Simply speaking, dialysis means purification of blood. After failure of the kidney to perform its job, all the toxins that were removed by the kidney
What is the meaning of dialysis?
Simply
speaking, dialysis means purification of blood. After failure of the kidney to
perform its job, all the toxins that were removed by the kidney will accumulate
in the body of the patients. Toxin accumulation in the body is responsible of
many manifestations of kidney failure e.g. loss of appetite, weak bones, sexual
dysfunction, depression and anemia.
Another major
problem that can be solved by dialysis is water and fluid accumulation. The
process of water removal called “ultrafiltration”. So, dialysis process that is
performed three times per week, four hours each, has two main targets:
1)
Toxin
removal.
2)
Extra
water removal.
So, patients
should be weight before and after starting the process of dialysis. After
several sessions of dialysis, we can determine how much water can be removed.
The ideal weight of the patient after dialysis is called the “dry weight”. The dry weight is identified by the body
weight at which patient has smooth breathing, normal or near normal blood
pressure and with absence of edema from his lower limbs. Weighing the patient
after finishing dialysis will inform how much he removed. Between sessions,
patients should be optimum as regard fluid intake. Weight gain should not be
more than 1-2 Kilograms. By time, trial and error, and patients’ experience,
the ideal dry weight can be achieved.
Which is better maintenance on dialysis or kidney transplant?
Patients
maintained on regular dialysis can live in accepted standard of life as long as
they were compliant to the dialysis program. Optimum dialysis should be on
thrice weekly basis with four hours each. Sophisticated software programs are
now available through the modern well-developed dialysis machine.
However, after
few years, chronic dialysis complications will be developed e.g. dialysis
dementia, mineral bone disease, depression and poor quality of life.
Consequently, kidney transplant would be the best option for a patient with end stage renal failure. Two types of kidney transplant: 1) Cadaveric (deceased) kidney transplant. 2) Live kidney transplant. The latter could be related or non-related kidney donation. By far, the related kidney type of transplant is much better. As the donated kidney is a foreign body, the patient’s immune system started to deal with this organ vigorously. If there is no suppression
to this system, the implanted graft will be rejected that mean failure of the
transplant.
So, for life
immunosuppression is mandated to keep this kidney (graft) safe from the
aggressive behavior of the immune system. The process of immunosuppression
could be achieved through for life use of medication dedicated for dealing with
the immune system e.g. corticosteroids. Many regimens are now available through
many newly provided drugs aiming at limitation of drug toxicity with the best
results of immune system control.
Serial
investigations as regard graft function, efficacy of the immunosuppressive
agents and the early detection of infections e.g., viral infection, are usually
performed through regular visits to the transplant center. Close monitoring of
the new kidney (graft) function and patient adherence to his clinician orders
are the most effective factors to achieve the best graft longevity.
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