Hemodialysis Procedure
In this procedure patients blood is removed through one needle (tube) and passed through the artificial kidney (dialyser). Blood purification occurs here when blood is passing through semi-permeable membrane capillary fibres (in dialysis) by process of diffusion and ultrafiltration. Generally 200 to 300 ml of blood is passed through dialyser per minute and 500 ml of dialysis solution (Dialysate) per minute. Each dialysis lasts for three to five hours depending upon type of dialyser. Most patients require two to three times a week dialysis for life long or till patient is operated for renal transplantation.
Advantages of Hemodialysis
With regular dialysis most patients feel better to a great extent and many patients can be rehabilitated. Patient can survive for a long time in a good health (the longest surviving patient on hemodialysis in the world has been on dialysis for 22 years and still living in good health). With recent advances anaemia can be corrected by injection of ertythropoietin and bone problems can be minimized by using calcium carbonate with activated vitamin D3. Patient does not require major surgical procedure.
Disadvantages of regular hemodialysis
Patient has to follow diet, fluid, salt and potassium restriction to a great extent (like avoiding dry fruits, fruits, juices, coconut water etc.). Even with dialysis patient feels weak due to anaemia. This can be corrected but will involve additional expenditure of about Rs. 15000/- per month. Travelling also will be restricted due to need for regular dialysis. Many patients develops bone problem or neuropathy with long term dialysis. In male patient there is problem with loss of libido or even impotency. Other important complications of long term dialysis is hepatitis (either B or C). B hepatitis can be prevented by vaccination now. Other complication recently encountered is AID in long term dialysis patients. This is most likely due to blood transfusion. Most important problem about dialysis in India is its expenses. Each dialysis procedure costs patient around Rs. 400 to 600. So patients monthly expense only on dialysis will be around Rs. 6000/- or so. How many patients in India can afford life long dialysis this rate?
Home Hemodialysis
One way to decrease the cost of long term dialysis is home hemodialysis significantly around Rs. 350 per dialysis, i.e. yearly expense will be around Rs.36,000/-. The patient has to invest for hemodialysis machine and this cost is in around Rs. 3,00,000/-. For home hemodialysis generally one member is trained and they do dialysis at home. It takes 6 to 8 weeks to train a non medical person. Other advantages of home dialysis are;
- Patient can adjust dialysis as per his/her schedule and so can work full time
- Patient and family members are not displaced from their home and routine work.
- Patient is in home atmosphere
- Less chances of infection particularly hepatitis is less.
- Less expensive in long term. Even very few can invest for the cost of machine and recurring expenses.
What next????
After dialysis for few days, few weeks or few months most of the patients and their family members ask WHAT NEXT? This is the most common question asked to NEPHROLOGIST. Younger patients ask very soon.
Unfortunately kidney failure occurs in younger age between 20 to 40 years. This is the age where the patient is needed most by his/her members - parents, spouse and children. Many times the patient is the sole bread winner for his entire family. The reason for asking this question varies but most common causes are;
- Patient is tired of regular two to three a week dialysis.
- Patient does not like fluid and diet restriction.
- Inspite of adequate dialysis patient still feels weak due to persistence of anaemia.
- Patient complaints that he/she cannot work full time as he/she has to adhere to dialysis schedule.
Financial expenditure (about Rs.4000/- to Rs.6000/-per month) does not allow continuation of regular dialysis in most of the patients.
It is not possible for the patient and his accompanying family members to stay away from their place as dialysis facility is not available near their place.
Initially most of the patients follow diet and fluid restriction and comes for regular dialysis, as they are feeling better. But soon they get tired of this and start drinking more fluids, eating more salt and fruits and irregular dialysis schedule. With this they get into serious problem like breathlessness, excess weight gain, chest pains, high blood pressure etc. Most of the Nephrologist worry about these but most dreaded complication is due to high potassium level due to excess fruit intake as this can give rise to sudden death in dialysis patient.
Early patients do well with regular dialysis as they tend to accept dialysis along with diet and fluid restriction well while younger patient do not do well for a longer time as they do not accept dialysis and diet and fluid restriction. In this situation only other alternative is KIDNEY TRANSPLANTATION.
