoneal.
Each method has its own advantages, contraindications and features of the implementation. To understand what hemodialysis is and the content of this procedure, it is necessary to recall the function of the kidneys. In fact, its purpose is to purify the blood through a device called an “artificial kidney”. Through an artery or vein, the blood enters special equipment in which there are filters. Thanks to these devices and a sterile solution, the blood is completely cleansed of toxins and poisons, after which it is returned to the patient's body.
With this procedure, a person is seated in a special chair and connected to the apparatus, after which the blood is filtered for several hours.
Hemodialysis is required to be carried out 2-3 times a week, taking into account the patient's age, height, weight, and the presence of background diseases. Sometimes limited to one procedure.
But most often it is carried out until a kidney transplant is performed.
During hemodialysis, nothing changes in the protein composition of the plasma. This filtering method is indicated for those patients whose arteries and veins are easily accessible. Thanks to the hemodialysis procedure, it is possible to achieve the following goals:
- get rid of uremic toxins and colloidal substances;
- stabilize the electrolyte composition;
- normalize blood pressure by removing fluid.
Many patients believe that they can avoid this procedure by following a strict diet, but by doing so they miss the opportunity to preserve partial kidney function. It is necessary to start the hemodialysis procedure as soon as doctors inform about its need. Refusal of medical care can lead to complete loss of the kidney. Timely conduct of hemodialysis will prolong life for a significant period.
How is peritoneal dialysis different?
Peritoneal dialysis is also aimed at filtering the blood, but the procedure itself differs in the way it is carried out. Cleansing is carried out using a special solution, which is injected for several hours into the abdominal cavity through a catheter. Almost 2 liters of dialysate is poured into the peritoneum, the membrane of which serves as a natural filter. Toxins, toxins, decay products enter the dialysis solution within 4-12 hours. After the “hold time”, all fluid from the peritoneum is drained along with the “waste”. The procedure is called drainage and takes about 30 minutes. And after that, the sterile solution is poured again, and the process is repeated.
Peritoneal dialysis involves the selection of a solution, taking into account the individual disease of a person. This procedure has clear advantages over hemodialysis.
Its advantage is that a person can not give up his usual way of life, as he has time for any business, leisure and hobby.
Partial kidney function is also preserved, the patient is less at risk of undergoing cardiovascular pathologies, and it is easier to tolerate viral infections. A strict diet is not required, and there is a high chance of a kidney transplant.
Peritoneal dialysis can be done in patients with diabetes. This procedure is carried out both at home, after appropriate training, and in the hospital. The number of solution changes is 3-5 times a day. To carry out dialysis in this way, you need to purchase a tonometer, scales, a table, a hook on which you need to fix the solution container. You will need to buy a heating pad for dialysate, an antiseptic in the form of hydrogen peroxide and a comfortable chair. The advantage is that a person is not tied to a dialysis center, but at the same time, the procedure at home has some disadvantages. However, patients can maintain a completely mobile lifestyle.
Doctors decide which one to choose, but the peritoneal method gives a person more freedom. In severe cases, only hemodialysis is indicated.
How long can you live on dialysis
Since this procedure is indicated for serious diseases, which in themselves already pose a danger to human existence, the question naturally arises of how many years they live with kidney dialysis. No doctor can accurately answer this question.
Much depends on the stage of the disease, the age of the patient, general condition health and other pathologies.
A lot also depends on the behavior of the patient himself, on his attitude and desire to follow all the recommendations of doctors. Dialysis is indicated for the following ailments:
- acute or;
- diabetes mellitus;
- acute poisoning with toxins;
- electrolyte imbalance;
- drug overdose;
- overhydration (when standard treatment is ineffective).
These conditions themselves are complex and can be fatal, so dialysis should not be delayed. And life expectancy directly depends on whether the patient will adhere to a diet, carry out the procedure regularly, and whether he will behave correctly after hemodialysis. In the last century, some people lived for more than 25 years. For half a century, medicine has stepped forward, but for most people this method may not be available due to the high cost of the procedure. Previously, those on hemodialysis died more often due to the fact that the body "without kidneys" was greatly weakened.
Even a common cold could lead to death, but more often patients had intestinal problems or pneumonia. Now doctors provide patients with everything necessary to prolong life. The case of a woman who had been on hemodialysis for more than 30 years is listed in Russian book Guinness records.
Although exact statistics are not available, average duration The life expectancy of people on dialysis is 14–20 years.
If a transplant is performed after dialysis, a person can live for about 55 years. How long a patient lives with kidney dialysis also depends on the quality of the drugs that have to be taken.
It is no secret that medicines can be counterfeit and of poor quality, equipment can be cheap, and a specialist can be unskilled. All this can lead to a reduction in life expectancy due to complications or errors of the medical staff. Therefore, it is worth choosing a dialysis center with good reviews and reputation.
How to prolong life after dialysis
To reduce the burden on the body, doctors usually prescribe a strict diet to patients. Protein foods are introduced into the diet and those in which there is a lot of potassium and phosphorus are excluded. During dialysis, it is necessary to constantly monitor the level of potassium in the blood, since its excess leads to heart rhythm disturbance and death. Limit your salt intake to avoid swelling. In case of violation of the diet, it is necessary to notify the doctor, as it may be necessary to change the hemodialysis regimen. How much life can be extended if the regime is followed, the doctor will explain, but the chances of "obedient" patients are high.
Sometimes dialysis is the only option for kidney failure. But with the right attitude, a person can live normally for another 20-30 years. The main disadvantage is that the patient is tied to the dialysis center. But thanks modern technologies during the procedure, you can sleep, listen to music with headphones or watch your favorite TV series on your tablet. Over time, patients get used to this lifestyle and try to lead it in a full way, making time for communication, entertainment and hobbies.
Olga Lukinskaya
Little is said about kidney health, and their diseases may not manifest themselves in any way until a certain stage. Nevertheless, if deficiency develops, that is, the organs do not cope with their task, the person finds himself in a very dangerous situation: the body does not have time to cleanse itself and intoxication can quickly lead to death.
For people with severe kidney failure, two treatment options are available: kidney transplantation and dialysis, that is, blood purification with a special machine. Transplantation options are limited by the lack of donor kidneys - so people live on dialysis for years. We spoke with L about what life on dialysis is like and why you should not give up even in the most dramatic situations.
My story with kidney problems began in early childhood, in circumstances that no one remembers exactly. It seems that I had some kind of complicated poisoning, pulmonary edema, resuscitation and two days in a coma. They saved my life, but I became a patient of nephrologists forever.
My diagnosis then was rather abstract - nephritis, that is, inflammation of the kidney. As a child, I had little idea why my mother “tormented” me with diets, frequent tests, why I had an exercise therapy group in physical education. Mom always told me about my features, about what happened in childhood, but I did not attach any importance to this, because I did not see any real manifestations of the disease. Childhood and youth were carefree, like everyone else. By the age of eighteen, during the next standard blood tests, an elevated level of creatinine was found, and this alerted the doctors. I underwent a full examination at the Clinic of Nephrology, Internal and Occupational Diseases. E. M. Tareeva with Professor Shilov, and after a couple of weeks I was given an accurate diagnosis - chronic tubulointerstitial nephritis. In the kidneys there are glomeruli of thin tubules - and with this disease, their work is disrupted.
I must say that with all of today's propaganda healthy lifestyle they don't talk about kidneys at all. The kidneys are an organ that removes the breakdown products of food and various chemical reactions from the body. They purify the blood from decay products such as creatinine and urea, normalize the content of trace elements (potassium, phosphorus, calcium), allowing them to maintain their balance and remove excess with urine. The kidneys do their job thanks to the glomerular tubules, in which blood is filtered. With kidney disease, these tubules suffer - and the worst thing is that they do not recover. They don't grow back like nails or hair; if they die, then for good. As a result, the body is not sufficiently cleansed and it develops intoxication with the decay products of food, muscle tissue (it is destroyed during exercise), and other things.
The degree of impairment is determined by the glomerular filtration rate (GFR), that is, how the renal tubules work. The causes of kidney disease are completely different: high blood pressure, genetic diseases such as polycystic kidney disease, severe alcohol and food poisoning, when the kidneys cannot cope with a large amount of toxins, various infections, side effects of drugs, such as diuretics or drugs to reduce pressure. My illness has mixed causes, and it was difficult to determine the specific one - but I was glad that I was diagnosed and prescribed medication.
Every month I donate blood to the tissue bank of the Sklifosovsky Institute; there it is compared with all incoming cadaveric kidneys for compatibility. So, some may be “lucky” in three months, while others wait several years
Nevertheless, I did not see any manifestations of the disease at this stage, and remembered it only once every few months, when my mother forced me to undergo tests for control and go to a nephrologist for a consultation. I lived a full life - actively went in for sports, ran ten kilometers a day, drank with friends, was fond of different diets - and the body did not give me any signs. Kidney disease is a very silent disease that shows itself when things have gone too far.
At that time, I made many mistakes: the fact is that in order to inhibit kidney disease, it is very important to follow a diet with a low protein content so as not to burden the kidneys (which is why the Dukan diet is dangerous). It is important to avoid strenuous physical activity, which increases the level of creatinine in the blood, monitor blood pressure and eat less salt. In my case, I also had to take blood-thinning drugs - I also have thrombophilia, that is, a tendency to thicken the blood. True, it is not a fact that dieting would help me delay dialysis: my kidney failure before it lasted twenty-seven years - and this is a very long time.
I realized the full gravity of the situation late, eight years after the diagnosis, when I already had the fourth stage of chronic kidney disease (there are five in total, and the fifth stage is terminal, when the kidneys simply do not work). Then I began to fanatically fight for what was left: I followed a protein-free diet, watched for edema, took care of myself as best I could. Then I learned what happens to a person when his kidneys fail - dialysis appears in his life or, if he is lucky to find a transplant on time, a kidney transplant.
As for transplantation, in our country, related (from a close relative, and the husband or wife are not considered them) or cadaveric organ transplantation is allowed. This area is clearly regulated by law, and transplants for money or even volunteers are prohibited by law. With related transplants, everything is quite clear: the donor and the recipient are examined in detail, a verdict on transplantation is issued, and in case of a positive decision, a double operation is performed - one kidney is taken from the donor and transplanted to the recipient.
With cadaveric transplants, everything is somewhat more complicated - if I'm not mistaken, we have one waiting list for the whole country. I live in Moscow, and now they put me on a waiting list in two clinics, but this is the same list. Many mistakenly call it a queue, but this is not so: the sequence of transplants depends on the arrival of suitable organs. Every month I bring a test tube with blood to the tissue bank of the Sklifosovsky Institute; within a month it is compared with all incoming cadaveric kidneys for compatibility. Therefore, some may be “lucky” in three months, while others wait several years.
If it was not possible to make a transplant on time (and it is extremely rare, because a suitable kidney still needs to be found), then when the kidneys begin to fail completely, dialysis is performed. This is a procedure that imitates the work of the kidneys, that is, it cleanses the blood of decay products and removes excess fluid. There are two types of dialysis: hemodialysis and peritoneal dialysis. In the case of hemodialysis, the cleansing is performed by a dialysis machine that takes the blood, purifies it and returns it back - this procedure usually lasts four to five hours, and is carried out three times a week in a special dialysis center. To purify the blood qualitatively, the speed must be quite high, and one cannot simply insert thick dialysis needles into a thin-walled vein and artery. Therefore, the so-called vascular access is formed on the arm - the vessels are sutured, forming an intense blood flow; this is called a fistula. The preparation of the fistula itself is a whole operation; then you need to train your hand with an expander in order to strengthen the walls of the formed vessel, but you can’t load it too much.
When it turned out that I had the fourth stage of kidney failure, I began to prepare for the fact that the fifth would come - and I would need dialysis. I knew by heart all the symptoms of kidney failure and constantly looked for them in myself: swelling, a strange taste in my mouth, a change in the smell of the skin, weakness, dizziness, anemia, nausea, lack of appetite, weight gain due to internal swelling. Nothing hurt me, but I was scared: the ring on my finger presses a little - is it really swelling? I asked my relatives if my breath smelled, and generally drove myself incredibly; I always thought that tomorrow I would be on dialysis.
Two things helped to balance my psychological state: working with a psychologist and getting the most detailed information about dialysis and people who have already gone through it. Classes with a psychologist helped to distract from heavy thoughts and begin to assess their prospects soberly, without too much drama. In terms of information, the forum of Dr. Denisov was a discovery for me. This is a place where people with kidney disease can chat with each other and ask any medical or psychological questions. I am very grateful to Dr. Denisov for this forum - it is a support group and a mine of information for anyone with kidney failure.
Unfortunately, kidney diseases do not develop linearly: against the background of relative stability, a sharp deterioration can occur. Thanks to the information from the forum, I realized that I need to form a vascular access in advance - otherwise you may end up in a situation where there is no access and dialysis is carried out for a long time through a subclavian catheter that goes directly to the heart vessels - this method is used, but ideally it is short-term. I plucked up the courage to go to a vascular surgeon and they did a fistula. Although the indicators still allowed me to live without dialysis, I was attached to a dialysis station - they are both in state institutions and commercial (but subsidized by the state). Any citizen of the Russian Federation has the right to such therapy at the expense of the state; in addition, a person on dialysis can receive the first group of disability, most often indefinitely. Free dialysis can be done (by prior arrangement) in any city in the country, and this allows you to travel around Russia.
Do not insert thick dialysis needles into thin-walled veins and arteries. Therefore, a "vascular access" is formed on the arm, a fistula - the vessels are sutured, forming an intense blood flow
Exactly one year after the formation of access, the doctor and I made a decision: it was time to start renal replacement therapy (that is, dialysis), without bringing the body to extreme stress. I did not want to go through resuscitation and edema of twenty to thirty kilograms, and I smoothly entered the dialysis regime. My center is open 24 hours a day, six days a week, and it was possible to choose a suitable schedule; I worked and did not plan to stop, so I chose the evening shift. Transportation is provided for people in a very serious condition, but I drive myself. You come, change into comfortable clothes, weigh yourself, discuss your health with the doctor - and go to the dialysis room. Usually there are five or six (sometimes more) patients and a health worker who monitors the indicators, connects the devices, and is responsible for sterilizing the machines after the procedures. Several doctors are always on duty at the center. Dialysis lasts several hours, during which they are fed cookies and tea; some take snacks with them. Some dialysis centers allow visitors.
I spend my four hours the way most people do on a typical evening at home: reading, watching TV shows, sleeping. I was lucky, and after dialysis I feel very good - no headaches, no nausea. As for the restrictions - they have changed. If earlier I had to eat less protein so as not to burden the kidneys, now I need a lot of protein, because many important components are washed out during dialysis. You can no longer be afraid for the kidneys - they will not get worse. Now the main danger is heart problems. It is important to exclude sweet fruits, starchy vegetables, and not to eat too many greens. There are real stories when a person on dialysis ate one and a half kilograms of grapes or a small melon and died: the kidneys do not work and do not remove potassium, and because of its excess, the work of the heart is disturbed, and it can stop. I try to eat no more than one small vegetable a day and a minimum of fruit - sometimes a few berries or an apple. Products not recommended yet high content phosphorus (eg cheese) and it is important not to drink a lot of fluids. I still pass urine, and with the right balance of dialysis and fluid intake, you can maintain this state for a long time, but sooner or later the kidneys will stop working. Excess fluid puts a strain on the heart, leads to shortness of breath, swelling internal organs and should try to avoid it.
If you take care of your health and nutrition, everything will be fine. I'm in my thirties now and have been on dialysis for two years, but I know people who have been like this for about twenty years. For a woman in need of dialysis, pregnancy is a huge risk. There are examples, but it is very difficult, and no one comes out of this story healthy. The woman has to undergo dialysis every day. It also happens that menstruation disappears on dialysis (I don’t know the reasons), but it is restored after a kidney transplant. Without dialysis, a person dies of intoxication - and this happens quickly, in a week or a month.
I'll tell you about my life outside of dialysis: I have always been very active, loved to play sports and did not perceive myself as a sick person. I have several higher educations in economics and marketing, I speak fluent English and some other languages. After the first education, I started working and did not stop doing it. My profession is office, without physical exertion, it is quite suitable for my condition. IN Last year before dialysis, the employer knew about my problem and supported me in every possible way; I am very grateful for this, because when I was worried about later life on dialysis, at least the question of employment did not pressure me. I tried to be as involved as possible in the work, I took her with me to the hospital if I went to the examination. When dialysis began, it had almost no effect on the work area - the only thing is that after late dialysis it’s hard to get up early.
Now I have changed my place, the employer does not yet know about my situation, and I am in no hurry to reveal my cards, because I see no reason. I cover the holes from the needles on my arm with a band-aid or a long sleeve. In my free time, I swim and do moderate cardio. I read books, go with friends to restaurants and exhibitions, to the cinema. It's like everyone else - just a few times a week I need to spend four or five hours in the dialysis room.
When I come to government agencies to receive disability benefits, they do not believe me that I am a disabled person of the first group. Some are silent, others say that people like me look very different. There are a lot of elderly people on dialysis, and they often begin to lament how such a young girl ended up on dialysis. There are also many middle-aged men; my favorite story is how they get drunk before dialysis, and then they go to work or home sober as a glass, since the dialysis washed everything out.
Great stress - going to the doctor with any other ailments. Whether it's stomach pain or acne, everything is attributed to kidney failure: "What do you want, you're on dialysis." Some doctors don't know what dialysis is at all, brushing it aside and calling it an "innovation" even though it has been used for decades. Often the only adequate doctors who understand you are nephrologists: when you get dialysis, you understand that you are with these people for a long time and your health, well-being and life are in their hands. Therefore, it is very important to be thoughtful about their work, to be interested in the processes in your body, to understand how the machine works - to be a conscious patient, and not an eternal complainer. With a proper attitude towards people comes respect and understanding on their part. Many patients mistakenly think that they are being tormented, that the device only makes things worse - but these thoughts are only from ignorance. Dialysis is not a sentence, but a second chance at life.
Any ailment is written off
to kidney failure: "What do you want, you're on dialysis." Some doctors don't even know what dialysis is and call it an "innovation" even though it's been used for decades
In the last year before dialysis, I was depressed and fearful. My young man at that time tried to support me, but could not cope with the fact that it is simply dangerous for me to have children now. We parted ways during the pre-dialysis period. Now I am in a different relationship and I am very happy: my partner understands my situation, accepts me and tries to help in everything. It is very important that there is support and support - in my case, these are parents, a beloved man and close friends who listened to my fears, tears and endless stories for hours.
I have traveled all my pre-dialysis life. It is still possible now, but there are additional expenses: I have to plan and pay for dialysis abroad. Depending on the country, one procedure costs two hundred to five hundred dollars; There are also agencies that help organize this. I have already traveled on dialysis; the devices are arranged approximately the same, it is important to set the usual settings, and then everything will go well.
It can be hard and sad for me, because I would like to have time and do more, but I don’t have enough strength or time. I scold myself, sometimes I regret it, but most often I try to look for ways to better organize my time. I am grateful that I was given the chance to live life to the fullest in such circumstances, and I try to use this chance. I may not become famous like Stephen Hawking or Nick Vuychich, and I will not have billions of dollars in income, but I manage to lead a full life and enjoy it no less than healthy people, see prospects and make plans - and this is already a small victory.
I want to convey to those who are faced with the same situation that they are not alone and that there is life on dialysis. I have spoken to girls my age who are on dialysis after resuscitation or live with kidney failure and know what lies ahead for them. They are all very scared and it seems that life is no more. These are tears, depression and in literally desire to lay hands on oneself. I thought so too, but there really is no need to be afraid. You need to collect information and learn to accept circumstances, live with them and enjoy life in spite of everything.
