Hemodialysis and myocardial infarction. What is kidney hemodialysis and why is it needed? Forecast of the condition after the procedure

Diabetes mellitus is one of the diseases endocrine system, in which the natural work of many is disrupted internal organs. Main problem diabetes mellitus is that against its background, multiple diseases develop, which become the cause of death for diabetics.

Over time due to higher level glucose, a large amount of under-oxidized metabolic products accumulate in the blood, which are gradually removed from the body through the kidneys. They filter the blood, removing excess harmful substances in the urine.

The filtering capacity of the kidneys directly depends on cardiac activity, since filtration is carried out passively due to the pressure created in the renal arteries. If there are signs of disorders of the cardiovascular system, then this will certainly affect the entire body including the kidneys, which will lead to

Unfortunately, it is difficult to make a correct diagnosis in time early stages the disease is not possible, since it is asymptomatic, although it is at such a moment that it can still be stopped with a special therapeutic diet.

With gradual progression of diabetic nephropathy, chronic renal failure (CRF) will eventually develop with a marked decrease in glomerular filtration rate (GFR). When the GFR reaches a value of about 10 ml/min, then it will no longer be possible to purify the blood without the help of outside intervention, because the kidneys simply will not be able to perform their functions on their own.

If the water-electrolyte balance of the blood is not restored in time and toxins are not removed, then the person will simply die, because the blood flowing through his veins, in the literal sense of the word, will poison the entire body!

Hemodialysis (HD), which is also called a “device,” helps to carry out extrarenal filtration. artificial kidney" They also resort to its help in the early stages of nephropathy, if the doctor has reason to predict the development of the disease.

Kidney hemodialysis is an artificial filtering system through which the blood is purified.

It consists of several double-ended catheters (inserted into the patient’s vein) and connected to a hemodialyzer, through one outlet of which a special dialysate is supplied ( chemical solution), blood is “distilled” through the other, passing through a special double-sided semi-permeable membrane. Due to the different densities of substances (blood and the dialysate itself), blood diffusion occurs, as a result of which the concentration of biological substances is equalized.

Thanks to the membrane (it can be compared to a fine sieve, filter, through which a substance can penetrate only with a certain molecular weight) the blood is cleansed, and the amount of toxic substances in it decreases.

However, in case of kidney failure, it is not enough to simply cleanse the blood. It is also necessary to reduce the concentration of fluid in the body to prevent edema (especially of the lungs).

This is only possible if the dialysate pressure does not exceed the blood pressure. IN otherwise this will result in reverse filtering. This manipulation of blood is called ultrafiltration, which is caused by transmembrane pressure and is capable of removing excess fluid through the process of diffusion.

Therefore, when a patient is being prepared for a procedure, blood pressure must be monitored before, during and after the procedure.

The substance itself - dialysate, which I use in the process of blood filtration - is prepared from purified water and a solution of salts and acids (water treatment involves selecting a concentrated acid solution diluted in the required volume with water).

Depending on the patient’s condition, the effect of kidney HD can be regulated by the sodium, potassium, calcium, magnesium, bicarbonate, chlorine, glucose contained in the dialysate, varying its pH, etc.

But the most effective among them is sodium. The optimal value of this substance in solution is from 140 to 142 mmol/l, but this indicator directly depends on the individual parameters of a particular patient.

For example, if the sodium concentration is too low (below 135 mmol/l), then after an hour, or even less, the patient, while on hemodialysis, will feel all the signs of hyponatremia with convulsions, nausea, vomiting, etc. If you increase it (on average above 145 mmol/l), then there is a high risk of getting signs of hypernatremia with increased blood pressure, thirst, drowsiness, which can even lead to the death of the patient due to intracellular dehydration, leading to hypertensive crisis, cerebral edema with irreversible consequences.

However, the above example is extremely abstract, because each patient, depending on his state of health, has his own threshold of sensitivity to sodium parameters. If his blood pressure was higher than normal before hemodialysis, then a sharp decrease in sodium to the recommended normal values ​​will cause the patient to feel unwell during and after the procedure.

The dialysate must correspond to the norm of a particular person with a gradual tendency towards normalization of indicators.

For example, reduce the conductivity of the dialysate not sharply, but by 0.1 - 0.2 mS/cm (millisiemens per centimeter) per week.

To start the work, it is necessary to provide access to the patient’s circulatory system. For such purposes use:

• fistula

A direct connection of an artery to a vein is made using its own vascular system. The forearm area is more suitable. The vein in the cubital fossa and the brachial artery connect.

• catheter

Placed in one of the veins of the neck, chest, thigh. Needles are inserted into the catheter, through which blood flows. This type of connection of the hemodialyzer to the veins can be classified as “disposable”, because it is not used so often and is not suitable for repeated use.

• transplant

It is a sterilized synthetic tube that “replaces” the great saphenous vein.

Indications

Not all patients can undergo this procedure. It is strictly regulated and prescribed for:

• acute renal failure
• acute glomerulonephritis
• pyelonephritis
• poisoning with alcohol-containing solutions (liquids)
• significant changes in electrolytes in the blood, which pose a serious danger to human life and health
• drug overdose
• intoxication with poisons
• overhydration, which cannot be relieved by other means

But it is worth mentioning that HD significantly changes the strategy for monitoring glycemia and insulin. For example, the procedure significantly affects the secretion, clearance and sensitivity of cells to insulin. Therefore, it is recommended to reduce the dose of the hormone when undergoing HD treatment.

It is preferable to use glurenorm (gliquidone), since it is almost completely eliminated (i.e., eliminated from the body naturally) through the liver.

Contraindications

The relative ones include:

• mild tuberculosis
• diseases fraught with massive bleeding (these include: peptic ulcer, uterine fibroma, Melory-Weiss syndrome and others)

To absolute:

• mental illness (epileptic seizures, psychosis, schizophrenia, etc.)
• incurable forms of malignant tumors
• leukemia
• anemia
• severe forms of nervous system diseases
• patients with diabetes mellitus over 70 years old
• old age (over 80 years old)
• presence of two or more serious pathologies, which include: myocardial infarction, heart failure, advanced atherosclerosis, lung disease, liver cirrhosis, etc.
• alcoholism, drug addiction without further social rehabilitation

Possible complications

During the HD process, some complications arise, the cause of which may be, for example, of a technical nature, when a failure occurs in the device itself. But most likely the following complications, which, however, happens extremely rarely:

• hypertension
• hypotension
• hypernatremia
• hyponatremia
• convulsions
• air embolism
• catheter blockage
• accidental infection of a patient during preparatory procedures hemodialysis
• epileptic seizures
• weakness
• nausea
• vomit
• dizziness
• violation heart rate
• allergic reactions on individual components of the dialysate

How often and how long do they live on hemodialysis?

The answer to this question will turn out to be very abstract, because everything largely depends on the individual person and his state of health.

If the patient’s kidneys have completely failed, then the blood purification procedure is carried out much more often, about 3 times a week. If the face shows all signs of at least residual preservation of the excretory capacity of the kidneys, then the procedure is reduced to 1 time per week, sometimes even less often. The whole process lasts from 4 to 5 hours.

Of course, not everyone will be able to carry out the procedure on an outpatient basis in the kidney hemodialysis department, since elderly people often simply do not have the opportunity to simply get to the hospital. For them, it is possible to carry out blood purification at home under the supervision of a specialist or specially trained person.

Modern technologies make it possible to create special portable devices, but their cost is quite high! In addition, it would be hard to call the first HD devices portable, because the weight of a relatively “cheap” device can exceed 10 kg. Those that are worn on a belt weigh from 4 to 7 kg.

All equipment and components are not sold in Russia (you can only purchase consumables). This “pleasure” is acquired abroad. In Russia, several meetings have already been convened on this subject. medical advice, but the issue was never moved forward. Except that in a number of cities of the Russian Federation, as part of state support, hemodialysis points were organized in city hospitals. This is already considered a major breakthrough almost thirty years ago, when the first GD apparatus was created under the USSR.

As for the life expectancy of patients who are forced to resort to HD, there is no clear answer. Yes, and as such, statistics in Russia on complications and mortality from kidney diseases are simply not kept.

In addition, the main problem that becomes the cause of death of patients does not depend on complications after the procedure, the cause of which is rather a case due to equipment failure, blood clot formation in the catheter, incorrectly selected and prepared dialysate solution, etc.

The basis of everything is serious immune disorders.

The immune system becomes weak, and a person may die from pneumonia, intestinal problems, or viral diseases.

If you combine proper hemodialysis with a timely kidney transplant, the life expectancy of patients can be increased by more than 20 years.

On average, according to medical data. In US statistics, this period varies from 0 to 14 years. It all depends on the patient himself and his immunity, which is quite realistic to maintain and artificially by introducing the required amount of vitamins, etc.

Diet for HD

It is necessary to maintain health special diet, since without proper nutrition to normalize metabolic processes and it will not be possible to reduce the load on the kidneys. Regulate this process by medication very dangerous, since any drug has a number of serious side effects that will only aggravate the situation rather than improve it.

The diet is developed individually by a specialist nutritionist together with a group of treating doctors (nephrologist, neurologist, endocrinologist, etc.). Its basic principles correspond to tables 7a and 7b (but only in the presence of kidney disease) and are as follows:

• limit the amount of salt you consume
• adjust the concentration of potassium in the blood with special foods (reduce consumption of potassium-containing foods: bananas, potatoes, chocolate, nuts, dried fruits)
• monitor fluid intake (to prevent swelling)
• balance your protein intake to prevent albuminuria
• reduce the amount of phosphorus-containing foods
• control calcium balance in the body

In addition, if the patient is prescribed a certain schedule of HD and adheres to a diet, then the doctor should be warned in advance about any disruptions in nutrition!

For example, several prohibited foods were consumed: salty, smoked fish, pickles, tomatoes, a lot of sweets, if you have diabetes, etc. The medical professional must react to this in time and adjust the hemodialyzer (dialysate solution).

However, patients with diabetes mellitus without renal complications should limit their diet exclusively to foods rich in: potassium, phosphorus, sodium (salt), since these substances are used in the preparation of the dialysate solution and are replenished with it. All other products are simply eliminated from the body during the 4 hours spent in the clinic under the device. To prevent protein-energy depletion, it is necessary to eat even better than normal healthy people without endocrine complications.

In addition, they are recommended in conjunction with a normal balanced diet and attendance at the HD procedure. physical exercise, the intensity of which depends on the individual parameters of the person (age, complications, daily glycemia, etc.).

At advanced stage For kidney disease, hemodialysis can be replaced by more radical methods - a donor organ transplant operation. To prescribe this procedure, you need to undergo many tests and carry out a planned

Hemodialysis– a procedure for purifying blood through a semi-permeable porous membrane using an “artificial kidney” apparatus. Hemodialysis is necessary for people with acute renal failure, poisoning with drugs, alcohol, and poisons. But most of all, people with chronic renal failure need hemodialysis. The device takes over the functions of non-functioning kidneys, which makes it possible to extend the life of such patients by 15-25 years.

A hemodialysis machine filters toxins and urea from the blood, gets rid of excess fluid, normalizes electrolyte balance, blood pressure and restores acid-base balance.

According to statistics, in 2013 there were 20,000 people on hemodialysis in Russia. But doctors say that 1,000 people per million of the population need blood purification. Thus, the number of people who need an “artificial kidney” is 144,000 people. Today, there is an acute shortage of dialysis centers in the regions, and many patients with chronic renal failure have to wait months for their turn.

The cost of procedures per person per year is about 1.5 million rubles. This includes the cost of a disposable blood filter (dialyzer), dialysate fluid (about 120 liters per procedure) and operation of the artificial kidney machine. But if there is a place in a dialysis center, then the patient’s treatment should be paid for through special government programs.

What is hemodialysis

Purpose of prescribing hemodialysis– cleanse the blood of harmful substances:

• urea - a product of protein breakdown in the body;
• creatinine – the final product of energy metabolism in muscles;
• poisons - arsenic, strontium, toadstool poison;
• medications - salicylates, barbiturates, sleeping pills, boric acid derivatives, bromine and iodine compounds, sulfonamides;
• alcohol - methyl and ethyl;
• electrolytes – sodium, potassium, calcium;
• excess water.

1. Blood processing system:
   • blood pump;
   • heparin pump;
   • device for removing air bubbles;
   • blood and venous pressure sensors.
2. System for preparing dialysis solution (dialysate):
   • air removal system;
   • system for mixing water and concentrate;
   • dialysate temperature control system;
   • detector for monitoring blood leakage into the solution;
   • filtration control system.
3. Dialyzer (filter) with a hemodialysis membrane made of cellulose or synthetics.

Operating principle of a hemodialysis machine.

• Removing exchange products. There is a high concentration in the blood of a person with kidney failure various substances: urea, toxins, metabolic products, proteins. They are not present in the dialysate solution. According to the laws of diffusion, these substances from a liquid with high concentration, penetrate through the pores in the membrane into a liquid with a lower concentration. This way the blood is cleansed.
• Normalization of electrolyte levels. In order not to remove elements necessary for life from the blood, the dialysate solution contains sodium, potassium, calcium, magnesium and chlorine ions in the same concentration as the blood plasma of a healthy person. Therefore, according to the laws of diffusion, excess electrolytes pass into the dialysate, and required amount remains in the blood.
• Maintaining acid-base balance. In order to maintain a normal acid-base balance, a buffer is present in the solution - sodium bicarbonate. Bicarbonate moves from solution into the plasma and then into the red blood cells, providing the blood with bases. Thus, the blood pH increases and returns to normal.
• Removing excess water by ultrafiltration. Blood flows through the filter under pressure due to the operation of the pump. The pressure in the dialysate flask is low. Due to the pressure difference, excess fluid passes into the dialysate. This helps eliminate swelling of the lungs, joints, brain, and remove fluid that accumulates around the heart.
• Prevention of blood clots. Heparin helps prevent blood clots by preventing blood clotting. It is gradually added to the blood using a special pump.
• Prevention of air embolism. An “air trap” is installed on the tube that returns blood to the vein, where a negative pressure of 500-600 mm Hg is created. The purpose of this device is to catch air bubbles and foam and prevent them from entering the bloodstream.

Types of hemodialysis

Types of hemodialysis depending on the location

1. Hemodialysis at home.

   For this purpose, specially developed portable devices Aksys Ltd."s PHD System and Nxstage Medical"s Portable System One are used. After a course of training, you can use them to cleanse your blood at home. The procedure is done daily (nightly) for 2-4 hours. The devices are quite common in the USA and Western Europe and are considered a good alternative to a kidney transplant. So in the UK, more than 60% of dialysis patients use home “artificial kidneys”.

   Advantages: the method is safe, easy to use, there is no need to wait for your turn, it allows active image life, the blood purification schedule corresponds to the needs of the body, there is no danger of contracting hepatitis B.

   Flaws: high cost of equipment 15-20 thousand dollars, need to take a training course, help is needed at first medical worker.

2. Hemodialysis on an outpatient basis.

   Outpatient hemodialysis centers provide extrarenal blood purification to patients with acute renal failure and end-stage chronic renal failure, when kidney function cannot be restored. Patients are served on a first-come, first-served basis. In most cases, the procedure is carried out 3 times a week for 4 hours. For this purpose, devices from the Swedish concern “Gambro” AK-95, “Dialog Advanced” and “Dialog+” from B/Braun, and INNOVA from GAMBRA are used.

   Advantages: the procedure is carried out by qualified specialists, sterility is maintained in the center, constant control doctors over test results (creatine, urea, hemoglobin) allows timely adjustment of treatment. If possible, patients are taken for dialysis and after the procedure are taken home by special transport or by ambulance.

   Flaws: the need to wait your turn and visit the dialysis center 3 times a week, there is a possibility of infection with hepatitis B and C.

3. Hemodialysis in stationary conditions.

   Hospitals have departments equipped with “artificial kidney” devices. They are used to treat poisoning and acute renal failure. Here patients can stay 24 hours a day or as a day hospital.

   Technically, the hemodialysis procedure in a hospital is not much different from blood purification in hemodialysis centers. Similar devices are used to filter blood: “BAKHTER-1550”, “NIPRO SURDIAL”, “FREZENIUS 4008S”.

   Advantages: constant monitoring by medical personnel.

   Flaws: the need for hospitalization, the possibility of infection with hepatitis B.

Types of hemodialysis depending on the functionality of the devices

1. Conventional (traditional) dialysis.

   Apparatuses with a cellulose membrane with an area of ​​0.8 - 1.5 sq.m. are used. This filter is characterized by low permeability, only molecules pass through it small size. At the same time, the blood flow is low from 200 to 300 ml/min, the duration of the procedure is 4-5 hours.

2. Highly efficient dialysis.

   The procedure is carried out on dialyzers with a membrane surface area of ​​1.5 - 2.2 sq.m. In them, blood moves at a speed of 350 - 500 ml/min. In the opposite direction, the dialysate moves at a rate of 600 - 800 ml/min. Thanks to high efficiency membranes managed to increase the blood flow rate and reduce the procedure time to 3-4 hours.

3. High-flux hemodialysis using high-permeability membranes.

   These devices differ from the previous type of “artificial kidney” by special membranes through which substances with high molecular weight (large molecules) can pass. Thanks to this, it is possible to expand the list of substances that are removed from the blood during hemodialysis. This blood purification allows you to avoid a number of complications: amyloidosis tunnel syndrome carpal tunnel, reduce anemia and improve survival. However, the highly permeable membrane allows substances from the dialysate to pass into the blood, so the solution must be sterile.

Artificial kidney devices differ in the structure of dialyzers

Peritoneal dialysis is an alternative to hemodialysis.

• there are no places for hemodialysis;
• there is no way to get to the hemodialysis center;
• contraindications for hemodialysis.

Through capillaries in the peritoneum, waste, urea, and excess fluid pass into solution and the blood is purified. In this case, the peritoneum acts as a natural membrane.

Advantages: Blood purification can be done at home; heparin is not required; fluid is released slowly, which reduces the load on the heart.

Flaws: long sessions, the need to maintain sterility, otherwise there is a high risk of bacteria entering the abdominal cavity and the development of peritonitis, not recommended for patients suffering from obesity or intestinal adhesions.

Indications for hemodialysis

• the amount of urine excreted is less than 500 ml per day (oligoanuria);
• kidney function is preserved by 10-15%, the kidneys purify less than 200 ml of blood per minute;
• urea level in blood plasma more than 35 mmol/l;
• plasma creatinine level more than 1 mmol/l;
• the level of potassium in the blood plasma is more than 6 mmol/l;
• standard blood bicarbonate level is below 20 mmol/l;
• signs of increasing edema of the brain, heart, and lungs, which cannot be relieved with medications.

Contraindications for hemodialysis

• Infectious diseases, which can provoke the entry of microorganisms into the blood and the development of endocarditis (inflammation of the heart) or sepsis (blood poisoning). The hemodialysis procedure increases blood flow and the spread of pathogens.
• Stroke and mental illness: epilepsy, psychosis, schizophrenia. The procedure is a stressful factor and can aggravate changes in nervous system that happened earlier. When purifying the blood, a slight swelling of the brain occurs, which causes headache and can provoke an attack mental disorder. Low intelligence and the inability to follow instructions from doctors and nurses make hemodialysis impossible.
• Active tuberculosis of the lungs and other internal organs. Increased blood circulation causes the spread of Mycobacterium tuberculosis throughout the body. Another difficulty is that tuberculosis patients cannot visit hemodialysis centers so as not to infect other patients.
• Malignant tumors. Hemodialysis may promote the appearance of metastases cancerous tumors, since increased blood flow spreads malignant cells throughout the body.
• Chronic heart failure, the first months after myocardial infarction. Imbalances of potassium, calcium and magnesium and other changes may occur during hemodialysis chemical composition blood. This can result in heart rhythm disturbances and cardiac arrest. And blood stasis in heart failure is associated with the risk of blood clots and their breakout during hemodialysis.
• Malignant arterial hypertension. Severe form of hypertension, when the pressure rises to values ​​of 300-250/160-130 mm Hg. This affects the blood vessels, heart, fundus and kidneys. In such patients, the procedure can provoke a short-term increase in pressure associated with vasospasm. The result may be a stroke or myocardial infarction.
• Age over 80. In people with diabetes, hemodialysis is contraindicated after 70 years of age. It's connected with age-related disorders heart and blood vessels. The veins do not provide sufficient blood flow for dialysis and may not be able to withstand the additional stress. In addition, in such patients, due to vascular atrophy, it is almost impossible to isolate a section of the vein for regular procedures, and reduced immunity increases the likelihood of infectious complications.
• Blood diseases– bleeding disorders, leukemia, aplastic anemia. As blood passes through the dialyzer, blood cells can be damaged, which can worsen anemia. The administration of heparin reduces blood clotting and increases the risk of internal bleeding.

Extrarenal blood purification is a very pressing problem. IN different countries Developments are constantly underway to create a small and effective “artificial kidney”. Already today there are devices that you can carry with you and blocks that are transplanted into the human body instead of non-functioning kidneys. It is hoped that in the coming decades such developments will become available to all patients with chronic renal failure.

Healthy kidneys are a blood filter. Its entire volume passes through the kidney filter more than 1000 times per day. In 1 minute, 1 liter of blood is purified. In a short period of time, the kidneys, our natural filter, remove molecules of substances toxic to the body and excess water from the blood, which enter the urinary tract and leave the body. Beneficial substances that circulated in the blood return to the bloodstream.

Unfortunately, according to various reasons the kidneys can become damaged and lose their functions, which leads to the retention of toxic substances in the body. If the blood is not cleansed of toxins, the person will die from self-poisoning. About 50 years ago, people with kidney failure died in at a young age. on hemodialysis at present, depends on the availability of proper equipment, professionalism of medical staff, concomitant diseases, but to a greater extent from the person himself, his lifestyle and adequate attitude towards his health.

Artificial kidney filter

In the mid-18th century, using the laws of physics, a scientist from Scotland developed a blood purification system. He studied it on dogs deprived of kidneys. The device did not live up to expectations due to the development of many complications.

The first hemodialysis procedure in humans was performed by a German doctor at the beginning of the 19th century. 15 procedures were performed different people, who did not live long after that. This is due to the development of thromboembolism. They used leech hirudin, a blood-thinning protein, which was quickly neutralized by the patients' immune system and the blood thickened to form blood clots. A positive result of the method was achieved in 1927 with a procedure using heparin, but the patient still died.

In the fall of 1945, a Dutch doctor improved the device used at that time and successfully brought the patient out of her uremic state, finally proving the effectiveness of hemodialysis. In 1946, the doctor published a manual on treating patients with uremia using hemodialysis.

How the magic filter works

Hemodialysis is a system of blood purification without involving the kidneys. To perform the procedure, access to the vein and artery is necessary. Systems are inserted into these vessels and shunts are formed, which are connected to the hemodialyzer. From the arterial shunt, blood flows into the apparatus, where there are capillaries with semi-permeable membranes. The capillary is surrounded by a cavity containing dialysate fluid, where, according to the law of osmosis, harmful molecules are released from the blood. From the dialysate, substances necessary for life enter the capillary and enter the patient’s bloodstream. In order to prevent blood clots, an anticoagulant is introduced into the system. The processed dialysate is removed and the purified blood is returned to the patient. The procedure lasts from 4 to 12 hours and is repeated 3 times a week, and in some cases every day.

How long do people live on hemodialysis? Statistics show an average of 15 years, but in history there is evidence that there were patients who lived 40 years. The Russian book of records describes a woman who spent 30 years on dialysis.

The method of extracorporeal blood purification carries many costs. Over a million rubles are spent per person per year. Currently exists Government program, thanks to which the costs are paid by the state. Scientists are trying to improve the devices themselves, so that in the near future this procedure will become available to everyone suffering from kidney failure. Let's consider what types of hemodialysis machines exist.

By functionality

1. Classic - a device with a small membrane area. Only small molecules pass through the filter. Blood flow rate up to 300 ml/min. The procedure lasts 4 hours.
2. Highly efficient. The area of ​​the semi-permeable membrane is 1.5 - 2.2 sq.m. Accelerates the blood flow rate to 500 ml/min, which reduces the duration of the procedure to 3 hours. In the opposite direction of the blood, dialysate moves at a speed of up to 800 ml/min.
3. High flow. Allows you to cleanse the blood of anything, allowing even large molecules to pass through.

By type of dialyzers

Capillary. They are closest to the physiology of a healthy kidney.

Disc (plate)

Portable devices

There are portable blood purification devices. They are common in Western countries. More than half of patients with chronic renal failure use these devices. The equipment is expensive, estimated at $20 thousand. Portable devices have their advantages:

No queue;

The possibility of contracting blood-contact infections (hepatitis, HIV) is excluded;

You can move freely with them during the procedure.

The disadvantage of such devices is that an unpredictable reaction may occur and emergency assistance will be required.

Peritoneal dialysis

Fluid (dialysate) is injected into the abdominal cavity through a puncture on the anterior abdominal wall. The volume is about 2 liters. One end of the tube is in the stomach, and the other is closed. No dialyzer required. membrane in in this case is the peritoneum, through which toxic substances pass into the dialysate solution. The liquid is kept for 4-5 hours, after which the liquid is removed through the catheter, and a clean solution is refilled in the same volume. There is a risk of inflammation of the peritoneum, which can lead to additional methods treatment, up to emergency surgery. When performing any type of hemodialysis, sterility rules must be observed. This procedure is contraindicated for overweight people (abdominal obesity) and people who have adhesive disease.

What are the reasons for hemodialysis

This procedure became the only salvation for thousands of patients whose kidneys were unable to perform their functions.

Hemodialysis is prescribed to people with the following health problems:

1. Acute and chronic and chronic renal failure). It is characterized by low 24-hour urine output and a laboratory-confirmed decrease in glomerular filtration rate (GFR). How long they live on kidney hemodialysis depends on the tolerability of the procedure and the patient’s compliance with the doctor’s recommendations. Dialysis is carried out to replace completely lost kidney function and remove nitrogenous waste from chronic renal failure. In acute renal failure, hemodialysis is carried out to remove toxic substances from the body that caused acute renal failure and to release excess fluid.

2. Diabetic nephropathy. It is a late vascular complication of diabetes mellitus. The capillaries of the kidney filters become sclerotic due to constantly elevated glucose levels. The renal threshold for blood glucose levels is 10 mmol/l. When the sugar level is above this indicator, glucose begins to be filtered into the urine. The molecules are large and damage the delicate walls of the capillaries. How long you can live on hemodialysis with diabetes mellitus depends on the degree of compensation of the pathology, the level of glycated hemoglobin, and the presence of other severe types of complications. For diabetics over 70 years of age, hemodialysis is contraindicated.

3. or ethyl). Metabolites of some alcohols cause the formation of crystals that damage kidney tissue and cause acute kidney failure. How long people live on hemodialysis after poisoning depends on the degree of damage renal tissue. There is a chance of restoring kidney function, and hemodialysis will no longer be needed.

4. Toxic effects medicines and poisoning. There is a direct damaging effect on the kidneys. Hemodialysis is performed to remove poison and medicinal metabolites from the body. If the body is able to cope, then hemodialysis is carried out until kidney function is restored. How long they live on kidney hemodialysis in this situation depends on the type and amount of the damaging agent.

5. A state of overhydration, when the body contains a large amount of water ("water poisoning") and there is a risk of developing edema of the brain and lungs. The purpose of the procedure will be to remove excess water, lower blood pressure and reduce swelling.

6. Violation of the ratio of electrolytes in the body. Occurs when fluid loss occurs with frequent vomiting, diarrhea, intestinal obstruction, prolonged fever. Special dialysates with the necessary electrolytes are used to replace or remove them. Carry out until the electrolyte balance is restored.

7. Kidney transplantation. Until the transplanted kidney starts working, it is supported. How long do they live after kidney rejection on hemodialysis? The same amount of time as they would live without a transplant. About 20 years.

Indications for the procedure

Certain indicators for which an “artificial kidney” is indicated:

1. Daily urine output is less than 500 ml. Normally - 1.5-2.0 liters.
2. Decrease below 15 ml/min. Normal value- 80-120 ml/min.
3. The creatinine value is above 1 mmol/l.
4. Urea level is 35 mmol/l.
5. Potassium above 6 mmol/l.
6. Bicarbonate level below 20 mmol/l - metabolic acidosis.
7. Increasing edema of the brain, lungs, heart, refractory to standard therapy.

Contraindications to hemodialysis

1. Infectious process. Microorganisms circulate in the bloodstream. The hemodialysis procedure increases blood flow throughout the body and there is a huge risk of pathogenic flora entering the heart, which can cause inflammation. Danger of developing sepsis.
2. Acute cerebrovascular accident. The procedure may increase blood pressure levels and make the situation worse.
3. Mental disorders and epilepsy. Hemodialysis is stressful for the body. Minor change blood pressure may cause headache and mental disorder or convulsive syndrome. For high-quality therapy, it is necessary to calm the patient and perform medical requirements dialysis center workers during the procedure.
4. Foci of tuberculosis in the body. This type patients are a source of infection and cannot attend hemodialysis centers. Even if you create a specialized dialysis department, there is a risk of contamination of the body with Mycobacterium tuberculosis.
5. Malignant tumors. Dangerous due to the spread of metastases.
6. Chronic heart failure, acute myocardial infarction and the first days after it. Hemodialysis affects the electrolyte ratio and any change in it can lead to cardiac arrhythmias, even cardiac arrest. In chronic heart disease, blood flows through the vascular bed at a lower speed and there are areas of thickening, and the dialysis procedure can provoke the movement of a blood clot and blockage of an artery.
7. Severe degree arterial hypertension. There is a risk of a hypertensive crisis.
8. Age over 80 years. The reason is that the cardiovascular system aged patients undergo involution. Veins and arteries become fragile, making it difficult to access hemodialysate. It has been noted that people over 60 years of age live on hemodialysis for as long as the capabilities of their cardiovascular system allow.
9. Blood diseases. The administration of heparin can aggravate bleeding disorders, and the hemodialysis procedure can destroy some red blood cells, which worsens the course of anemia.

Hemodialysis complications

• Inflammation and purulent complications in the area vascular access.
• Muscle pain and discomfort.
• Contact dermatitis.

System:

• Violation of the general condition in the form of weakness, headache, malaise, nausea, muscle pain.
• Generalized allergic reaction to membrane components.
• Violation of blood pressure levels (decrease or increase).
• Air embolism.
• Sepsis. In case of non-compliance with the rules of asepsis against the background of weakened immunity in this category of patients.
• Iatrogenesis - infection viral hepatitis and HIV. A high degree of sterilization is required. In conditions of a large flow of patients and a small amount of equipment, an insufficient level of processing of systems is possible. It all depends on the work of the medical staff.

Who performs

Hemodialysis in a hospital should only be performed by healthcare workers. IN last years The practice of performing hemodialysis at home has spread. This is much more convenient for the patient, since he remains with his family. The procedure can be performed at home by anyone (not a healthcare professional) who has undergone training. How long the average person lives on hemodialysis depends in this case on how sterile the person performing the procedure is. If he does not wash his hands thoroughly enough (this must be done first with soap, then with a disinfectant solution, for example, Betadine), or does not observe sterility when applying a bandage at the site where the fistula is inserted into the patient’s body, the infection that enters the patient’s body can kill him in a matter of months. If everything is done correctly, the patient will live as long as a person who does not have kidney problems.

Diet for hemodialysis

How long you can live on hemodialysis largely depends on how the patient monitors his health. He should not drink, smoke, eat smoked meats, pickles, marinades, flour sweets, fried. The menu of such a person should consist of fresh, high-quality products containing vitamins and proteins (chicken, rabbit, lean beef, boiled eggs). You should limit yourself to foods such as milk, beans, nuts, and cheese.

Hemodialysis of the kidneys and blood is an efferent method of extracorporeal detoxification of the body. It is carried out using a device called an “artificial kidney”. It is used to cleanse the blood of electrolytes and nitrogenous waste in cases where the kidneys cannot cope with this work.

The basis of hemodialysis is the exchange of substances through a semi-permeable membrane, which is washed on one side by the blood flow and on the other by the dialysate solution. A hydrostatic pressure gradient is created between the dialysate fluid and the blood, with the help of which excess fluid is removed from the body by ultrafiltration. In the same way, they are removed from the blood harmful substances and products of exchange.

The machine used for hemodialysis consists of three main components:

1. blood supply device
2. dialyzer,
3. devices for supplying and preparing dialysate solution.

Using a roller pump, blood is pumped through tubes into the dialyzer. Devices that measure the rate of blood flow and its pressure are attached to this system. The optimal blood flow is considered to be 300-450 ml per minute. After preparation, the dialysate solution enters the dialyzer from a dispenser or reservoir. In most machines, the dialysis solution passes near the membrane once at a speed of approximately 500 ml/min in the opposite direction to the blood flow.

The composition of the dialysate solution is similar to blood plasma. Depending on the level of electrolytes in the blood, the composition of the solution can be adjusted. Most often it is necessary to change the concentration of potassium, but the content of chlorine, calcium and bicarbonate, as a rule, remains at a constant level. To regulate the amount of fluid removed from the blood, the sodium concentration in the dialysate solution is reduced or increased.

Indications for hemodialysis

Hemodialysis is not prescribed for every disease: the indications for its implementation are strictly defined. These include the following conditions:

• acute and chronic renal failure;
• alcohol poisoning;
• serious changes in blood electrolytes;
• drug overdose;
• intoxication with poisons that tend to penetrate the hemodialysis membrane;
• overhydration, which is not amenable to conservative therapy and threatens the patient’s life.

These conditions can lead to death without hemodialysis. The main indications are acute renal failure, as well as terminal stage chronic failure kidneys, which allows you to prolong the life of the patient. In addition, people on hemodialysis can continue to live a normal life and even work.

The basis for prescribing hemodialysis for chronic diseases kidneys are indicators of serum creatinine more than 800-1000 µmol/l, urea - 20-40 mmol/l, glomerular filtration rate - less than 5 ml/min. Metabolic acidosis is also taken into account when the bicarbonate content is less than 15 mmol/l.

Contraindications

Even if there are appropriate indications, hemodialysis is not always used - contraindications can be relative and absolute.

Relative contraindications

• active form of pulmonary tuberculosis;
• diseases that threaten the occurrence of massive bleeding (Malory-Weiss syndrome, uterine fibroid, peptic ulcer and etc.).

Absolute contraindications

• mental illness (psychosis, epilepsy, schizophrenia);
• incurable malignant neoplasms;
• diseases of the blood system (leukemia, aplastic anemia);
• severe diseases of the nervous system;
• age over 80 years or over 70 with diabetes;
• presence of two or more accompanying pathologies: malignant neoplasm, ischemic heart disease with previous myocardial infarction, heart failure, atherosclerosis with occlusion peripheral vessels in the decompensated stage, chronic hepatitis, liver cirrhosis, obstructive pulmonary disease;
• vagrancy, alcoholism, drug addiction with no interest in social rehabilitation.

Procedure and regimen of chronic hemodialysis

The hemodialysis regimen and program are determined individually. Most often, hemodialysis is performed 3 times a week, the procedure lasts about 4-5 hours. There is a sufficient choice of membranes for dialysis, differing in usable surface area. This allows hemodialysis to be used in various programs: from daily two-hour dialysis to twice every week. If residual renal excretory function remains, hemodialysis can be performed less frequently.

The procedure is usually performed on an outpatient basis, but there are portable machines that allow hemodialysis to be performed at home. The advantages of home hemodialysis are the possibility of more frequent implementation and the absence of the need for constant visits. medical center. It is more compatible with the patient's work, diet and lifestyle are closer to normal. Some hemodialysis machines can even be taken with you on trips or long trips. This type of hemodialysis has become widespread mainly abroad.

Some time before the first procedure, it is necessary to make access to the circulatory system, which is usually performed on an outpatient basis. To ensure efficient flow of blood into the dialyzer from the body and back, there are three types of access: fistula, graft and catheter.

1. A fistula is a direct connection of an artery to a vein through its own vessels, usually created on the forearm. At the same time, blood flow in the vein increases, making its diameter larger and the wall stronger. This makes the vein suitable for frequent needle insertion.
2. A graft in the form of a synthetic tube can also be used to connect an artery to a vein. It does not require time for joint healing and vascular remodeling, so it is used for more early stages, for example, until the fistula becomes suitable. The disadvantage of this method is the more frequent occurrence of complications.
3. Sometimes a catheter is used for temporary access - a soft tube that is placed in one of the veins in the neck, chest or thigh. To carry out dialysis, needles are inserted into a catheter, through which blood flows. This type of access is used for single dialysis, when there is no time to create another access.

Diet for hemodialysis

Nutrition during hemodialysis involves reducing the accumulation of waste products in the blood. When choosing a diet, you must consider the following rules:

• The daily menu should include a balanced amount of protein-rich foods, which include chicken, meat and fish.
• It is necessary to control potassium intake. It is found in salt substitutes, some fruits (bananas, oranges), vegetables (potatoes), chocolate, dried fruits and nuts. If the potassium content in the blood increases, heart complications are possible.
• The degree of fluid restriction depends on the disease that led to kidney failure. Typically, between procedures, the patient's weight should not increase by more than 5% of the initial body weight. If more fluid enters the body, edema, complications from the heart, lungs and other organs, as well as arterial hypertension may develop.
• Food restriction table salt: salty food leads to thirst and fluid retention in the body.
• The doctor may prescribe medications to normalize the metabolism of calcium and phosphorus, which is often disrupted in people on hemodialysis. At the same time, you should limit the consumption of foods rich in phosphorus.

Recommendation: if during the interdialysis period the diet was nevertheless violated, for example, the patient could not resist salted fish or drank too much liquid, then you should not hide this from the doctor. If a specialist knows about an error in nutrition, he will prescribe special mode and a hemodialysis program to restore impaired homeostasis in the body.

Complications of hemodialysis

During the procedure, nausea or vomiting, muscle cramps, arterial hypo- or hypertension may occur. In addition, a rare and serious complication of hemodialysis can be air embolism, which can lead to the death of the patient. The development of air embolism is caused by a malfunction of the device or a violation of the technique of its use.

Most often, complications arise from vascular access. When using a graft or catheter, they may become blocked by a blood clot. With a fistula connection of vessels, there is a danger of infection, which results in the development of sepsis, septic embolism, bacterial endocarditis and other dangerous diseases.

At rapid decline plasma osmotic pressure, possible disturbances of consciousness in the form of stupor, confusion, epileptic seizures, which is called dialysis syndrome. At sharp decline Blood potassium, sodium, or calcium levels may cause heart rhythm disturbances. In rare cases, allergic reactions to membrane components are possible.

Important: if any symptoms appear during hemodialysis discomfort, then you should immediately report them to a specialist. Sometimes, to eliminate them, you only need to adjust the composition of the dialysate solution or the rate of blood flow. During development serious complications begin to provide assistance.

Hemodialysis is a blood purification procedure that occurs outside the kidneys, and with the help of special apparatus"artificial kidney" Dialysis is necessary for people with acute renal failure, in case of poisoning with alcohol, drugs, or poisons. Patients with renal failure need the procedure more chronic type: hemodialysis allows them to prolong their life by 15-25 years. Often, patients prescribed continuous hemodialysis live safely for several decades.

As mentioned above, hemodialysis is the purification of the blood, but not in the kidney, but with the help of a special device. The “artificial kidney” filters it through a special membrane, cleans it of urea, excess water, as well as various toxins, that is, it performs the functions of the kidney that are lost for one reason or another (see indications).

A complete list of substances from which the blood is purified during hemodialysis:

• Urea is a product of the breakdown of proteins in the body.
• Creatinine is the end product of energy metabolism in muscles.
• Poisons – strontium, arsenic, toadstool toxins and others.
• Medicines (with uncontrolled use or non-compliance with dosages).
• Ethyl and methyl alcohol (in case of intoxication with these substances).
• Electrolytes – potassium, calcium, sodium salts.
• Excess water.

Kinds

Depending on the technical implementation of the procedure, experts distinguish the following types of hemodialysis:

• Conventional dialysis uses machines with a cellulose membrane. This filter is characterized by low permeability, only molecules of small mass can pass through it, and the blood flow is quite slow - from 200 to 300 milliliters per minute. The procedure lasts 4-5 hours.
• Highly efficient dialysis is carried out on machines with larger area membrane surface, blood flow speed reaches 350-500 ml/min. The procedure takes 3-4 hours.
• High-flux dialysis - highly permeable membranes are used, substances with high molecular weight can pass through them, so the blood is exposed during the procedure deep cleaning, it is also possible to minimize the risk of complications.
• Peritoneal dialysis is an alternative to conventional hemodialysis and is prescribed when there are no places for hemodialysis or there are contraindications. A hole is formed in the abdominal wall, a catheter is inserted there and 2 liters of dialysate are poured. The solution is drained only after 4-6 hours, and a new portion is poured. All toxins enter the solution through capillaries.

Indications

Indications for hemodialysis:

Contraindications

Contraindications to hemodialysis are absolute and relative. Absolute contraindications:

• Cirrhosis of the liver.
• Damages of cerebral vessels.
• Anemia or leukocytosis.
• Serious damage to the central nervous system.
• Malignant formations.
• Chronic hepatitis.
• Mental illnesses.
• Heart failure.
• Lung pathologies in the obstructive stage.
• Pathologies of peripheral vessels.
• Age over 80 years, and over 70 with diabetes.
• Alcoholism and drug addiction.

• Ulcers of the stomach and duodenum.
• Uterine fibroid.
• Active forms of tuberculosis.

Preparing for hemodialysis

The main preparation for hemodialysis is to create an access through which blood will flow into the machine in large quantities. To create such access you need surgical intervention, it can be performed in two ways: creating a fistula (ordinary people often call it a catheter for hemodialysis) and introducing a special stent.

The first method involves the use of a fistula - a connection between an artery and a vein. The fistula “ripens” after 7 days: it increases in size, appearance begins to resemble a cord. The duration of the process varies from 3 to 6 months. After the fistula has matured, dialysis needles are inserted into it.

In the second case, a tube is inserted into the patient, which provides a connection between the artery and vein. Hemodialysis can be performed within 2-6 weeks after stent placement.

What other activities include preparation for hemodialysis:

• Psychological work with the patient.
• Slowing renal function.
• Preventive vaccination against hepatitis B.

Executing the procedure

It is best to carry out this procedure in medical institution, however, if your partner is trained, you can perform extrarenal blood cleansing at home. The most important thing is to thoroughly rinse and sterilize the device.

The procedure must be carried out within 5-6 hours; it is imperative to monitor the patient’s pulse and blood pressure.

After the procedure, a sterile bandage is immediately applied.

How does blood purification occur? For this purpose, a dialyzer and a special filter are used. As the blood enters the dialyzer and passes through the filter, it is cleared of toxins and then returned to the body through other tubes.

If the procedure is performed in a medical facility, the patient is seated in a chair and connected through a fistula in the arm to an “artificial kidney” machine, with the help of a pump the blood is pumped out of the body and into the dialyzer. In the dialyzer, the still unpurified blood is mixed with a solution and, passing through the membrane, is completely purified and returned to the body.

Complications

Since hemodialysis is a very serious procedure, it does not eliminate the risk of complications.

What consequences may arise:

• Arterial hypertension.
• Anemia.
• Pericarditis.
• Elevated levels of potassium in the blood.
• Damage to the nervous system.
• Bone diseases.

Price

Hemodialysis is a rather expensive procedure, especially considering that in most cases one session is not enough. The price of hemodialysis varies from 6 to 10 thousand rubles. The total cost per year can reach up to 200 thousand rubles. The final cost of the procedure varies depending on the patient’s place of residence and the level of equipment in the hemodialysis department. So, in major cities(Moscow, St. Petersburg, Yekaterinburg and others) the procedure remains accessible to the patient.

Lifestyle and nutrition for hemodialysis patients

A healthy lifestyle is of great importance for patients undergoing hemodialysis. First of all, the patient’s diet is subject to change: a properly selected diet can reduce waste that accumulates in the blood and poisons the entire body.

The main principles of the diet are to control the level of potassium in the body, and you should also control your salt and fluid intake.

The patient should limit the intake of medications containing aluminum.

During dialysis, it is recommended to increase protein intake to 1.2 g per kilogram of weight, this is due to the fact that artificial filtration of blood is still not perfect; along with toxins, it can also remove useful substances necessary for the construction of cells.

The patient should permanently stop drinking alcohol.

Sports activity is also important. It should be moderate, but power loads and overvoltage should be excluded.

Extrarenal blood purification gives patients with chronic renal failure a chance for a normal and relatively healthy lifestyle; for patients with poisoning and acute renal failure, the hemodialysis procedure is effective solutions to cleanse the blood and improve well-being.

The principle of the procedure is discussed in detail in the video: