What is Dialysis ?

Dialysis is a procedure that removes waste products and excess fluid from the blood for people whose kidneys are not working well enough. Normally, the kidneys filter the blood. It converts harmful waste products and water into urine and removes them from the body.

When you have kidney failure, the kidneys cannot filter the blood as they should. As a result, harmful products and water accumulate in your blood. Dialysis replaces the kidneys. It purifies excess water and harmful products from the blood.

 

Who Needs Dialysis ?

There are 5 major stages of kidney disease. In the last stage, your kidneys perform about 10 to 15 percent of their normal function. You may need a kidney transplant and dialysis at this stage. 

Some people go on dialysis until they find a new kidney.

 There are some important signs that you may have kidney failure or may require you to undergo dialysis. 

  • Changes in the amount of urine, especially urination at night and a decrease in the amount of urine and color change in the urine.
  • Swelling in the legs, feet, and ankles from excess fluid in the body.
  • Weakness and fatigue due to insufficient red blood cells and excess waste accumulation in the bloodstream.
  • Loss of appetite and vomiting due to accumulation of waste in the blood.
  • Itching is also a common symptom due to the accumulation of waste.

How long will I need dialysis for?

Kidney patients often need a kidney transplant, but in some rare cases, dialysis can be stopped once the kidneys recover. 

Finding a suitable donor for kidney transplantation is a time-consuming process. For this reason, dialysis may be required in the process up to kidney transplantation. 

 

There are two types of dialysis :

Hemodialysis 

 

In hemodialysis, a machine filters your blood through a dialyzer (artificial kidney) and returns the clean blood back to your body.

It is much more common than peritoneal dialysis. It can be performed in dialysis facilities, hospitals or at home. 

It is a process that will take 3-4 hours, usually 3 times a week. 

 

Peritoneal Dialysis 

Peritoneal dialysis uses the membrane in your abdomen (peritoneum) instead of using a machine as a filter.

A thin tube called a catheter inserted into the abdominal cavity sends fluid into the peritoneal cavity. 

The peritoneum contains thousands of blood vessels that can filter blood like a kidney. As blood passes through these blood vessels, excess fluid and waste products are taken into the dialysis fluid.

 

Which Dialysis is Better ?

When considering which dialysis procedure is good choice for you , you should know that you can always change your decision and you can switch to a different dialysis procedure whenever you want.

 

Both processes have advantages and disadvantages. Medical reasons and lifestyle determine which type of dialysis is suitable for you.

 

In hemodialysis, you need to be treated 3-4 days a week. For this reason, you have to visit the hospital or dialysis center each time.

Peritoneal dialysis can be performed at home or even while you sleep but it needs to be done every day.

 

Drug Use in Kidney Failure

The kidneys are organs that have an important function in removing waste products and metabolic wastes from the body as aresult of the breakdown of drugs. 

In patients with kidney failure, the kidney cannot function adequately. This situation can cause metabolic and drug residues to reach toxic levels in the body. For this reason , it is necessary to apply the dose of the drugs taken well . Because even taking the drugs in normal doses can cause the drugs to accumulate in the body and have various side effects.

 

The minimum number of drugs should be used as possible. Medicines should never be used except under the control of a doctor.

 

Hypertension

Many kidney patients suffer from hypertension. Hypertension causes progression of kidney failure and problems in the cardiovascular system. Therefore, blood pressure should be controlled. It happens in two ways:

 

  • Changes in lifestyle

The amount of salt to be taken daily should not exceed 3 grams. Losing excess weight and exercising are also effective in keeping blood pressure at its ideal value.

 

  • Drug therapy

Drugs used to lower blood pressure are divided according to their effects (diuretic drugs, drugs that dilate the vessels, drugs that reduce the amount of blood pumped). These drugs can be used under the supervision of a doctor.

Anemia 

Anemia is another important problem in kidney patients. Erythropoietin is a hormone that plays an important role in the production of red blood cells. It is produced in the kidneys.

 Low secretion of erythropoietin hormone in kidney patients is the most important cause of anemia. Various drugs are used to increase erythropoietin for its treatment. 

Iron therapy is also applied to support iron stores. Blood pressure may rise during erythropoietin therapy. For this reason, blood pressure should be taken under control before starting treatment. 

 

Bone diseases

Another important task of the kidneys is to retain vitamin D and calcium. When the kidneys are not working well enough, more potassium accumulates in the body than necessary.

Since there is not enough calcium and vitamin D in the bones, the bones become sensitive and fractures may increase.

Different drugs can be used for this purpose. (Calcium-containing phosphorus binders, Aluminum-containing phosphorus binders, Aluminum and magnesium-free phosphorus binders). Furthermore, drug therapy can be applied to obtain vitamin D.

 

For Dialysis Patients 

Dialysis patients should not use drugs that are nephrotoxic (the drugs have a toxic effect on the kidneys). 

In hemodialysis and peritoneal dialysis, some of the drugs taken may be lost from the body due to dialysate. Additional doses may be required after dialysis

For peritoneal dialysis patients, most drugs can be taken from the peritoneal space.

 

5 Drugs That Kidney Patients Should Avoid or Adjust Their Dose

If you have kidney disease, these 5 common types of drugs should be avoided or their doses adjusted under medical supervision.

 

  • Cholesterol medications

 If you have chronic kidney disease, the dosage of some cholesterol medications, also called statins, may be adjusted.

 

  • Pain medications

You can damage your kidneys if you take too much of these over-the-counter medications, such as the common aspirin, naproxen, and ibuprofen . They can cause a decrease in blood flow to the kidneys. 

Various narcotic pain relievers can accumulate in the body and cause serious problems in patients with chronic kidney disease. For this reason, when the elderly and those with kidney disease need to use painkillers, they should use paracetamol group drugs that are less harmful to the kidneys.

 

  • Anti-microbial meds

Most antiviral and antifungal and antibiotic drugs are cleared by the kidneys. Taking too much of the antibiotic may damage the kidney tissue and the dose may need to be reduced. It is recommended to get the opinion of the nephrologist before using antibiotics.

 

  • Diabetes medications

Insulin taken by diabetics is excreted by the kidneys. Diabetes is a major cause of kidney disease. Therefore, kidney patients should keep their blood sugar levels well. Blood sugar can be kept in balance with diet , physical activity and drug use . If you have diabetes and kidney disease, it is recommended to keep in touch with your doctor.

 

  • Upset stomach/antacid medications

These over-the-counter medications can alter the electrolyte balance in your body if you have chronic kidney disease.

 

How Do I Protect My Kidneys ?

If you have chronic kidney disease or are on dialysis, there are several ways to extend the life of your kidneys and make them healthier. 

 

Make healthy food choices

Eating well is very important if you have kidney disease. A healthy dietnot only makes you feel healthy, it also prolongs the life of your kidneys.

Here are ways to make your diet better :

 

  • Keep salt intake as low as possible

Foods high in salt can cause kidney problems. Make your own meals at home with healthy ingredients for a less salty diet.

 

  • Don’t make your diet high protein

Excess protein can cause the kidneys to work harder and longer.

 

  • Eat foods low in saturated fat and cholesterol

Kidney patients are at higher risk of having heart-related problems. Therefore, attention should be paid to cholesterol. Instead of butter and margarine , fish , eggs and lean meat should be preferred . It is also known that especially the white of the egg is very beneficial for the kidneys.

 

 Maintain a healthy weight

Being overweight negatively affects the kidneys and increases the risk of diabetes.

 

Know your GFR (Glomerular Filtration Rate)

Your GFR gives you information about the percentage of your remaining kidney function. You can better protect your health by knowing how well your kidney is working under the guidance of your doctor.

Having a GFR below 60 carries a risk of kidney disease. A GFR of 15 or less means kidney failure.  

 

Get regular checkups for your kidneys

Kidney diseases usually do not show symptoms until they reach the level of need for dialysis or kidney transplant. For this reason , having your kidneys checked regularly helps to detect problems earlier and to take precautions early .

 

Control your blood sugar if you have diabetes

In more than 40 percent of people with kidney failure, the biggest cause of this problem is diabetes. Therefore, blood sugar should be kept under control. 

Watch your blood pressure

Blood pressure control is one of the most important things that prolongs the life of the kidneys.

 

Consult your doctor before using drugs

Do not overuse antibiotics and use painkillers under the supervision of a doctor.

Imaging drugs used in radiological examinations such as angiography, tomography, magnetic resonance are harmful to the kidneys. These drugs must be used under the supervision of a doctor. It is very useful to take enough liquid 2 days before using such drugs (it is better to take it intravenously).

Avoid herbal remedies and weight loss products

Herbal medicines are considered to be natural and not harmful. However, most of the medicines used in the treatment of cancer are of plant origin and have many serious side effects.

Consumption of such teas and herbal medicines containing this substance may cause chronic kidney failure, which requires dialysis. It is even known that these products develop cancer in the urinary tract. For this reason, herbal products such as slimming teas should be avoided.

 

                                                        REFERENCES

 

1 – https://www.pskc.net/for-patients/about-kidney-disease/how-to-protect-your-kidneys/ 

2-  http://tekinakpolat.com/bobrek-yetmezligi-ilac/ 

3-  https://www.medicana.com.tr/haber-detay/3269/bobregin-az-bilinen-dusmanlari 

4-  https://www.nhs.uk/conditions/dialysis/ 

5-  https://my.clevelandclinic.org/health/treatments/14618-dialysis 

6-  https://www.webmd.com/a-to-z-guides/kidney-dialysis 

7-  https://www.kidney.org/atoz/content/drugs-your-kidneys 

8-  https://www.webmd.com/a-to-z-guides/medicine-hurt-kidneys 

9-  https://dergipark.org.tr/tr/download/article-file/418873