Renal replacement therapy

Symptoms of uremia

In the human body, metabolic products are produced daily, which, together with blood, are transported to the kidneys and then removed from the body. Along with the purification of blood, another task of the kidneys is to remove water. Kidney diseases lead to the limitation of their functional ability. Therefore, their excretory function and detoxification function are reduced. Because of this, metabolic products and water accumulate in the body, which leads to the progression of the disease. In the case of development of kidney disease before this stage and in the absence of a donor kidney, metabolic products and water are excreted by the blood purification procedure. This procedure is called dialysis.

Possibilities of purification of blood

One of the possibilities of dialysis is the purification of blood with the help of an apparatus that purifies blood outside the body through an artificial dialysis membrane (hemodialysis). Another method of purifying the blood is peritoneal dialysis. Here, as a natural dialysis membrane, the peritoneum is used.

Hemodialysis

Over the past 40 years, hemodialysis (blood purification) has become a standard procedure for renal replacement therapy. In Germany, about 50,000 patients are currently undergoing hemodialysis.

For what reason and in what cases is the hemodialysis procedure necessary?

The kidney is the most important organ of excretion. It continuously produces urine and, together with it, removes toxins and excess liquid from the body. With a decrease in kidney function, the concentration of waste in the blood increases. At the same time, fluid is not completely removed from the body, which leads to hyperhydration and worsening of the situation with high blood pressure.

If the functional capacity of the kidneys falls below 15% of the norm, due to insufficient removal of toxins and fluids, symptoms such as fatigue, lack of appetite, decreased efficiency, shortness of breath, poorly amenable correction of high blood pressure, impaired sensitivity, inflammation of the mucosa stomach, heart rhythm disturbances or even inflammation of the pericardial sac. With the help of effective treatment through hemodialysis, the excretory function of the kidneys can be compensated so much that these complaints no longer arise, while the patient’s capacity for work is largely preserved.

What happens during hemodialysis?

In hemodialysis, slags, medications and other substances that are normally excreted by healthy kidneys along with the urine are removed from the blood, and excess fluid is filtered. The patient's blood is pumped by the dialysis pump through the thin capillary tubes of the dialyzer, outside these tubes are washed with a constantly renewable washing liquid. In this case, slags through the walls of the tubes penetrate from the blood into the washing liquid, and thus are removed from the blood. At the same time, due to the pressure difference between the blood flow and the rinsing solution regulated by the dialysis apparatus, the liquid from the blood through the dialysis membrane is filtered out into the washing liquid.

Peritoneal dialysis

Peritoneum is thin and shiny skin, its surface is from 1 to 2 m2 and completely covers the abdominal cavity. Since the peritoneum is well supplied with blood, it is an excellent replacement membrane. To conduct peritoneal dialysis in the abdominal cavity at the regular intervals through a firmly inserted catheter into the skin of the abdomen, a special liquid (washing solution, dialyzer) is supplied. This liquid washes the peritoneum. Since renal insufficiency accumulates metabolic products in the blood, these substances are discharged through small blood vessels into the washing liquid. After several hours, the substance saturated with substances is removed through the catheter and replaced with a new liquid for dialysis. Thanks to this, a new purification process begins, proceeding in a gentle and natural way. Along with the metabolic products from the human body, suffering from kidney disease, an excess fluid must be eliminated, among other things. To this end, glucose is added to the dialysis fluid. Glucose has the ability to draw fluid from small blood vessels of the peritoneum and, thus, to release the human body from excess fluid. Unlike the procedure for detoxification during hemodialysis, which is usually performed 3 times a week for 4-5 hours, peritoneal dialysis is performed in the slow and constant mode (continuously). Thus, this procedure is very similar to the natural process of detoxification occurring in the kidneys.

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